The Dog Cancer Survival Guide (21 page)

Quality of Life
: How enjoyable is life for the dog? Sometimes treatments may extend longevity, but also increase the number of side effects a dog experiences. If side effects can’t be managed or become too severe, life quality may go down. On the other hand, life quality can also be deliberately increased. Paying attention to the optimal balance of life quality
and
longevity is discussed in the Making Confident Choices section of this book.

Radiation Therapy
: Radiation therapy is a conventional medical treatment that sends high-energy particles, usually photons or electrons, into tumors. These particles interact with the atoms in the DNA of the cancer cells and destroy them. This, in turn, destroys the cancer cells. Radiation also kills cells by increasing the amount of harmful free radicals within the cell. Healthy cells that fall in its path, especially rapidly multiplying cells such as those in the skin, can also be harmed. Dogs must be immobilized to receive radiation, so each session requires general anesthesia.

Remission
: This term indicates that the cancer has responded, or gone away, to some degree. Vets usually modify this with words like
complete
or
partial
, to indicate the degree of remission. In common use, remission is usually synonymous with complete remission.

Rescue Protocol:
If a dog has gone into remission, but then has a relapse, another course of treatment may induce a second remission. That second treatment is called a rescue protocol.

Residual Disease
: This phrase is used to describe cancer cells that remain after attempts to remove them have been made.

Response
: The cancer “responds” to treatment, or gets better. You may hear “her response so far is good” or “he isn’t responding to this treatment.” Sometimes response is also used as a synonym for complete or partial remission.

Side Effect
: In any given treatment, a certain effect is desired; for example, a desired effect of surgery might be tumor removal. Any effect other than the desirable effect is called a side effect. Side effects can range from harmless (loss of hair) to harmful (a life-threatening staph infection). Sometimes side effects increase with higher intensity treatments – for example, the higher a chemotherapy dose, the more likely a dog is to vomit. Sometimes, however, side effects are “idiosyncratic.” Idiosyncratic side effects are (non-allergic) side effects where the severity of the reaction is not in proportion to the dose of the treatment (how much is given). Idiosyncratic reactions, not seen in large numbers of dogs, seem to be caused by individual variation. In other words, one dog reacted badly to that medication, although the vast majority of dogs would not, even at the same dose. It is important to keep in mind that side effects can happen for several reasons, and cannot always be anticipated. It is, therefore, important to ask about the possible side effects of any treatment you are considering.

Staging
: Staging is the evaluation of a cancer to determine how far it has spread or metastasized. Diagnostic tests used to stage cancer may include lymph node aspirates, lymph node biopsies, chest X-rays, abdominal ultrasounds, CT or MRI scans, and occasionally bone marrow or internal organ aspirates and/or biopsies. Generally, the lower the stage number (stage one, for example), the more likely the cancer is to respond to treatment and therefore have a better prognosis.

Supplement Hierarchy
: Many supplements are discussed in this book, and some guardians ask which are most important. For this reason, I created a hierarchy that lists supplements in their order of importance. Starting with the supplements at the top of the hierarchy and adding others as time, budget, and the dog’s preference or tolerance will allow, is a good strategy (see
Appendix A
).

Surgery
: Surgery is a conventional treatment that removes tumors by cutting them out of the body. While the ideal goal is complete removal, this is not always possible. In these cases,
palliative
surgery may be recommended: removing some, but not all, of the tumor (also known as debulking). Surgery is generally done under anesthesia, and may require postoperative recovery care, such as wound cleaning, changing of bandages, physical therapy, and limiting movements to allow incisions to heal.

Systemic Cancer
: This is cancer of any type that has spread to and/or affects the entire body. Some cancers, such as lymphoma, are systemic by default because they occur in cells that circulate throughout the entire body. In other cases, a cancer is called systemic if it has
metastasized
to distant locations from the primary tumor or if it has invaded the surrounding tissues via
local invasion
.

Touch Therapies
: Touch therapies include massage, Reiki, T-Touch, and other energy healing modalities that involve hands-on, physical contact with the patient. Memorial Sloan-Kettering Cancer Center in New York City has integrated several touch therapies into their standard menu of cancer treatments because their research shows that touch therapies may help with outcomes like pain reduction, chemotherapy tolerance, and a variety of other issues related to cancer.

Treatment Plan Analysis
: At this point, there is no cure for systemic cancer, so there is no “one right plan” for cancer treatments (the right plan would be the one that cured the cancer). Treatment plan analysis is the process of looking at all of the available treatments for your dog’s cancer and making a plan based on your values, your dog’s age, your desired quality of life, your budget, and other factors. Often guardians leave the planning to the vet, but, the vet may not know enough about the guardian to make a good plan. Taking on the responsibility of treatment plan analysis empowers you to make conscious choices and know you have done everything possible to help your dog. Part Four of this book is dedicated to treatment plan analysis.

Tumor
: A growth, mass, or bump made of benign or malignant cells is a tumor. Tumors can be technically classified as benign (generally not dangerous) or as malignant (dangerous, cancerous). In common use, however, the word is usually used only when the tumor is malignant. If your vet refers to a growth as a tumor, she likely means it is a malignant tumor.

Ultrasound
: Ultrasound is a diagnostic medical imaging technique that can help get a picture of the deeper areas of the body. While this tool’s most familiar use is to check on human baby development during pregnancy, it can also produce an image of the interior of any other soft-tissue organ. In contrast, an x-ray image often just shows a silhouette or shadow of internal organs without revealing their internal architecture. The heart, eye, muscles, tendons, and many internal organs in the abdomen can usually be seen with ultrasound imaging. The technique is noninvasive, has no known risks for the patient, and is available at many veterinary hospitals. Dogs typically do not need sedation during ultrasound.

Wide margin
: Margins of at least two to three centimeters (sometimes more, and sometimes less, depending upon the case) that surrounded the cancer and were removed from the body during a biopsy or other surgery. Malignant tumors are more likely to recur if they are removed with narrow margins, so wide margins, if possible, are preferred.

Wild Diet
: Dogs are not designed to eat dry kibble, just like we are not designed to eat crackers as our main food source. Dogs in the wild eat freshly killed animals. While the wide availability of pre-packaged commercial dog food in the last half century has led us to think of it as the dog’s natural diet, it is decidedly not so. According to human cancer research (including that done by Sir Richard Doll, a British epidemiologist who was knighted, in addition to receiving several other honors for his work), about one third of human cancers can be prevented by improving the diet alone (see
Appendix E
for references). The wild diet is the basis for the dog cancer diet featured in
Chapter 14
.

X-rays
: X-rays are a form of electromagnetic energy, which can be used to take images of the interior of the body by projecting them onto a film sensitive to their wavelength. Because X-rays are flat, two-dimensional films and the body is three-dimensional, the area being imaged is usually X-rayed from two 90° angles. These two images are then compared, which allows for a more complete image of the interior of the body. When the chest is being imaged, however, two X-rays may not give a complete picture. In these cases, three-view X-rays are usually taken: one while the dog lies on her right side, another on her left side, and a third while lying on her back. Most veterinary hospitals have X-ray machines. Depending upon the area being filmed and the individual dog, dogs may need some sedation or anesthesia to get an X-ray.

T
here are a few certainties if your dog has cancer: one, there is a serious problem in her body, and two, her cancer probably started some time ago (certainly before she decompensated and started showing obvious signs of illness). As an oncologist once told me, “Beyond that, it’s complicated.”

As unbelievable as it might seem – and as frustrating as it is when you want answers now – scientists do not (yet) have one single explanation for cancer development that includes every piece of data. Much like the search for the “theory of everything” in physics, the one theory that accounts for all of the evidence is the goal of some cancer research. More is being learned everyday – but we’re not there yet.

Understanding how cancer starts and spreads is important: if we know how it starts, we can understand how to treat it. Because of the complexity of this subject, we’ll skip most of the details and focus on the basics – just enough for you to understand why I include certain treatments in Full Spectrum cancer care and exclude others.

Most cancer researchers have what is called a “reductionist” mindset. Reductionism is the theory that every complexity can be understood by looking at how individual components of the problem interact. Reductionists assume that in order to understand cancer, it must be broken down into smaller and smaller parts. The interaction of those smaller parts (which may have smaller parts, which may have smaller parts, which may have smaller parts, and so on) can explain everything, this theory says. Understanding and solving the “one problem” at the lowest level can also solve the larger problem. In other words, to reductionists, the whole is just a sum of its parts.

This mindset has led to the prevailing view of cancer development: it begins at one of the smallest, most basic levels, with mutations in the genes in the DNA. Fix (or destroy) these mutations, this view says, and you can cure the cancer.

There are a few who don’t subscribe to this point of view. These researchers point out that the reductionist approach has resulted in few substantial gains over the last sixty years of cancer research, especially when compared to other areas of medicine. These experts want to widen the lens we use to focus on cancer, and view it as a system with many seemingly independent parts. Maybe, they postulate, we don’t have to understand how cancer operates on a cellular level. Perhaps, if we looked for patterns on broader levels, we could control cancer – even if we don’t fully understand it. These experts are interested in looking at how changing the internal environment in the body (through lifestyle and other treatments that don’t directly “attack” the cancer cells) can either support cancer’s development or diminish it.

In other words, perhaps the whole is more than a sum of its parts.

For a clear presentation on this newer kind of thinking, I recommend starting with Dr. David Agus’ speech to the TED Medical conference. It is called A New Strategy in the War on Cancer, and you can find it at
www.Ted.com.

For our immediate purposes, both mindsets have yielded important information that may help you understand your dog’s cancer and evaluate treatments. We’ve already noted that cancer and its development is a complex topic; a thorough discussion of it is beyond the scope of this book. The good news is: you don’t need to know everything in order to make some treatment decisions.

Broadly stated, the genetic mutation theory of cancer development posits that cancer begins when mutations form in a cell’s genes and the cell grows and multiplies to form a tumor (or cluster of cancer cells).

Genes are found in segments of the DNA, the mysterious stuff that regulates the body and contains all of the blueprints – or job descriptions – for each cell. Genes control each body cell from birth to death. If the genes are normal, the cell behaves normally; if the genes are abnormal, the cell may behave abnormally, too.

Different genes control different cell functions and processes. For example, one set of genes controls cell growth: when these genes are activated, cells grow and multiply, or make new cells. When your dog was a puppy, these genes were very active, and today, when your dog sustains an injury like a cut, some of these same genes activate new cells that close it up.