The Dog Cancer Survival Guide (90 page)

Your veterinarian is likely a well-educated, skilled and experienced practitioner, but, in my opinion, when it comes to cancer, dogs, just like humans, need to see an oncologist.

Although most cancers cannot, at this time, be cured, they can usually be managed with proper care. An oncologist can help you understand your dog’s prognosis and offer a more nuanced and comprehensive conventional treatment plan than one you might get from a general practice vet.

Diagnosing cancer, and using chemotherapy, radiation and surgery to treat it, is not something that can be learned over the phone or from a book. There are no “recipes” that I can give you or your general practice vet that will ensure a positive outcome for your dog. Your best bet, if you are considering chemotherapy, surgery or radiation, is to consult with an oncologist directly. Receiving the right care from the start can have a dramatic effect on your dog’s outcome.

I realize your access to an oncologist may be limited by distance and/or budget. Oncologists usually practice in urban centers, where there is a larger population of patients and better access to state-of-the-art facilities, and they are more expensive than general practitioners. To find an oncologist in your area, visit
www.ACVIM.org
and use the “find a specialist” search feature.

If physically visiting an oncologist is not possible, keep in mind that your vet can consult one by phone. Many labs have oncologists on staff and private practices often offer phone consults to veterinarians, and occasionally to owners.

Some clients worry that using a specialist will cut their regular vet out of the loop. Some also wonder, “who should I follow up with?” as they start to consult with specialists. I am not in any way urging you to replace your family veterinarian with an oncologist. Your own vet, who is the expert on your dog’s overall health, best manages all general care. When I see a new client, I always call the veterinarian that day to discuss the case, and I keep her in the loop with constant communication. I fax updates for her files after every single visit, and I send all the lab results and paperwork over, so she remains in the loop. If she calls with questions or new information, I take those calls promptly. I consider myself a specialist, called in just for the cancer treatments and follow-up appointments, strictly related to that illness.

One thing that stops many dog owners from consulting with an oncologist is a very common assumption: oncologists cost too much, and the treatments they use cost too much.

That may be true for owners who are on a very tight budget, but in my experience, if you’re choosing to treat the cancer, bringing an oncologist onto your team can actually save money in the long run.

When I run diagnostic tests on cancer patients, I often order blood work, urine tests, lymph node or mass aspirates, chest X-rays, abdominal ultrasounds and sometimes, a bone marrow test. I may ask a colleague for an informal consult or get a formal second opinion on a biopsy. These tests can total over $1,000, just to stage the cancer.

The tests are important. Knowing the stage of the cancer helps me to predict outcomes and decide which treatments to use. Most general practice vets would order the same tests I do, with a similar price tag. So what’s the difference? Expertise.

If an owner tells me her budget is limited, I can weed out tests that may be less necessary, saving money for actual treatments. If the family veterinarian can perform those treatments – for example, a surgery that does not require a board-certified surgeon – I send the case back the regular vet. I can do this because I have expertise: I have seen so many dogs and so many cancer cases and analyzed so many pathology reports and created so many cancer treatment plans. Without all of that experience, I would not be confident in my decision to limit some testing and start treating.

Extra tests, especially when a dog owner chooses not to treat the cancer with conventional treatments, are a waste of money. I am too often in the uncomfortable position of having to tell a new client that the battery of tests that have already been run was unnecessary. This is especially frustrating when the client decides not to treat the cancer. In those cases, the money spent on those tests could have been spent on some form of treatment or saved altogether. It’s better to understand what your dog is actually battling before running too many expensive tests.

An oncologist’s experience and knowledge allows him to evaluate the necessity of each test to create a plan that fits into the owner’s budget. This is why I recommend that, after the initial diagnosis, you consult an oncologist, if possible. The perception may be that calling in a specialist costs more money, but in my experience there is less waste and more value for each dollar spent.

An oncologist can evaluate your dog’s case and weigh the specifics against what is known about the cancer’s remission rates and median survival times. He can compare protocols and make a recommendation for what will give the best outcome.

Oncologists are not just cold, scientific specialists. They tend to be compassionate about budgets and personal circumstances. A good oncologist will be willing and able to create a plan that takes your budget and time into account and to talk about the possible side effects and potential risks involved in the treatments she recommends. A good oncologist will be able to go over the options and work with you to find a protocol that takes all of these things into consideration.

Many dog owners get an emotional charge when they hear the words “chemotherapy” and “radiation.” This is understandable, because many people have had to endure those treatments themselves, or watched a loved one go through them.

It’s a mistake to think that our dogs experience the same things humans do. Chemotherapy in particular is
very
different for dogs from how it is for people. Most protocols do not make dogs seriously ill, because we use doses that are lower than those used in people. In my practice, many owners express their surprise at how well their dogs feel during and after chemotherapy treatments. Most side effects are mild and manageable, and the majority of my clients have told me they’re happy they took the leap and chose chemotherapy.

If you’re particularly worried about side effects, make sure to tell your oncologist about your concern. He may be able to prescribe supportive medications, or there may be new treatment options available for you to try, instead.

Review
Chapters 11
and
41
for more general information on surgery, radiation and chemotherapy, and for specific strategies on how to manage common side effects such as nausea, vomiting and diarrhea. Your dog’s comfort and quality of life is a high priority for me, both as an oncologist and as a dog lover. I want your dog to live as long as possible and I want your dog to
live well.

Some dog owners feel the amount of time likely to be gained by using chemotherapy, surgery and radiation is too little. I empathize, because I have felt the same way. Every dog dies too early – even those who outlive the normal life expectancy for their breed.

I include the most recent statistics about each canine cancer in the chapters to follow. It’s important that you understand what these statistics really mean.

In canine cancer, we often use a statistic called the median survival time. Median survival times tell you the length of time past initial diagnosis at which half of the dogs were still alive. For example, if a study looks at sixty dogs, and the median survival time is twelve months, that means twelve months after diagnosis, thirty dogs were still alive and thirty were not.

Using this statistic is advantageous because it is less likely to be skewed by very unusual cancer cases. For example, some clients wonder why we don’t use average numbers: add up the total survival times for all sixty dogs in the study, and then divide the result by sixty. While this average – also called the mean survival time – might seem like a useful statistic, it may not always be so.

Averages can be skewed by even one or two unusual cases. For example, if one dog in the study was an extremely long-term survivor, adding that in the average survival time might give the impression that most of the dogs in the study lived much longer than they actually had. The opposite could also be true: if one dog, sadly, died very early, averaging in his short survival time might give the impression that most of the dogs lived a much shorter time.

It’s important to remember as you read statistics that the numbers do not necessarily apply to your dog. Each case is different, and statistics only tell us part of the story. We can’t know what any statistic means for your dog at this time; they’re included to help you form a general expectation.

Keep in mind the undeniable fact that dogs do not live as long as humans. For example, an extra year of time, for a dog whose breed has a ten-year life expectancy, is 10% of her normal lifespan. When we’re looking at survival times, we must remember: time is relative.

The twelve most common cancers (in my experience) are covered in the next twelve chapters. I share what we know about each cancer’s cause, effect on the body, diagnosis and prognosis, including statistics on survival times with and without treatment.

I present information about how to treat each of these major cancers, using surgery, chemotherapy and radiation. This advice, of course, is general and not intended as a recipe or a treatment plan. I recommend you take what you learn here, and then consult with your vet or oncologist to make a plan that takes your dog’s cancer and other health conditions into account.

Some cancers have common protocols that, when followed, yield fairly consistent outcomes. Unfortunately, for most cancers, there are no standard protocols. In these cases, I offer the best of what we know at this time. This can be disheartening and frustrating for dog owners, of course. It’s also frustrating for oncologists. Cancer is a complex and intricate disease; giving you honest facts and helping you to form realistic – or cautiously optimistic – expectations is part of my job.

While the most common canine cancers I see are covered in this section, there are many more types of cancer in existence, and some of those can develop in dogs. If your dog has one of these very rare cancers, I strongly recommend you bring an oncologist onto your team, because he or she will be best able to advise you with the latest strategies.