Name: 狗狗口腔惡性黑色素瘤：VLOG 116 (Dog Oral Malignant Melanoma: VLOG 116)
Uploaded: 2024-09-03T04:59:49.000Z
Duration: 13 min 20 s

程度副詞

They're highly metastatic, so they can spread to those lymph nodes.

它們具有高度轉移性，是以會擴散到淋巴結。

We talked about the liver, the lungs and other organs as well.

我們還談到了肝臟、肺和其他器官。

So just removing the tumor out of the mouth of the dog is not going to, you know, cure the dogs of these cancer.

是以，僅僅切除狗嘴裡的腫瘤並不能治癒狗的癌症。

Hey, everybody, welcome back to the blog.

This blog is all about oral malignant melanoma.

本博客主要介紹口腔惡性黑色素瘤。

I just also dropped another video about melanoma.

我剛剛還發布了另一個關於黑色素瘤的視頻。

So if you're watching this one, I would love for you to go back.

所以，如果你正在看這部電影，我很希望你能回去看看。

There will be a link below about the other video, because there I will talk an overview just about what melanoma is and some of the other locations that we see it.

下面會有另一段視頻的鏈接，因為在那裡我將概述什麼是黑色素瘤，以及我們看到黑色素瘤的一些其他部位。

So I talked about dermal melanoma in that video.

所以，我在視頻中談到了真皮黑色素瘤。

But in this video, we're going to focus on oral malignant melanoma, which is the number one location and the most common oral cancer that we see.

但在本視頻中，我們將重點介紹口腔惡性黑色素瘤，它是我們最常見的口腔癌。

We're going to be covering surgery, radiation, systemic therapy, such as the immunotherapy vaccine and some of the prognostic factors.

我們將介紹手術、放療、全身治療（如免疫療法疫苗）以及一些預後因素。

So here we are at oral malignant melanoma.

現在我們看到的是口腔惡性黑色素瘤。

So of the oral tumors, malignant melanoma is the most common one, but it is not the only tumor that we see in the mouth of dogs.

是以，在口腔腫瘤中，惡性黑色素瘤是最常見的一種，但它並不是我們在狗的口腔中看到的唯一腫瘤。

We also see things like fibrosarcomas and squamous cell carcinomas.

我們還能看到纖維肉瘤和鱗狀細胞癌。

And a good rule in general for tumors of the mouth in dogs is that they have a better prognosis if it's of the lower jaw, the mandible, and towards the nose of the dog as opposed to further back.

一般來說，狗的口腔腫瘤有一個很好的治療原則，那就是如果腫瘤位於下頜、下顎和狗鼻子的方向，預後會更好，而不是更靠後。

And a lot of it has to do with accessibility for surgery and being more surgically resectable.

這在很大程度上與手術的可及性和可切除性有關。

So it's easier to remove a tumor that's of the mandible as opposed to the upper jaw and towards the nose of the dog.

是以，相對於上顎和狗鼻子的腫瘤，下顎的腫瘤更容易切除。

The upper jaw is connected to a lot of the nasal bones and can really start to be more complicated to do surgery.

上頜骨與很多鼻骨相連，做起手術來確實比較複雜。

So that is just a good rule for all oral tumors in general.

是以，這只是一個適用於所有口腔腫瘤的好規則。

So lower jaw more towards the nose of the dog, as opposed to towards the back of the mouth of the dog is going to be easier.

是以，下頜更靠近狗的鼻子，而不是狗的嘴後部會更容易一些。

And those tend to have a better prognosis.

And a lot of that is they can remove them more likely with surgical margins.

其中很大一部分原因是，他們可以通過手術邊緣更容易地切除它們。

But so which are the dogs that we tend to see oral malignant melanoma?

那麼，哪些是我們常見的口腔惡性黑色素瘤犬呢？

I told you it tends to be heavily pigmented breeds.

我告訴過你，這往往是色素含量高的品種。

Those are going to be dogs like Scotties.

我們在其他品種中也能看到它們。

Golden Retrievers are over-representative, Chows, Poodles, Dachshunds.

金毛尋回獵犬、秋沙犬、貴賓犬和臘腸犬的比例偏高。

We see them in black Labradors, unfortunately, as well.

不幸的是，我們在黑色拉布拉多犬身上也能看到它們。

I say that because I have black Labradors, if you don't know that.

我這麼說是因為我養的是黑色拉布拉多犬，如果你不知道的話。

And we see them in mixed breed dogs as well.

我們在混種犬中也能看到它們。

Tends to be a cancer of middle-aged and older dogs.

And these are cancers that, you know, I think about is two battlefronts.

這些癌症，你知道，我認為是兩個戰場。

They often can be growing into the bone in the mouth, upper and lower bone, depending where they are.

它們通常會生長到口腔、上部和下部的骨頭裡，具體位置取決於它們生長的位置。

And the second battlefront is they're highly metastatic.

第二個戰線是它們的高度轉移性。

是以，它們會擴散到這些淋巴結。

We talked about the liver, the lungs, and other organs as well.

So just removing the tumor out of the mouth of the dog is not going to, you know, prevent the growth of these cancer and they're very, very highly metastatic.

是以，僅僅從狗的嘴裡切除腫瘤並不能阻止這些癌症的生長，它們的轉移性非常非常高。

And I will warn you every once in a while, you will get a biopsy and they'll say that this was a benign one of the mouth.

我還要提醒你，偶爾你會去做活檢，他們會說這是口腔良性腫瘤。

And in general, most dogs that have an oral melanoma, it is malignant until proven otherwise.

一般來說，大多數患有口腔黑色素瘤的狗狗都是惡性的，除非另有證明。

And I've seen ones that have had those biopsies that suggest a benign behavior or a benign biopsy, and they just tend to be malignant.

我還見過一些活檢結果表明是良性行為或良性活檢的患者，結果卻往往是惡性的。

Some of the ones that are more lip can do better and also be easier to do than some of the ones that are more invasive into bone.

一些脣部手術比一些侵入骨骼的手術效果更好，也更容易操作。

But again, they tend to be a pretty aggressive cancer, both in the mouth and with a high metastatic rate.

但同樣的，它們往往是一種相當具有侵襲性的癌症，無論是在口腔內還是在轉移率方面都很高。

For things that have been shown to be prognosis, size has definitely been shown to be prognosis.

對於已被證明是預後的事情，大小肯定已被證明是預後。

And when we talk about the staging system for that, size comes into play.

當我們談到分期系統時，尺寸就會發揮作用。

And so it's, it's broken down, but the smaller we can find them, the better that they do and whether or not they've metastasized to the local lymph nodes and whether or not they have spread distantly to the lungs and the different organs that we've talked about have been shown to be prognostic.

是以，它被分解了，但我們能發現的越小，它們就越好，它們是否轉移到了局部淋巴結，是否遠處擴散到了肺部，以及我們談到的不同器官，都被證明是預後的關鍵。

此外，還有其他一些不完整的邊距。

So dogs that have incomplete margins in one study were three and a half more times likely to die of tumor related causes, whether it was regrowth or metastasis.

是以，在一項研究中，邊緣不完整的狗死於腫瘤相關原因（無論是再生還是轉移）的機率要高出三倍半。

So just really emphasizing how important it is to try to find these tumors early and deal with them either with surgery or radiation or some of the things that we'll talk about.

是以，我們需要強調的是，及早發現這些腫瘤，並通過手術、放射治療或我們將要談到的其他方法來治療它們是多麼重要。

所以還是那句話，真的很重要。

Also just something else to emphasize with the highly metastatic rate is these lymph nodes.

另外，需要強調的是這些淋巴結的高度轉移率。

In dogs that had big lymph nodes in one study, 70% had metastasis, but normal lymph nodes in the study, 40% still had metastasis.

在一項研究中，淋巴結腫大的狗有 70% 發生了轉移，但在淋巴結正常的狗中，仍有 40% 發生了轉移。

Just going to emphasize that normal lymph nodes should definitely be worked up with lymph node aspirates.

我只是想強調，正常的淋巴結一定要做淋巴結穿刺。

So just really important that you can't always say, Oh, the dog's lymph nodes are normal.

所以，重要的是，你不能總是說，哦，狗狗的淋巴結是正常的。

So again, this is a highly metastatic cancer and it's just something that we want to emphasize.

是以，我們再次強調，這是一種高度轉移性癌症。

And also the lymph nodes are positive for metastasis that changes the stage and changes the prognosis for the dog.

此外，淋巴結轉移陽性也會改變狗狗的分期和預後。

那麼，您的狗狗需要進行哪些測試呢？

Lymph node aspirates, chest x-rays, ultrasound are going to be part of the workup.

淋巴結穿刺、胸部 X 光檢查、超音波檢查都是檢查的一部分。

So if the mouth melanomas, the oral melanomas are surgical can be removed if they're not too big, you know, lower towards the front of the mouth.

是以，如果口腔黑色素瘤（口腔黑色素瘤）不是太大，可以通過手術切除，你知道的，就是向口腔前下方切除。

Surgery is going to be our best treatment option for the dermal ones, the digit ones.

手術將是我們治療真皮層和數字層的最佳選擇。

You know, surgery is definitely going to be the primary treatment of choice for the local disease.

要知道，手術肯定是治療局部疾病的首選方法。

But the problem is a lot of these ones, especially towards the back of the mouth can be very invasive into bone.

但問題是，很多這樣的牙齒，尤其是口腔後部的牙齒，會對骨頭造成很大的傷害。

And so if there's any concern, we will often do a CT scan.

是以，如果有任何疑慮，我們通常會做 CT 掃描。

Another really important thing is to do that CT before surgery and not try to remove it and then have to try to go back and figure out where they didn't get margins and things like that.

另一件非常重要的事情是在手術前做 CT，而不是試圖切除它，然後不得不試圖回去找出他們沒有得到邊緣和類似的東西。

So really a CT scan for these complicated ones, these large ones is going to be really helpful.

是以，CT 掃描對於這些複雜的、大塊的腫瘤確實很有幫助。

And these are ones that I often think a good idea to see a board certified surgeon first because these do often require removal of part of the jaw or they're going to tell us that surgery is not an option.

我通常認為，最好先去看有執照的外科醫生，因為這些病症通常需要切除部分下頜，否則他們會告訴我們手術是不可行的。

And then we're going to look for a plan B like radiation, which we're going to talk about in the next part.

然後，我們要尋找一種 B 計劃，比如輻射，我們將在下一部分討論。

So radiation actually plays an important role for these dogs with either incomplete margins or non-resectable non-surgical melanoma of the mouth.

是以，對於邊緣不完整或無法切除的口腔非手術黑色素瘤患犬，放射治療實際上發揮著重要作用。

And even though technically melanoma is considered a radiation resistant tumor, that sounds bad, right?

儘管從技術上講，黑色素瘤被認為是一種抗輻射腫瘤，但這聽起來很糟糕，對嗎？

It's not going to respond to radiation, Dr. Sue.

There are ways that the radiation oncologists have figured out protocols.

放射腫瘤學家們已經想出了一些辦法。

And what that means for you and your dog is that the protocols, the take home message is they actually give a higher dose per treatment.

這對您和您的愛犬來說意味著，治療方案，也就是每次治療的劑量會更大。

What I want to know is that it usually means they're not getting those daily radiation protocols with a lot of side effects and each radiation treatment in dogs and cats requires anesthesia, but they're usually coming in once or twice a week, usually weekly for four or six treatments.

我想知道的是，這通常意味著它們沒有接受那些副作用很大的日常放射方案，而且貓狗的每次放射治療都需要麻醉，但它們通常每週來一到兩次，通常每週進行四到六次治療。

And I usually leave it up to the radiation oncologist because I'm a medical oncologist and not a radiation oncologist.

我通常會讓腫瘤放射科醫生來決定，因為我是腫瘤內科醫生，而不是腫瘤放射科醫生。

And sometimes protocols are changing, but the take home message is because of the way that melanoma cells respond to radiation, they usually do a weekly radiation for about four or six treatments.

有時，治療方案也在不斷變化，但有一點值得注意的是，由於黑色素瘤細胞對放射線的反應方式，他們通常每週進行一次放射治療，每次治療大約四到六次。

And that means not a lot of anesthesia and not a lot of skin and mouth side effects.

這意味著不需要大量的麻醉，也不會對皮膚和口腔產生副作用。

So not a lot of burning and things like that.

是以，沒有很多燃燒之類的東西。

And so it could be a really good alternative option for these non-surgical cases.

是以，對於這些非手術病例來說，這可能是一個非常好的替代選擇。

It's often referred to a hypo fractionated protocol.

Just that's what they call it with pretty decent response rates.

他們就是這麼叫的，而且回覆率還不錯。

So I will often use radiation in these non-surgical cases and send them to a radiation oncologist after talking to the surgeon.

是以，我通常會在這些非手術病例中使用放射治療，並在與外科醫生溝通後將其送至放射腫瘤專家處。

So we all have to work together on these cases.

是以，在這些案件中，我們必須齊心協力。

A lot of the times the radiation oncologist will treat the lymph nodes.

很多時候，放射腫瘤科醫生會對淋巴結進行治療。

If they were confirmed to be positive with lymph node Asperger's or even prophylactically, they will just treat the neck area as well.

如果證實淋巴結阿斯伯格氏症呈陽性，甚至是預防性的，他們也會只對頸部進行治療。

If there are any microscopic cells, that is an advantage of radiation as well is that we can treat the lymph nodes and kill any of those cancer cells with radiation.

如果有任何微小細胞，這也是放射治療的一個優勢，因為我們可以治療淋巴結，用放射治療殺死任何癌細胞。

So now we've treated the local disease with surgery, the mouth maybe with radiation, but now we need to do something with that second battlefront, right?

現在，我們已經通過手術治療了局部疾病，口腔也可能接受了放射治療，但現在我們需要在第二戰場上有所作為，對嗎？

The systemic disease, preventing the cancer from metastasizing, you know, is our goal and therapy is always better before the cancer is metastasized and the treatment that we're typically going to be talking about immunotherapy is definitely most effective before the cancer is metastasized.

全身性疾病、防止癌症轉移是我們的目標，而治療總是在癌症轉移之前進行為好，我們通常所說的免疫療法無疑在癌症轉移之前最為有效。

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狗狗口腔惡性黑色素瘤：VLOG 116 (Dog Oral Malignant Melanoma: VLOG 116)

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