Chemotherapy and Cancer Care
We can imagine many people would be shocked to hear we regularly provide chemotherapy to dogs and cats with cancer. Here are two case studies which will show how cancers can be successfully diagnosed and treated in dogs and cats.
Boston is a beagle who came to us with lumps on his neck. When we examined him we found that all his lymph glands were massively enlarged, and straight away we suspected lymphosarcoma (sometimes called lymphoma). A biopsy performed several days later confirmed this and he was started on chemotherapy.
We currently use the Modified Madison Wisconsin Protocol which has been shown to produce the most reliable results and give the longest duration of remission (an average of 12-14 months from start of treatment). The protocol is given over a six month period involving weekly visits (most as outpatients) with occasional weeks off, and periodic blood monitoring.
During the protocol, he initially had some problems with nausea and vomiting. As the weeks went on we found some strategies to keep his nausea under control and apart from occasional ‘off’ days he responded well to the treatment.
In May 2012 his cancer treatment course finished. Since then he remained in remission for approximately three years with the good quality of life of an active beagle. That’s him pictured recently.
Bunty is a 17-year old cat who came to us with signs of vomiting and weight loss. On a physical exam, she looked remarkably good for her age but a lump was found in her abdomen. Blood and urine tests were normal, and so we scheduled an ultrasound examination to better diagnose the origin of the lump.
Her ultrasound images showed a large dark mass encircling and compressing, but not invading the stomach (the white part in the middle). The mass was thought to be a tumour acting as a gastric band, preventing the stomach from filling or emptying. There was no other sign of the mass or any other problem in the rest of the abdomen.
A needle biopsy performed at the time was inconclusive so we performed a surgical biopsy. The results confirmed a type of cancer called lymphosarcoma.
Lymphosarcoma, much like lymphoma, is usually very sensitive to chemotherapy drugs. This makes these patients good candidates for treatment. After an discussion of the pros and cons of treatment, Bunty’s owners decided to give her the treatment. The protcol we use for cats is not the same as that for dogs, and involves less frequent trips to the vet.
The picture is of her being weighed after two months on the protocol. Apart from one day every three weeks when she would not eat, she was happy and healthy and enjoying life again. Eventually, after a year, her tumour started causing problems again and we advised a humane euthanasia to prevent suffering.
Just like in humans, tumours are a significant cause of illness and death in animals. We have many ways of treating them, always starting with surgical removal if possible. Many lumps can be easily removed by including a margin of healthy tissue; if we are concerned about the chance of recurrence we will always biopsy first to plan the excision. Advanced techniques such as skin flaps or grafts can be necessary on rare occasions.
If an aggressive tumour cannot be removed, sometimes all is not lost. Some tumours, like lymphosarcoma mentioned here, are not resectable but easily suppressed by cancer chemotherapy. Others respond to freezing, or radiation. Others are beginning to be treatable by new and highly advanced specific anti cancer drugs like Palladia. Some, unfortunately, respond poorly to all treatments.
The biggest difference between cancer treatment in humans and animals is that we will not go to the extremes we see humans subjected to. At the back of our minds is always the awareness of the patient’s quality of life. There is no treatment of hopeless cases just because we can, and sometimes we will stop a protocol if the patient is not tolerating it. Pain management is always of paramount importance.
What is important to remember is that no one should feel that they must agree to cancer treatment. In most cases in pets, the treatment will not produce a cure. We aim for a long disease-free remission period and a happy pet. After all, even if the cancer comes back, they have been given another year or so without having to worry about the future like a human would. Boston’s lengthy remission has been wonderful, but should not be seen as the expectation.
The best message to pet owners is always to remember that the earlier we see a mass, the more options there are going to be.
We thank the owners of Bunty and Boston for giving permission to write their stories.