Oral tumors in cats and dogs
It is natural to be very worried and freightened when a mass is identified in your companion animal's mouth, or on the face. Dr. Kressin works dilligently to help you through this difficult time by establishing a diagnosis. He is very familiar with the emotional difficulties because he has diagnosed and treated his own pets for oral tumors.
Dr. Kressin works with your family veterinarian as well as, Dr. Reiman, a medical oncologist, and other specialists to establish the stage of your pet's disease, the prognosis and treatment plans. The initial consultation is used to help better understand these important issues, and to address personal concerns.
"Cancer's of the mouth are very common in dogs and cats. Dr. Kressin is an essential part of our team in treating my patients with cancer. I want my clients and their pets to receive the highest quality care tempered with compassion. The staff at Animal Dentistry & Oral Surgery Specialists take the time to clearly explain options for my patients and work with pet owners to achieve the best care available. Quality of life is always emphasized with options to control pain and improve function - allowing my patients to have a better outcome and live life to the fullest extent possible".
The series of images (below) help owners understand how a major maxillectomy (jaw surgery)for a fi-brosarcoma affected Ella.
How are oral tumors diagnosed and why is the diagnosis important?
It is not possible to look at or to touch an oral mas and determine the diagnosis, prognosis or an appropriate treatment plan.
Dr. Kressin's first goal is to establish the correct diagnosis. The diagnosis may eliminate your initial worry and fear! Dr. Kressin has worked with many pets that appeared to have severe life threatening oral tumors that were easily resolved or managed. Patients may have facial swellings, draining tracts, oral cysts or tissue growths that appear very bad, but they are able to be treated. The correct diagnosis is very important!
The evaluation of every oral mass requires dental radiographs to determine if there is local invasion and to procure a deep biopsy to obtain a representative tissue sample. If the biopsy is not performed meticulously, the diagnosis may be wrong and misleading. The biopsied tissue is submitted to a pathologist to determine the type of tumor (the diagnosis). The diagnosis is the basis for determining the prognosis and the best treatment plan. Computed tomography (CT scan) and Magnetic Resonance Imaging (MRI) are additional diagnostics we can utilize at our Milwaukee facility.
Why is staging of my pet's disease (oral tumor) useful?
Staging of your pet's disease (oral tumor) is the evaluation of the extent of the tumor's local involvement, and the spread of tumor cells to distant areas. Blood tests, chest radiographs, lymph node samples (fine needle aspirates) and possibly, advanced imaging (CT or Cat Scans) may be used. Staging is useful in establishing the prognosis. Staging provides clues on what you may expect with the disease.
What can you expect with oral and dental tumors?
You can expect honest, clear and credible information because Dr. Kressin has extensive experience in treating oral tumors. Consultation with Dr. Kressin is the first step toward deciding what you need to do. Get your questions answered. What options do I have for my pet? What is involved in oral surgery? How will my pet likely respond to treatment? Is this putting my pet through a painful procedure? How will my pet feel? How will my pet eat? What care is needed after oral surgery? What is this surgery likely to cost? Are payment plans available for me? Please don't delay, call for a consultation today!
The prognosis is established with consideration of the tumor type, size, location and the staging. The biology and prognosis of oral tumors are well understood. It must be stated, dogs do not read the text books or behave as books say they should. The biology of these oral tumors however, do provide good information on what to expect.
Should oral surgery be performed?
Dr. Kressin's second goal is to determine whether oral surgery should be performed.
Dr. Kressin has no interest in performing surgery without potential benefit for the pet!
Dental radiographs are always taken and they can be extremely helpful in determining the invasive nature of the tumor. Computed tomography (CT Scan or Cat Scan) is sometimes performed to provide a three dimensional map of the tumor. These imaging techniques help determine the ability to fully remove the tumor. Tumor free margins is very desirable but not always possible.
Oral and dental tumors can be uncomfortable and many are extremely painful. Palliative oral surgery can be tremendously rewarding for owners, pets and vets. Palliative surgery usually eliminates or reduces pain and improves quality of life. A little more quality time with companion animals is often well appreciated and long remembered by owners.
What treatment options are available for oral tumors?
Oral surgery is the best treatment option for oral tumors diagnosed early. Surgery offers the greatest opportunity to eliminate the tumor. The correct diagnosis is essential when deciding on the best treatment plan.
Medical therapy (chemotherapy), radiation therapy and immunotherapy are additional treatment options. A combination of these treatments may produce the optimal prognosis.
Immunotherapy for oral melanoma has been the greatest recent treatment development. The results have been very impressive!
Oral Surgery Terminology recognized by the American Veterinary Dental College!
Partial mandibulectomy (S/M) – Surgical removal (en block) of part of the mandible and surrounding soft tissues Dorsal marginal mandibulectomy (S/MD) – A form of partial mandibulectomy in which the ventral border of the mandible is maintained; also called marginal mandibulectomy or mandibular rim excision Segmental mandibulectomy (S/MS) – A form of partial mandibulectomy in which a full dorsoventral segment of the mandible is removed Bilateral partial mandibulectomy (S/MB) – Surgical removal of parts of the left and right mandibles and surrounding soft tissues Total mandibulectomy (S/MT) – Surgical removal of one mandible and surrounding soft tissues Partial maxillectomy (S/X) – Surgical removal (en block) of part of the maxilla and/or other
Clinical cases of oral and dental tumors
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7 yr cat; oral mass in back of left lower jaw. This mass was removed 2 weeks previously, but not evaluated by a pathologist.
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Another view from above. This mass was removed and submitted to a pathologist. The lesion was not a bad tumor. Deep excision was curative. No follow up photo to show as cat would not allow post op photo!
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This was another cat with an oral mass in approximately the same location, but further back.
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The mass was removed and the pathologist diagnosed a serious squamous cell carcinoma. The surgical margins were tumor cell free. These two cases (above) illustrate that you never know the diagnosis or prognosis by looking at tumors. A diagnosis is the essential first step.
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This oral mass was uncomfortable. The cat would rub at her face and salivate more than usual.
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Closer view of the above oral mass.
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Side view of the same oral mass.
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The oral mas was excised after an initial biopsy was performed.
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The pathologist diagnosed a malignant squamous cell carcinoma. The surgically excised tissue was also submitted to the same pathologist, which confirmed the biopsy diagnosis and that the excision was complete with tumor cell free margins.
Early surgical treatment of malignant tumors can be very rewarding. These lesions have a better prognosis when they are located near the front of the mouth.
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This 6 yr old dog had a benign ossifying epulis on the left lower jaw. This tumor was uncomfortable (cheek side). This tumor projected upward between the lower first and second molar teeth. It flipped from the tongue side and back toward the cheek side on a thin tissue "stalk". Because this tumor would flip from side to side, it was not as obvious as shown in these photographs. This emphasizes the need for a good oral exam, which is not always easy, or possible to perform!
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This is the same tumor as shown to the left demonstrating its location between the first and second lower molar teeth on the tongue side (viewed from above looking downward).
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The three lower molar teeth were removed. The surgery was "curative" and resolved this problem.
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The "excisional" tissue was submitted to the pathologist for histology (evaluation). The margins were "tumor cell free" and the tumor was confirmed to be benign. Excellent long-term prognosis.
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This oral mas of the upper jaw was uncomfortable (outside mouth view).
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Same oral mass viewed from inside the mouth.
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Large ameloblastoma adjacent to the left lower canine tooth.
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Closer view of the locally invasive tumor. Surgery is the best treatment option!
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Teeth soft tissue and bone are removed and submitted for histology (pathologist).
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Pathologist confirms tumor cell free margins.
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8 months; firm mass under the right eye. Facial view.
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Same dog, intraoral view. Dr. Kressin provided a Cat Scan.
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Incisional biopsy provided the diagnosis; multilobulated osteosarcoma.
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Intraoperative view.
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Postoperative view.
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Oral melanoma is the most common oral tumor in dogs. An exciting new vaccine has recently become available with impressive results even for dogs that have metastasis (tumor spread) to
the lungs.
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This fibrosarcoma of the upper dental arcade was massive and uncomfortable. Palliative oral surgery was elected to provide comfort.
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Another view of this fibrosarcoma.
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Postoperative view of palliative maxillectomy.
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Side view. The owner was very pleased.
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Close up view. This dog was clearly more happy, playful and seemed pain free. Quality of life was greatly improved.
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Ameloblastoma; (previously called acanthomatous epulis). Dental radiographs are important when evaluating for the invasiveness of oral tumors.
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Ameloblastoma; same tumor as to the left.
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Another view of Ameloblastoma.
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This ameloblastoma has destroyed the support for the canine tooth. It was treated by rostral mandibulectomy to the first molar tooth.
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Papillary squamous cell carcinoma in a young dog.
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This oral mass was a dentigerous cyst. Histology (tissue analysis) confirms the diagnosis.
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Unerupted first premolar teeth are very common sites of odontogenic cysts.
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Gingival enlargements are particularly common in Boxer dogs.
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Here is another view of gingival enlargement.
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Familial gingival hyperplasia can mask serious oral tumors. Tissues procured from gingivectomy are submitted for histology (tissue analysis).
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Oral melanoma. This tumor was excised and the patient was treated with a xenogenetic DNA vaccine.
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This oral mass was biopsied and the pathologist diagnosed fibrosarcoma.
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Another view of the oral mass above.
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Surgical excision confirmed the diagnosis and the surgical margins were tumor free.
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Oral mass lingual (tongue) side of the right lower mandible (jaw). Biopsy revealed ameloblastoma.
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Outside view of the mass above shows that it was not easy to see.
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Pathologist confirmed ameloblastoma. A benign oral tumor.
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Biopsy revealed a squamous cell carcinoma. A malignant oral tumor.
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Closer view
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Surgical pen used to mark surgical margins 2 cm from the tumor.
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Surgical margins marked 360 degrees.
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En Bloc excision of oral mass.
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Top view of oral mass removed.
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Side view of mass with sutures placed to evaluate margins.
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Alternate view of tissue submitted for histology (tissue analysis by pathologist).
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Tongue tumor adjacent to the molar and premolar teeth.
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Close-up view of the lesion.
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Excisional biopsy ruled out neoplasia (tumor). This is a common traumatic oral lesion.
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(Check this site periodically for additional information and clinical images).
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