The Dog Cancer Survival Guide (107 page)

The conventional treatments Dr. Ettinger recommends for transitional cell carcinoma should be considered part of step one of Full Spectrum cancer care (
Chapter 11
). Please review that chapter for more general information about surgery, radiation and chemotherapy and how to handle their common side effects.

For more information on all other Full Spectrum steps, including nutraceuticals, immune boosters, dietary changes and brain chemistry modification strategies, review Full Spectrum cancer care, which begins on
page 103
.

You will also find information about specific chemotherapy agents in
Chapter 41
.

Some tumors are inoperable, so some owners simply decline surgery; in these cases, chemotherapy with piroxicam can be used as a solo treatment. Before completely declining surgery, however, I recommend you consult with your surgeon and weigh the pros and cons carefully.

If a urinary tract infection (UTI) is present at the time of diagnosis or during treatment, antibiotics may be prescribed to treat the infection and alleviate its symptoms.

When surgery is particularly difficult because of the tumor location, a type of laser surgery called carbon dioxide (CO2) laser ablation may be helpful. The best outcomes happen when this surgery is combined with mitoxantrone and piroxicam protocols. Although survival times achieved with CO2 laser ablation and treatment with mitoxantrone and piroxicam were similar to survival times associated with chemotherapy alone, resolution of symptoms was better with the combined treatment.

When there is a urinary tract obstruction, a cystostomy (the surgical implantation of a permanent catheter into the bladder) can be used to bypass the obstruction, drain the bladder and alleviate the pain. A urethral stent may also relieve obstructions in the urethra. In this case, a thin tube is inserted into the urethra to allow urine to flow past the obstruction. There can be complications from these procedures that may make them impossible for some dogs; your surgeon will have the best insight into your dog’s case. I have managed patients who have undergone both of these procedures and they can be good options for the right dog and right owner.

Some owners want to try photodynamic therapy (PDT), which uses light of a specific wavelength to help kill tumor cells, as it is sometimes used for bladder cancer in humans. Unfortunately, this therapy is not currently effective for TCC in dogs, although it is still being investigated. Although not widely available, it is occasionally used for dogs with squamous cell carcinomas in the mouth.

Radiation therapy can be considered, although high doses have some severe side effects, including bladder fibrosis and scarring of the urethra. This can cause obstructions and severe complications, so the dose is limited to remain safe for the bladder.

CyberKnife radiosurgery can also be considered for prostatic TCC, and we have used it at my clinic. This palliative use of radiation combined with mitoxantrone and piroxicam seems to be safe and can stabilize the disease. It has not been used in many dogs, so its ultimate efficacy is still being explored.

TCC is a highly metastatic disease that is not likely to be cured. That said, I consider it a treatable cancer; combining therapies can both extend life and make dogs much more comfortable than they are at diagnosis.

“Shadow’s experience has opened awareness and knowledge that we will use to help all of our dogs, and everyone we meet to both fight and prevent cancer. It’s the number one cause of death in our beloved dogs, and the reasons are mostly man-made, from environment to food to attitude. One lesson I learned in both our dogs, is that they both had a minor cancer experience about 6 months before a major one was diagnosed. With Shadow, he had a malignant growth on his leg that was excised and the vet told us it had been taken out completely. With Keymos, at 12 years his testes got hard, a sign of cancer changes and he was castrated. About six months after each experience both dogs had a larger, life-threatening diagnosis of cancer. Had we realized that the earlier experience placed cancer cells in the body that we could start to fight instead of feeling comforted by surgery, we may have prevented further spread. The most important lesson we have learned is to get off our lazy butts and give our dogs the best natural diet possible, the second is to not take things for granted and to make sure every day they feel joy and play with us. It is good for us all.”

-Susan Harper, High Wycombe, England

O
ral cancer is the fourth most common type of dog cancer. Several types of cancers can be found in the mouth, including melanomas, fibrosarcomas (FSA), squamous cell carcinomas (SCC) and the dental tumors known as epulides and ameloblastomas.

Oral tumors can occur in any location in the mouth: along the gums, the lips, the tongue, the palate (roof of the mouth) or pharynx (the upper part of the throat). Tumors that appear closer to the front of the mouth tend to have a better prognosis than those deeper in the oral cavity.

Early detection is critical, because the earlier these tumors are found and the smaller they are, the more responsive to treatment. Larger tumors found later may already have started to invade the local tissues, a common behavior. This progression can happen very slowly or very quickly. Distant spread, or metastasis, can also occur, usually much later in the disease.

Because these tumors can be so locally invasive, the goal of treatment is to control the primary tumor site with surgery and/or radiation. Surgery is the most economical, quick and curative treatment. Preventing tumor recurrence is very important because recurring tumors are much less likely to respond to later treatments. Finding an experienced surgeon who can do an aggressive first surgery is my highest recommendation.

The relative overall prognosis for oral cancer is usually good to excellent, with median survival times ranging from one year to over two years, depending upon the type of tumor.