The Dog Cancer Survival Guide (33 page)

For benign tumors, a one or two millimeter margin is probably adequate to prevent recurrence, but for most malignant tumors,
much
wider margins are required to prevent recurrence – from one to three centimeters!

Wide margins are doubly crucial in curative surgeries, because during a comprehensive margin evaluation the pathologist looks at a couple of areas along the margin only, not the entire edge. If I see a very wide margin of one to three centimeters on a biopsy report, I have more confidence in the pathologist’s conclusion that it is “clean.”

The aggression of the tumor and its location are also important to note. For example, if your dog had a three centimeter, high grade, soft tissue sarcoma removed from the wrist, where there is not much room for wide margins, I would be very concerned about recurrence if the resulting scar only measured four centimeters. In this case, a one centimeter margin might be too narrow.

This is why planning curative surgeries is so important. Knowing what the tumor type is and planning for wide excisions increases the odds that the first surgery will be successful. If it’s not, second surgeries, also called scar revisions, are trickier, and the dog’s prognosis worsens.

Once a diagnosis is made, your vet or oncologist will probably want to stage the cancer, or check for spread. Not all cancers spread, but most do.

Cancer cells can spread in two ways, and the first type of spread is local invasion, sometimes called local involvement or local spread. To visualize this, picture a crab (cancer is actually the Latin word for crab). The body of the crab is like the tumor. The long crab legs are tumor cells reaching into normal tissues that surround it. These legs burrow through cell walls, create new blood vessels to steal oxygen from the bloodstream, and secrete acid to lower the pH in the surrounding tissues. Tumors hijack normal tissues and replace them with more tumor cells. This is how a tumor which begins in the nasal cavity can spread next door into the bones of the skull.

The second way that cancer spreads is by metastasis, also called distant involvement or distant spread. In this kind of spread, the tumor releases cancer cells into the circulation (bloodstream or lymphatics), so they can sail away and find distant places to live. This is how a cancer that begins in the spleen can also be found as close as the local lymph nodes, or as far away as the liver, lungs, or bone marrow.

Finding out what a cancer’s stage is, or how much it has spread, will tell you and your vet how advanced your dog’s case is. It will tell you what to expect over the course of the disease, and the prognosis. All of this information can really help you decide which of the available treatments to use.

Bringing a specialist like me onto your dog’s team can seem like an added expense, but, in reality, it can help you to spend your money wisely. That’s because, unlike many general practice vets, I only think about cancer. I can read tests with a more experienced eye than most general practice vets. My experience can be really helpful in deciding which tests to run for your dog with his particular cancer.

All too often, an owner comes to me with a thick folder, full of tests her vet has ordered, some of which turn out to be unnecessary. Each test represents an added expense, and some people have spent over $1,000, without even treating the cancer itself.

Unnecessary tests waste both time and money. Some owners would rather spend that extra money on conventional treatments, but now have to accept less aggressive treatments – or skip them altogether – because of limited funds.

Other owners, who make an educated decision to skip conventional treatments in favor of an alternative protocol, probably do not need all of those extra staging tests.

There is no doubt that comprehensive testing is helpful, no matter what methods are used to treat cancer. Testing establishes a diagnosis, helps us form a prognosis and gives us a baseline from which to measure progress. If budget is an issue for you, I recommend consulting with an oncologist before too many tests are run, especially if you are considering conventional treatments.

The best time to bring a specialist on to your team is just before you do a biopsy, or after you get the biopsy report. If there is no oncologist in your area, ask your vet to consult with one via phone or email. Search for an oncologist, using the specialist search tool at
www.ACVIM.org.

Depending upon what the biopsy report shows us, we may need to look for spread with an ultrasound-guided aspirate or biopsy, X-rays, ultrasound, CT scans, urinalysis, various blood tests, or a bone marrow biopsy. To find out if the cancer has entered the lymphatic system, the lymph nodes may also be checked with a fine needle aspirate, or even a biopsy.

The tests will vary depending upon the type of cancer, its stage, and your own treatment and budget preferences. As Dr. Ettinger points out, a lot of money can be wasted on tests that you may not need, so be clear with your vet or oncologist about your budget. Reading the rest of this book, including the tests Dr. Ettinger uses for the most common canine cancers, will give some guidance about how far is far enough for you and your dog.

No matter how many tests we run, we don’t yet have tools that can detect micrometastasis. In micrometastasis, a very small number of cancerous cells spread throughout the body, using the circulation system; they do not form tumors right away, but have the potential to bloom into full cancers later on. These cells may not be found in testing, even with our most sophisticated imaging tools. Their invisible spread is one of the reasons I recommend so many “outside the box” therapies in Full Spectrum cancer care. By using as many non-invasive therapies as possible, we may increase the odds of reducing micrometastasis.

In this part of the book I will take you through Full Spectrum cancer care, step by step. We’ll start with a short discussion about the Full Spectrum mindset, and then move on to Step One, Conventional Treatments, Step Two, Nutraceuticals, Step Three, Immune System Boosters, Step Four, Diet, and Step Five, Brain Chemistry Modification. By the end, you will have a solid overview of the things you can do to help your dog, starting immediately.

F
ull Spectrum cancer care is based on the assumption that, no matter how much time you may have left with your dog, you can make the best of it ... or, as medical professionals say, optimize it. There are many steps you can take, right now, to help your dog, no matter what stage or type of cancer she has – and a lot of these steps are free.

If you are like most guardians, your relationship with your dog is precious. Cancer doesn’t change that. Your love for your dog can be a tremendous asset for you, motivating you to make high quality decisions. Full Spectrum cancer care is based on your loving relationship with your dog.

Every cancer case is unique, every dog is unique, and every guardian is unique. No two dogs need the exact same care; you may not choose to use all of the tools available. Even so, it’s important that you consider each one. That’s why I’ve broken my approach into five steps, each of which is outlined in detail in the next five chapters.

Your love for your dog can be a tremendous asset for you, motivating you to make high quality decisions
.

After reading those chapters and considering your own dog’s case, you will have a very good framework, from which to design your own Full Spectrum plan. The next part of the book, Making Confident Choices, will help you to fine-tune your thoughts and make a real plan based on your values, your budget, your time and, of course, your dog’s cancer case. Executing this plan with your team’s expert help can give you an edge on your dog’s cancer.

Let’s go over the basics of the Full Spectrum mindset.