Ce este in neregula cu pisicile? In cazul lor, spre deosebire de caini, tumorile mamare sunt in peste 80% din situatii, de natura maligna. Tratamentul este in primul rand, dar nu exclusiv, de natura chirurgicala. Circulatia limfatica de la nivel mamar are o slaba predictibilitate si din acest motiv interventiile chirurgicale sunt, de cele mai multe ori, radicale, extinse, cu morbiditate excedentara. Chiar daca o masa tumorala afecteaza o mamela de la un capat de lant mamar, este posibil sa metastazeze in limfonodul de la capatul opus (de aici utilitatea tehnicilor de identificare-mapare-a limfonodurilor santinela/care nu sunt mereu cele regionale). Din acest motiv, la pisici, tehnicile de chirurgie oncologica presupun mastectomie unilatetala sau bilaterala. Diferenta este data de statisticile ce spun ca se poate dubla, in anumite conditii, atat perioada de supravietuire dar si procentul de complicatii postoperatorii. Un alt aspect este legat de dimensiunile masei/maselor tumorale. Cu cat sunt mai mari (2-3 sau mai mult de 3 cm) cu atat ele solicita o interventie mai extinsa (limite de minim 2 cm tesut sanatos si un plan fascial profund) si pot deja sa fi produs metastaze pulmonare la momentul depistarii. Aspectele chirurgicale sunt centrate pe necesitatea unor margini de tesut sanatos largi in jurul maselor tumorale, reconstructia zonelor extinse cu defect ulterior si reducerea la maxim a “spatiului mort” chirurgical. In acest caz, ulterior mastectomiei bilaterale, s-a folosit pentru reconstructie in zona inghinala un dublu “iliac flank fold flap”. Chiar si asa, cancerul este cancer si ofera mereu surprize neplacute.
What is wrong with cats? In cats, compared to dogs, mammary tumors are, in more then 80% of the cases, malign. Surgical treatment is the primary, but not exclusively, treatment. The pattern of lymphatic circulation is lacking predictability and with this in mind, surgery is often extensive, with a high degree of morbidity. Even if a single tumoral mass is present at one end of the mammary chain, metastasis can reach the lymphnode at the other end of the mammary chain (this is the reason one should employ mapping techniques, to find the sentinel lymph node, most often then not, not being the regional one). This is one reason most of oncologic surgeons recommend unilateral, but mostly bilateral mastectomy in cats. One other side of the matter is the number of masses and the size of the mass/masses. The more they are between 2-3 cm or more then 3 cm wide, the more they may predict a malign behavior, with more often pulmonary metastasis at the time of visit. Surgical principles gravitate around wide, more then 2 cm, margins and at least, if not affected, fascial plane in depth. These are some premises for a wide surgical resection and large defects to close. The surgeon may want to use a local or an axial flap to close the surgical would but even in the most experienced, one can expect 40% chances for surgical complications. The more advanced the surgery, the most common complication are. Another issue is the surgical dead space, which needs special attention. This cat is one with bilateral mastectomy and a double iliac flank fold flap reconstruction technique. Even so, cancer is cancer and can offer some undesired surprises.
de Dr. Daniel Lescai
Doctor in Medicina Veterinara
