WHEN YOUR DOG HAS CANCER: MAKING THE RIGHT DECISIONS FOR YOU AND YOUR DOG

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CHAPTER 1

The Diagnosis

Your dog has cancer. Words you never want to hear from a vet, of course, but may as is not an uncommon disease. After recovering from the shock, the first step on your journey to battle cancer is to evaluate the current condition of your dog and fully understand the facts surrounding the diagnosis you received.

Your veterinarian will most likely be your initial source for information. Ideally, this is someone who is familiar with your pet and his/ her health history. Depending on your veterinarian’s area of expertise, she may choose to refer you to a veterinary oncologist, a specialist who treats cancer. Such a specialist may be enlisted for a consultation or second opinion as she will be well-versed in standard cancer treatments and should have knowledge of experimental treatments or clinical trials that might be relevant to your dog. Depending on where you live, you can also try your local veterinary college.

An organization called Oncura Partners offers a free consultation to their customers. The consultation is online for veterinarians that have an account with Oncura. More information can be found on their website: www.oncurapartners.com. Pet owners should first ask their veterinarians if they have an account with Oncura, but if they do not, pet owners can call Oncura directly at 1-866-233-9100 to get referred to a veterinarian that does. Another option is Lap of Love, Veterinary Hospice and In-Home Euthanasia, www.lapoflove.com, which offers a fee service for families who have just received a cancer diagnosis (see Resources for contact information).

Tests to confirm a diagnosis of cancer

In most cases, either your vet or the specialist will want to conduct tests on your dog to reach a firm diagnosis if they suspect cancer. The following is a list of initial tests that may be prescribed:

• Blood analysis. A sample of your dog’s blood will provide information regarding white and red blood cell counts, which can be an indication of whether your dog is fighting an infection. Note that a blood analysis alone will likely not provide a positive cancer diagnosis, but may be useful in evaluating the overall health and strength of your dog.

• Urine analysis. The presence or absence of bacteria, mineral crystals, blood and other compounds in the urine will help to complete a picture of your dog’s overall health. As with blood analysis, urine analysis will likely not provide a positive cancer diagnosis, but may be useful in evaluating the overall health and strength of your dog.

• X-rays. An X-ray is a medical imaging technique that may show the presence of tumors or masses inside your dog. It provides a two dimensional (2-D) representation of your dog’s internal organs and cavities. While X-rays can be extremely useful in identifying the presence of some tumors and other masses within your dog, they will likely not indicate whether a particular tumor or mass is benign or malignant, nor what type of cancer is present.

• Ultrasound. An ultrasound is another medical imaging technique that provides insight regarding what is happening internally within your dog; it also provides a 2-D representation of your dog’s internal organs and cavities. Whereas an X-ray provides a static snapshot, ultrasound provides a more dynamic view, since the technician can position the ultrasound wand at different angles. Ultrasounds also reveal the presence or absence of blood flow which may help the doctor better diagnose a tumor or mass.

As with X-rays, ultrasound is extremely useful in locating and sizing tumors and masses within your dog, but likely cannot prove or disprove the malignancy of the tumor or mass. There are some cases, however, where an ultrasound can show malignancy if certain characteristics are exhibited on key organs. For example, with my second canine cancer experience, the ultrasound revealed metastatic lesions on the liver and spleen. This was a diagnosis of cancer, although the specific type of cancer could not be determined until a fine needle aspirate was taken and analyzed. Only then did I find out what kind of cancer it was.

• Fine needle aspirate. This is considered a minor surgical procedure that uses a very thin hollow needle to take samples from tumors or masses. These tissue samples from the tumor or mass can be identified as benign or malignant. Note that this method can result in false negatives or positives, as only a small sample of the total tissue is removed and malignant cells may be missed. In addition, if the mass is a fluid-filled cyst, there is a risk of rupture from the insertion of the needle. Similarly, there is the risk of hemorrhage, particularly if the tumor or mass is on an organ that is suspected to be cancerous.

NOTE: Be sure to ask the doctor performing the procedure to alert you if there are any risky aspirate sites before proceeding. You have the right to be notified of any potential risks prior to the procedure.

• Biopsy. This is a more invasive surgical procedure that is used to take larger tissue samples from tumors or masses suspected to be cancerous. As with the aspirate method discussed above, a sample of tissue taken from the tumor or mass can be identified as benign or malignant using this method. Because this method is a surgery, there are risks associated with anesthesia, infection, potential hemorrhages or ruptures. Lastly, depending on the location and nature of the tumor or mass, it may be a more effective approach to remove the mass entirely, with margins, rather than just sample it and potentially have to perform surgery a second time.

Depending on where the cancer is located, it might be necessary to test the functions of various organs to determine how well your dog may respond to surgery or other treatments. For example, if there is a tumor on one of your dog’s kidneys, the veterinarian may prescribe a test to determine how well your dog might function with only one kidney. If the unaffected kidney is strong enough, then removing the kidney with the tumor may present a solid option to treat the cancer. However, if your dog’s kidney strength is poor, this would not be a good option.

Reviewing the tests

Once you have the results of these tests, you will be given either a firm diagnosis of a specific type of cancer and its location, or at least a narrowed down list of possibilities. Having a complete picture of your dog’s diagnosis should help you, your vet and any specialists who have been consulted to begin to create a treatment plan (covered in more detail in Chapter 3) to suit your dog’s particular needs. I would recommend that you either bring someone with you to the vet’s office when you receive the diagnosis or take careful notes. It’s difficult to remember details when a diagnosis of cancer is made, especially if you are as stressed as you likely will be. It’s also important to arm yourself with a list of questions to ask so that you don’t forget anything.

To the extent possible, I recommend that you get as many tests as necessary performed (the less invasive, the better) so that you can learn more about the type of cancer that you are dealing with. Based on the type of cancer and how far it has spread, you will have a better understanding of what your options for treatment are. Be prepared, however, for incomplete answers as was the case with my canine cancer experiences and others described in this book.

The hardest part of this process is when there is no clear cut answer in determining how best to treat your dog, even once all the test results have come back. For example, when I learned that my first dog had cancer and that the next step was an ultrasound, I was sure that once I had the ultrasound results, I would know what kind of cancer he had and what I would need to do about it. I knew that if I had the facts, I wouldn’t be worried about what to do since I would know what I was dealing with. I felt confident that I could do the research and weigh the risks, and the right thing to do would be obvious. What I didn’t count on was the fact that the tests were not as conclusive as I would have preferred. In fact, when I was presented with the results, I found them to be somewhat confusing and I didn’t have a very clear sense of what the right thing to do was at all. Be prepared for this. Sometimes science and medicine are more of an art than perhaps we’d like them to be.

During my first canine cancer experience, even once the ultrasound and fine needle aspirates were performed, I still didn’t have a clear, complete picture of the situation. What I did know was that he had hemangiosarcoma, at the least, although it wasn’t entirely clear how many tumors were cancerous and how many were benign. Of the five tumors he had, only three were candidates for a fine needle aspirate. The other two were in tissue areas that were deemed risky for aspirates—the risk being that they would bleed and cause hemorrhaging. Of the three tumors that were aspirated, one was benign. One showed only blood cells, which did not indicate the presence or absence of cancer. The final tumor was the one that showed cells that were indicative of hemangiosarcoma. Based on this information, and the fact that there were so many tumors, the most reasonable conclusion was that the cancer had metastasized.

Begin to assemble a team

Once you have received a firm diagnosis, I would recommend assembling a cancer treatment team of veterinarians and animal caregivers. For example, if your family veterinarian practices Western medicine, I would encourage you to seek out the opinion of a holistic or naturopathic veterinarian as well. A holistic vet may either offer alternate treatment options to combat the cancer or suggest ways to reduce the degree of pain and complications that your dog may experience through the use of alternative therapies such as acupuncture, Chinese medicine and homeopathy. Similarly, if your veterinarian specializes in alternative medicine, homeopathy, Chinese medicine or holistic care, I would also encourage you to solicit the opinion of both general and specialized veterinarians such as veterinary oncologists who are well versed in Western practices. They will likely be most knowledgeable regarding recent advances in treatments for canine cancers. Each discipline of medicine has its value and can be combined in a complementary manner. Your budget obviously will dictate the number of professionals you can use in your plan. See the final section of the book for resources to assist you in finding a reputable veterinarian.

It is important to ask your practitioners lots of questions to assess not only their confidence in the diagnosis of cancer, but also their experience with the treatments that they are recommending to you. You can also ask your veterinarian to recommend others within their own practice or specialists who are either dealing with a similar diagnosis or have in the past. This is the time to engage family and friends who might have had dogs with cancer and who can offer you not only emotional support, but also the wisdom of their own experiences. See Chapter 10 for a few real-life examples of the range of possible experiences with canine