Plus-Hex CLINICAL
Disease management
Surgical intervention
Surgical intervention for the management of FMTs is routine in first opinion , charity and referral practices . Up to 90 % of FMTs are potentially malignant and therefore surgery is considered necessary in most cases [ 31 ] , even if histopathology cannot be conducted . Before surgery , radiographs should be taken [ 5 ] to ensure it is ethical and in the best interests of the patient and client to proceed . If respiratory metastasis is present , the veterinary team must consider the patient ' s quality of life in conjunction with the owner ' s wishes before commencing treatment . Unilateral or bilateral complete mastectomies are often the surgical approach used in cases of mammary neoplasia in cats [ 32 ] . Studies have identified that there is some communication between the left and right mammary glands [ 33 ] , therefore aggressive mastectomy is commonly required due to the close relationship of the structures as well as the often aggressive nature of FMT .
Surgical removal of both mammary glands in the affected pair , plus additional glands present , should be carefully considered to ensure the best outcome for the patient and veterinary team . Some authors suggest waiting a minimum of 2 weeks between surgeries in cases where bilateral mastectomies are required [ 34 ] . However , other authors contend that the period of time between surgeries will vary depending on the case [ 35 ] . Allowing appropriate time to pass between radical mastectomies has been proven to help reduce the risk of complications such as infection and wound breakdown [ 17 ] . A study conducted in the human medical field confirmed a link between non-healing wounds and pain-associated stress [ 36 ] . This link has also been identified in veterinary medicine [ 37 ] , confirming the importance of appropriate pain management in surgical recovery .
The decision to remove the local lymph nodes is dependent on the presence of enlargement at the node site or the results of fine-needle aspiration , if applicable . Removal of the inguinal lymph nodes is considered necessary in most cases due to the proximity of these structures to the mammary glands [ 3 ] . The axillary lymph nodes should be assessed on an individual basis [ 3 ] , which is the approach taken in human medicine [ 38 ] .
Patients undergoing any form of mastectomy should be evaluated using a holistic approach . Individual case considerations such as age , disease status , preexisting conditions , client interaction and financial factors should be reviewed [ 39 ] . Elderly feline patients may take longer to recover and are also at an increased risk of complications . Issues associated with age , such as hyperfragility of the skin [ 40 ] , can lengthen the wound healing time and contribute to dehiscence , and immunocompromise associated with geriatric patients
can also affect recovery [ 41 ] . The condition of masses must also be assessed before surgical intervention . Ulceration of aggressive tumours is not uncommon and secondary infection or self-mutilation are potential factors to consider [ 5 ] . Antibiotic therapy may be required before , during and after surgery if infection is present . Finally , ovariohysterectomy at the time of mastectomy has been shown to have little effect on patient survival time or tumour recurrence [ 2 ] . However , ovariohysterectomy is still the therapy of choice for benign masses such as fibroadenomatous hyperplasia [ 17 ] and therefore should be considered from a preventive perspective .
Chemotherapy
Although surgery is the most commonly used treatment for feline mammary tumours , it is rarely curative due to the high rates of malignancy and metastasis [ 42 ] . Radiotherapy and chemotherapy are available at referral centres in instances where further treatment is pursued [ 43 ] . Clinical staging is used before treatment to accurately assess the patient ' s current medical standing [ 44 ] and ensure an appropriately tailored approach . This assessment method is routinely used in human breast cancer patients [ 45 ] and is considered the gold standard in veterinary medicine . A full physical examination , preanaesthetic bloodwork and urinalysis are carried out primarily before referral diagnostic assessment [ 44 ] . Imaging , including computed tomography and ultrasonography ( Figure 3 ), is then used to gauge the extent of the tumour ( s ) and also to confirm the presence of metastatic spread . After the extensive work-up , a treatment regime will be implemented based on the patient ' s findings .
Figure 3 . Patient assessment before treatment includes imaging to gauge the extent of the tumour and any metastatic spread .
Radiotherapy
Radiotherapy is rarely used as a primary treatment in cases of mammary cancers [ 44 ] . However , radiation can be used in conjunction with chemotherapy , for example , to control the disease in cases where complete tumour removal was not possible , and as palliative care for inflammatory tumours or in cats that are
Volume 39 ( 5 ) • October 2024
35