Feel free to call one of our locations or e-mail us at firstname.lastname@example.org, if there is something we have not answered below.
1. My pet has been diagnosed with cancer – what is my next step?
There are many types of cancers that can affect your pet and the behavior and prognosis for each is unique.
Your primary care veterinarian will help you decide if your pet has a problem that should be addressed by a specialist, and will help to refer you for a consultation if it is indicated. From there we will be able to discuss all of the treatment options and outcomes. Since many tumors are very treatable, meeting with a specialist to discuss the options and gather information is the best first step and does not commit you to any treatment protocol or follow up.
2. How do we determine the prognosis ?
This is variable in every situation and depends on the tumor type, stage and grade of the tumor (see below). Your veterinary oncologist will review all of your pet’s records and discuss the expected prognosis with you based on different treatment options.
3. What is staging? What is grading?
Staging is performed to determine if and where the tumor has spread (metastasized) from the primary tumor site. This is important for both determination of treatment options and prognosis, and will likely be recommended in most situations as a starting point of evaluation.
Staging can consist of the following: physical examination, lymph node evaluation, chest x-rays, abdominal ultrasound, CT or MRI scans, and cytology and/or biopsy of the mass. Some or all of this staging may have been done by your primary care veterinarian and will not need to be repeated.
Grading of the tumor is done in certain situations by the pathologist when they look at a piece of the tumor. In general, the more aggressive/abnormal the tumor, the higher grade it is assigned. Higher grade tumors usually will have more potential to metastasize , and treatment is often aimed at systemic control instead of just local control.
4. What is the difference between cytology and biopsy/histopathology?
Cytology involves using a needle to obtain cells from a mass and then putting them on a slide. It is simple to do and generally does not require any sedation or anesthesia. Your oncologist and pathologist will then look at the cells and determine if they are suspicious for cancer or not. This is usually the starting point for most lump and bump workups. If the cells are benign (non-cancerous) no further workup is needed. Some tumors are easy to diagnose by cytology alone, other times it tells us we need to biopsy the lesion.
Biopsy/histopathology involves removing a small piece of the tumor and submitting it the pathologist for review. This will allow the pathologist to assess the architecture of the tissue and determine the tumor subtype and grade of the tumor. This is often very important information for prognosis and is usually a part of staging a tumor. Biopsies can be done by either your primary care veterinarian or your oncologist.
5. Is my pet’s quality of life going to go down during treatment?
The quality of your pet’s life is always the first and foremost objective in their care. Although there are potential side effects from any treatment, we make every effort to make certain that they are mild and manageable and resolve quickly. We will always keep you advised of any potential side effects from any treatment recommendations so that you know what to look for.
Our goal is always to keep the risk-benefit ratio strongly in our favor and to find every single good day there is to be had.
6. What options do I have for treatment?
Treatment options will vary greatly depending on the type, grade and stage of the tumor and can range from very aggressive to a more hospice care approach depending on your preference. Surgery may be all that is needed to control a local tumor that has not spread. If surgery cannot remove all of the tumor, radiation therapy may be needed to “clean up” the cancerous cells left behind after surgery. High grade or metastatic tumors tend to be treated with systemic chemotherapy.
Your oncologist will discuss all of your options for you and help you to determine the best treatment approach for your pet.
7. What is chemotherapy and what are the side effects?
Chemotherapy is the use of drugs to kill cancer cells throughout the entire body. It is indicated when we are treating a systemic disease such as lymphoma, or to prevent the spread of disease when we know the risk is very high, such as in osteosarcoma. These drugs can be given orally, under the skin or intravenously depending on the drug in question.
Chemotherapy drugs usually target rapidly dividing cells (a hallmark of cancer growth) and they cannot tell the difference between a cancer cell and a normal cell. As an adult your pet has few rapidly dividing tissues, but by reviewing those that are present you can predict the possible side effects. For example, human hair grows all the time so it is often affected by the chemotherapy. The hair coat of most dogs is always the same length and not actively growing, so hair loss is unusual unless you have a very curly coat or go to the groomer all the time (ie poodles, pulis and old English sheepdogs).
The entire lining of the gastrointestinal tract is replaced every three to five days, so these cells can also be impacted. Every effort will be made to mitigate these side effects with preventative anti-vomiting and anti-diarrheal medications. The majority of patients do NOT have GI side effects with chemotherapy. Those that do usually have mild issues and respond well to treatment at home. They will be self-limiting as the lining is replaced with healthy tissue quickly.
The other tissue of concern is the bone marrow which produces the red blood cells (carry oxygen) , the white blood cells (fight off infection) and the platelets (help with clotting). The red blood cells divide slowly so anemia is rarely seen. The platelets repopulate over 7-9 days and so while less likely to be effected, still should be monitored.
The most common side effect is a drop in the segmented neutrophil white blood cell count that could lead to infections. These cells are replaced every day, twice a day – faster than any tumor – and they limit the amount of chemotherapy we can safely administer.
If your pet should have a low white blood cell count, they may be placed on antibiotics at home to keep them healthy. A small percentage of dogs (5%) will get an infection when their white blood cell count is low. They are a true emergency and if ever your pet is not feeling well, be certain to take their body temperature and contact us immediately if it is above 103 F.
8. What is radiation therapy and what are the side effects?
Radiation therapy is usually delivered as a painless beam of high energy with nothing implanted or injected. This means your pet will be safe to go home with you every night. Radiation can have early side effects to rapidly dividing tissues (skin, GI tract, mucous membranes) and late side effects to slowly dividing tissues (bone, muscle, nervous tissue). These side effects can differ greatly given the type and location of the tumor and will be discussed with you in great detail by your oncologist prior to starting radiation therapy.
Radiation Therapy Treatment Plan
9. When do I know the end is near?
While every situation is different, there are some basic things we look for to assess an animal’s quality of life. Pets that stop eating or grooming themselves and are no longer performing their normal behaviors (playing, fetch, interaction with people etc) may be approaching the end. If we cannot control pain or clinical signs of the tumor (vomiting, pain, coughing etc) we will discuss quality of life and end of life issues with you.
When the time is right, we can help guide your decision and answer any questions you may have. No one knows your pet better than you do and your assessment of their quality of life at home is the most important determining factor.
10. What is the difference between palliative and definitive care?
Definitive care is given with a curative intent, to treat the tumor. May have more side effects as its a more aggressive treatment. The palliative care is a care with minimized side effects to live a better lifestyle during cancer.
The 5 Important Questions to ask if your pet has been diagnosed with cancer