The Dog Cancer Survival Guide (17 page)

This is a complicated question, and there is no one “right” answer. Let’s start with the most obvious and least controversial answer I have.

Some cancers simply are not visible to the naked eye, cannot be felt with the fingers, and don’t produce a noise that can be heard with a stethoscope. These cancers are often advanced by the time the dog decompensates and the guardian realizes something is wrong. This can be true for human cancers, too. In deep body cancers, we don’t usually realize something is wrong until after symptoms start to show up.

Cancer can take a long time to develop; we’ll talk more about this later. For now, it’s important to realize that cancer does not appear overnight. It just seems to.

Some dogs are born with genetic mutations passed on from their parents’ DNA, which can develop into cancer later.

This is a very complex subject, so I’m going to vastly over-simplify it. Cancer goes through many steps – for the sake of explanation, let’s pretend it is ten steps – before it is fully developed and diagnosed. If a dog is born with a genetic mutation that pre-disposes her to develop cancer, she may already be on, say, step three of ten, at birth. If the cancer does develop, it may take years for recognizable signs to appear.

To the guardian, that cancer may seem to pop up overnight when, in fact, it developed over the genetic history of the dog. If it were possible to trace the molecular history of that genetic mutation all the way back to where it began in her ancestors, you could even say that in some cases cancer develops over millennia.

It would be ideal if vets had screening tests that could catch cancer early, but, we don’t. While some human cancers can be found by measuring certain markers in the blood, we can’t do this for most dog cancers.

Routine physical exams can uncover suspicious lumps and bumps. Unfortunately, many dog lovers seem to think of the vet like they do a car mechanic: they take the dog in only when something is obviously wrong. Regular physicals are critical for finding cancer as early as possible, but, even they can’t always catch cancers that start on a microscopic level, or are located deep in the body.

When some vets find a lump during an exam, they recommend taking a “wait and see” approach. They advise the guardian to look for changes or growth before testing the lump for cancer. However, waiting can be problematic. If a lump is cancerous and left untreated, it can spread, becoming much harder to treat later.

No one, not even my oncologist co-author Dr. Ettinger, can tell what a lump is without testing it for cancer cells. When I see or feel a lump on a dog, I can often make an accurate,
educated guess
about whether it is a malignancy. However, I can also make an
inaccurate
, educated guess.

If I believe a lump is benign, I tell my clients something like this:

“Nine out of ten times when I feel a lump like this, it turns out to be benign ... but if your dog is the one dog about which I’m wrong it won’t matter to you that I was right about the other nine dogs. If you choose not to get this tested, keep in mind that your odds are good, but that you are still gambling.”

Many vets are hesitant to recommend extensive or expensive testing procedures, because we are sensitive to guardians, who might be thinking that we’re just “running up the bill.”This is especially true if tests come back negative.
If you weren’t going to find anything, why did you order that test in the first place?

While it’s true that there may be a few vets who run unnecessary tests, it’s impossible to know for certain that cancer is present without at least a fine needle aspirate and/or a biopsy. Metastasis, or cancer spread, can only be confirmed with X-rays or some other imaging test, blood tests, urine tests, and other screening tools, depending upon the cancer’s type. There is simply no way around it – in order to get a diagnosis, we must run tests.

So why don’t vets push their clients harder to get lumps and bumps tested as soon as they are discovered? If this were another disease, such as heart disease or diabetes, most vets wouldn’t even consider the cost of the tests. They would say,”We need to get this tested, so that if there is a problem, we can start treatment right away.”

So what’s different about cancer? Three things.

Cancer is the number one killer of dogs (following euthanasia), according to organizations like the National Canine Cancer Foundation. This is not yet common knowledge among vets.

According to estimates, one in three dogs will get cancer, and this increases to one in two in dogs over the age of ten. Those are scary numbers, and not every vet believes they are accurate, because the data is coming from a foundation, rather than a systematic examination of every clinic’s cases. This leads me to the second reason some vets don’t push for early cancer screening.

Veterinary school teaches many wonderful things, but (usually) not how to assess a published paper for bias on the part of the authors. As a veterinary student, I was never taught to ask questions like:

What are the strengths of their study? Are there any weaknesses? Were enough animals included in the study to make the results statistically significant? What are they overlooking in their conclusions? Could they be manipulating the data to serve a particular agenda? How was their research funded? By drug companies? By the government? By themselves? Do they have any financial interest in the outcome of their work? Do they have personal bias that might influence their interpretation of the data? It’s easy for vets to read their trade journals and assume that the authors are unbiased. It’s also just as easy for some vets to be swayed by marketing.

If you’ve brought a new puppy into your life in the last few years, you may have received a “puppy kit” from your vet. Pharmaceutical companies, dog food companies, and pet product manufacturers regularly provide free “gifts” to veterinarians to hand out to new puppy guardians. Perhaps the folder that held your puppy’s papers was also an ad for a heartworm medication. Perhaps the new doggy toy has the name of a popular dog food printed on the tag. I freely admit to using some of these gifts in my own practice.

While it’s wonderful when vets save money and give their clients a gift at the same time, it’s also an implied endorsement of the company’s products. Does it create a potential bias toward using that company’s products? Certainly. Is that bad? Not necessarily. The promoted products have a beneficial purpose that could be lifesaving. How-ever, we should ensure that each vet is aware of her bias, does her own research, and asks those tough questions of the information presented by the companies involved.

“The Vent if You’re Bent exercise helped me let out the anger about my young dog being diagnosed with a disease that was going to rob us of many years together. Cheat Day was for Apollo: on chemo days we started adding a trip to McDonalds or A&W on the way home. I would buy him a single cheeseburger and let him have the meat and cheese. Most of the time he was very happy to get it.”

– Sandy Miller, Palo, Iowa

If your dog has heart disease, conventional vets have effective medications that can often control it for a long time. If your dog is diabetic, we can usually help manage the disease so that it doesn’t affect her quality of life too much.

Unfortunately, when it comes to cancer, we have just a handful of conventional tools: chemotherapy, radiation, and surgery. In many cases, guardians consider those tools too expensive and not good enough at extending life, enhancing the quality of life, or providing comfort to the dog. Some vets agree, even if only on a subconscious level. The cure for systemic dog cancer has not been found, at least not yet, by conventional oncology.

In general, vets are animal lovers who entered the profession so they could be around animals all day long. Limited tools and dispiriting, confusing statistics make dealing with cancer a frustrating experience for most vets. It is profoundly unsatisfying not to be able to cure a dog with cancer.

This helplessness can cause vets a great deal of stress. The vet might try to avoid that feeling, without realizing it. He might go numb and make an insensitive comment. He might be unaware of the latest options for cancer treatments, and give up too soon. He might tell you “There’s no point in doing anything now, it’s too late. Take your dog home and prepare for the end.”

Vets can be sabotaged by stress, just like any other person. This is another reason why you must step up and advocate for your dog by becoming a fierce dog guardian.

You will probably never
really
know why the cancer wasn’t caught earlier. Perhaps we didn’t look hard enough or often enough, we didn’t use our existing diagnostic tools early enough, or we simply need better tools. Or, perhaps we could have done more, and we still would not have found the cancer.

Let’s turn ourselves to the last question.

No, he’s not. He’s alive right now, and the healthy cells in his body are operating as they always have. They are living right now. Many of them are even fighting the cancer.

There is another way to look at it, of course. Here’s another, equally valid answer: this may be a tough pill to swallow, but yes, in a way, your dog is dying right now. Death is inevitable, and always has been. It’s an unavoidable part of life on our planet. From this point of view, nothing has really changed, but you may now be more aware of your dog’s eventual death than you were before you received the cancer diagnosis. Or, you may understand that death is inevitable, but are feeling that death is coming too soon. I think most dog lovers feel this way about the possibility of their dog’s death.