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What caused my pet’s cancer? What caused my pet’s cancer? This is a difficult question to answer because many causes are established based on epidemiology studies rather than finding evidence of the cause within the disease. Some cancers do have the cause within the cancer, i.e. if vaccine adjuvant is seen within a tumor. However, usually a cause is not known or it is presumed. How long does my pet have to live? Many of our estimates are based on previous studies of groups of animals. It is impossible to predict how long an individual will live. What would you do if it were your pet? This is probably the most difficult question to answer. In some instances it’s easy. In other cases it is very difficult because there are so many factors influencing a decision and the “worth” of a treatment is a very individual decision. For instance, finances are a large factor in a decision. Some pet owners will be of the opinion that $5,000.00 is well worth a treatment that will result in a 6 month extension of good quality of life, while another individual will be of the opinion that $500.00 is too much to spend unless a cure is achievable. Neither point of view is wrong. When do I stop? Quality of life is a very individual opinion. I think our biggest fear when making the decision to euthanize is ‘is it too early?’ In many instances, pets can live with cancer for a while (few months to over a year) with a good quality of life. Therefore, the decision to euthanize is difficult. I find it is an easier decision when I make a list of what my opinion is of quality of life, and when my pet no longer meets one or two of those criteria, then it’s time or at least not too early. What treatment is right for my dog? When you find out that your dog has cancer, one of the first decisions you will need to make is whether or not to treat the cancer, and then deciding which treatment method to use. In most cases, surgery, chemotherapy or radiation will be recommended, depending on your dog’s type of cancer. Often, a combination of these approaches will offer your dog the best chance of cure or long remission. How you decide to treat your dog’s cancer is ultimately a very personal decision, and one which needs to be based on your dog’s type of cancer, their age, their personality, the treatment protocol that would be used, your individual philosophies, and unfortunately, the time and money that it would take to pursue treatment. For example, if your dog is 14 years old and has a very aggressive form of cancer, it may be more loving to choose dietary changes or holistic supplements to manage your dog’s symptoms and make them comfortable than to pursue surgery or chemotherapy. Or, you may realize that taking your dog in for radiation therapy two days a week for several weeks would be more damaging to their spirit than any potential benefit it may bring. Educate yourself about the potential benefits of any treatment, be honest about what you are willing to commit to, and most importantly, ask yourself if this is really in the best interest of your dog, knowing her better than anyone else in the world. This is an area where there are absolutely no right or wrong decisions. Listen to your heart, evaluate your specific situation, and go from there. Should I have my dog’s lymphoma staged and typed? When your dog is diagnosed with lymphoma, your vet may recommend other tests to stage the disease and identify if other organs have been affected. Also, a process called Immunotyping can determine if your dog has B-cell or T-cell lymphoma. The purpose for these tests is to predict outcomes. Sometimes this can be helpful, as dogs with T-cell type lymphoma often do not respond well to chemotherapy and have a reduced chance of going into and sustaining remission. The tests can also indicate if your dog has any other pre-existing problems that would make it more difficult for them to tolerate chemotherapy. However, it’s important to consider your dog’s well-being when deciding whether or not to perform these tests, which can be very stressful and usually will require the use of anesthesia. Also, these tests are expensive. One thing to keep in mind is that if a dog with lymphoma is going to respond to chemotherapy and go into remission, it will generally happen within the first 2-3 treatments (there are always exceptions to the rule, however!). And, the prognosis does not change substantially if they have multicentric lymphoma or organ involvement at the time of starting treatment, or not. So, you may want to consider going ahead with chemotherapy treatments and then see what happens rather than putting your dog through multiple tests and ending up with the same treatment protocol. The bottom line is to ask questions. For each test your vet suggests, find out what is involved, what information will be gained and whether or not that information will impact treatment. If treatment would be the same no matter what, then it is probably not necessary. Is there a standard chemotherapy protocol? For lymphoma, one of the most common forms of canine cancer, the chemotherapy treatment protocol most often used is the Wisconsin-Madison protocol. The Madison protocol uses the drugs Prednisone, Elspar (L-asparaginase), Vincristine, Cytoxan (cyclophosphamide), and Adriamycin (doxorubicin) during treatments that occur over a period of 26 weeks. Prednisone is taken orally at home, at first in high doses on a daily basis, and will gradually be reduced. The rest of the drugs are given at the clinic, with a different drug being administered during each visit. You should note that although there is a “standard” for how this and other protocols should be administered, the oncologist can adjust the protocol to meet your dog’s individual needs. If your dog does not tolerate a specific drug well or exhibits more severe side effects, modifications can be made to the drugs used, dosage and schedule of treatment. What are typical side effects of chemotherapy? Although each dog will vary in their ability to handle chemotherapy, most dogs will exhibit some side effects at one point or another during treatment. Reactions normally do not occur right after treatment though – side effects usually appear 2-3 days after the treatment. Your dog will probably seem a bit more tired than usual, and may not have his or her typical stamina at various points during treatment, but often this is very short lived. Below is a description of some of the typical side effects of the chemotherapy drugs most commonly used, as described in the Textbook of Veterinary Internal Medicine (2005). Prednisone: + Increased thirst - drinking large amounts of water Elspar (L-asparaginase): Can cause an allergic reaction. As a result, Diphenhydramine (Benedryl) is usually given to the dog before this drug is administered. Any reaction to this drug would normally occur within 15-20 minutes of administration. Vincristine: This drug was consistently the most difficult one for Georgia to tolerate, although for many, it is not a problem. Side effects that Georgia experienced from Vincristine were: + Diarrhea (sometimes explosive) Cytoxan (Cyclophosphamide): + Can be toxic to the bladder and cause bloody urine or chronic cystitis, so often lasix are often given along with this drug to ensure that your dog expels this drug from their bladder regularly. Adriamycin (doxorubicin): + This drug has a cumulative effect on the heart. If your dog receives too much of this drug over the course of treatment, they could develop heart problem. As a result, only so much of this drug can be given to your dog in their lifetime. The vet should monitor your dog’s heart throughout treatment to ensure that it is not causing any problems, and if your dog has any existing heart conditions, you may want to consider an alternate drug, such as Mitoxantrone. In some cases, you may want to consider having an x-ray or ultrasound done prior to each Adriamycin treatment to confirm that there is no heart damage present. This drug is often the one that causes the most side effects for dogs, although Georgia was not bothered by the Doxorubicin. What do I do if my dog has diarrhea after a treatment? One of the most helpful drugs to keep on hand is Metronidazole (flagyl). This drug can be very helpful if your dog experiences severe diarrhea during treatment (which is not that uncommon), and is given in pill form. A daily dose of Pepcid can also be very helpful in preventing stomach upset, and many pet owners choose to incorporate this into their daily routine. For those who prefer a natural solution, giving your dog a tablespoon or so of canned pumpkin (100% pumpkin, NOT pie filling), can help mild cases of diarrhea. If your dog does experience severe diarrhea, make sure they continue to drink enough fluids (you may want to put some chicken broth in their water to get them to drink more), and consider giving them a blander, easier-to-digest diet for a couple of days, such as baby food or rice and boiled chicken. Why do I need to monitor my dog’s temperature during chemo treatment? You should consider investing in an in-the-ear pet thermometer (unless you’re proficient at taking a rectal temperature), as it’s important to monitor your dog for fever throughout treatment. Because chemotherapy drugs often affect the bone marrow and reduce the body’s ability to produce new blood cells, including the white blood cells responsible for fighting infection, it’s very important to identify and treat any infections that might occur as early as possible, as this is potentially the most serious side effect of chemotherapy. A fever is a indication that your dog could have an infection of some kind. Your dog’s white blood cell count will generally be at its lowest 5-7 days after treatment, and this is when they are most susceptible to developing an infection. If your dog develops a temperature, call your vet immediately. This is an emergency! Why has my dog lost weight since being diagnosed with cancer? Two types of weight loss are common in cancer pups — anorexia and cachexia. Anorexia can occur when your dog loses interest in food, generally because they don’t feel well, or are nauseous. In these cases, it’s important to find something that your dog is willing to eat, which can sometimes take a little coaxing and creativity. If tempting your dog with some of her favorite foods is not enough to do the trick, you may want to consider providing something that is very bland, such as baby food. If that is still too much for your dog to handle, try giving her a frozen meal. Frozen food doesn’t have the same odor and flavor as unfrozen food does, so it can be easier to tolerate than regular food if your dog is feeling nauseous. Frozen Hill’s n/d canned food is a great choice, or even frozen fish, such as smelt, can be a good meal. Ultimately, if your dog becomes fussy about eating though to the point that they are consistently losing weight, it’s more important to get them to eat than to stay on a strict diet. Cancer cachexia is a different type of weight loss, and the reason that cancer is often called a “wasting disease”. Cachexia occurs when the body is taking in enough calories, but it’s not able to absorb nutrients properly and so the dog becomes weak as it begins losing fat and muscle mass. If your dog starts to lose weight because of cachexia, you may want to try adding digestive enzymes to their food, such as Prozyme. These enzymes will help your dog’s body to absorb the nutrients in their food more easily, helping them to maintain or gain weight more easily. A pre-digested fish protein called Seacure was also very helpful for Georgia, helping to add protein and calories that could be easily absorbed without having to increase the volume of food. Whether the cause is anorexia, cachexia or a combination of both, it’s important to monitor your dog’s weight regularly and to notify your vet if your dog starts to lose weight on a consistent basis. How soon will I see results from treatment if my dog has lymphoma? For lymphoma, it is common to begin seeing results very soon after the first chemotherapy appointment. For Georgia, within the first two weeks, her nodes shrunk back to normal size. What does remission mean? Remission does NOT mean that the cancer is gone. It simply means that all clinical signs of the cancer are gone. In the case of lymphoma, your dog has achieved complete remission when the vet can no longer find any enlarged lymph nodes in their body. How much will treatment cost? Cost will vary according to the size of your dog (the bigger the dog, the more drugs that need to be administered), the type of cancer they have, the number of extra tests that need to be conducted and your particular vet’s fee schedule. But, generally speaking, you should be prepared to spend several thousand dollars in the course of your dog’s treatment, especially if you go through chemotherapy. But, as you pay per appointment, not in a lump sum, this amount is spread out over several months. Also, if you have pet insurance, they will likely reimburse you for some of the costs of treatment. Information above from Georgia's Legacy |