When to Visit a Veterinary Oncologist

istockphoto.comWelcome back to the world of veterinary specialists. With this series of blog posts my ongoing primary goal is to help you determine when your pet might benefit from a visit with a specialist. Thusfar we’ve covered ophthalmology, dermatology, and neurology. Now up to bat is oncology with surgery on deck.

The job of the veterinary oncologist entails diagnosing, staging, grading, and treating cancer. Staging and grading occur once the diagnosis has been made and involve testing to determine just how advanced/aggressive the cancer is. This is based on the microscopic appearance of the tumor as well as documentation of all the places within the body that the cancer has already managed to set up housekeeping. Perhaps the most important part of an  oncologist’s job description is counseling their clients to help them make good choices on behalf of their four-legged family members.

When should your pet be evaluated by a board certified veterinary oncologist? Here are my recommendations:

  • Your pet has a mass/growth that your family veterinarian believes may be cancerous. It may have been discovered during a physical examination (palpated externally or internally) or with an imaging study such as an X-ray or ultrasound.
  • Your pet has a mass/growth that has been determined to be cancerous. In this situation I encourage you to view a consultation with an oncologist to be an information gathering endeavor- part of due diligence as your pet’s medical advocate. In no way will such a consultation obligate you to proceed forward with therapy.
  • A mass/growth that your family vet treated in some fashion has recurred.
  • The biopsy report (microscopic description) for a mass/growth that your family vet surgically removed indicates that some cancer cells were inadvertently left behind.
  • You simply want a second opinion so as to be more certain about advice you’ve received from your family veterinarian.

To find a board certified veterinary oncologist in your neck of the woods or learn more about this specialty, visit the American College of Veterinary Internal Medicine. Oncology is a subspecialty within this organization. If there is not a board certified oncologist practicing within your community, the next best choice will be a specialist in internal medicine. Because there are relatively few oncologists to go around, by default, most internists have vast experience diagnosing and treating cancer.

Have you and your pet ever visited a veterinary oncologist? What was the reason and what was the outcome?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

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5 Comments on “When to Visit a Veterinary Oncologist

  1. My dad’s 8 yr old lab/chow mix Charlie is now in remission for stage IV Lymphoma. He has been going to a vet oncologist since mid-October when he was diagnosed. We have nothing but rave reviews for the Vet Oncology staff; the doctors, the techs, and the reception staff. All have been very professional and take great care of our boy. The treatment plan, the probability of getting the disease into remission, the procedures and follow-up care was presented very clearly and they are there 24 hr/day to answer any questions or concerns. If for any reason we felt Charlie was not responding, we could discontinue at any time.

    Charlie is now back to being full of life. He is eating well and is excited about his daily walks. He LOVES going for his chemo treatments (and he loves the ladies there!). My parents are very lucky that the oncologist is in their town (i.e they didn’t have to travel to a vet school), which made pursuing this treatment option logistically feasible, which is important considering the cost and frequency (1X/week) of treatments.

    If you find yourself with an animal that has cancer, I would definitely recommend a consult visit with an oncologist. There are a lots of treatment options (drugs used, frequency, modality). It is just an information gathering session and you do have a few days to process the information and make a decision that is best for you and your pet.

  2. I am very grateful to those who posted here. I learned as much from them as from this great article.

  3. I’ve had 5 cats with cancer. Minnie Mouse, who was about 14 at the time, had tracheal lymphoma. Lymphoma is readily treatable with chemo. She had chemo and radiation at Univeristy of Pennsylvania and it worked. After the first dose on day 1 you couldn’t feel the tumor anymore and her breathing sounded normal. She didn’t seem to get sick from it and the times her white count was too low they’d skip the chemo. She’d go every other week for IV treatments and I’d give her pills at home. After her first round of chemo she had about 6 months off and then they did an ultrasound and found it had come back and wasn’t just contained in the trachea. So one regret is not doing the abdominal ultrasound before the first dose of any chemo to see if it is in other places which would have saved me the money for the radiation treatments. Radiation only helps if the cancer is isolated in one spot. Once they give the first dose of chemo, or even a dose of prednisone, the cancer shrinks and you can’t see it on the ultrasound. The second round of chemo they found the original chemo meds weren’t working so the tried CCNU. This one took some time to work but finally it did work. Finally Minnie Mouse got blisters in her mouth and we didn’t know if it was lymphoma, squamous cell carcinoma, or from kidney failure so we put her to sleep and Univ. of Penn did a necropsy and found she had no cancer in her body and it was from kidney failure. Even though her kidney enzymes were normal, because I gave her sub-q fluids daily, one of her ducts was blocked and that kidney was very small.

    Next was a cat named Triscuit who was sneezing a lot. My regular vet first tried antibiotics, then different antibiotics, then the test for cryptococcus which was negative. So went to Penn and they found out he had nasal adeno carcinoma. They were booked for their radiation department so I took Triscuit to Red Bank Veterinary Hospital for radiation, and he got the radiation 2 or 3 times, but the odds aren’t good for this type of cancer so we had to put him down as he stopped eating.

    Next cat was Ginny, a long haired calico feral named after James Herriot’s ferals Ginny and Ollie. Ginny was about 18 when she got squamous cell carcinoma in her mouth. I had read up on squamous cell carcinoma and there isn’t much they can do and the cats will stop eating so it is best to put them down. One day after my vet sent the biopsy specimen to the lab to be diagnosed is when Ginny had problems breathing so I took her to the emergency vet to be put down in the middle of the night. The next day the biopsy results came back to my vet saying it was squamous cell carcinoma. About a year later I read an article by a holistic vet in Dog Fancy Magazine (November 2006 page 19) saying she used black salve (cansema) to cure it on a 12 year old dog. At the time the article was written, the dog was 14 and had lived 2 years which means he must have been cured since no animal could live 2 years with squamous cell carcinoma. We used to use black salve when I was a kid to remove splinters (put some on a bandaid and over the splinter and it draws out the splinter within a day). If I had known about the black salve curing the dog of squamous cell carcinoma at the time Ginny had it I would have tried to find a vet on the east coast that would have tried it for Ginny.

    My cat Beeb got melanoma on her ear when she was about 15. Cats can get it on their ears or nose, where the fur is the thinnest, from being in the sun (which cats love to do), especially if they have white fur. Twice the big scabby thing just fell off her ear. The third time my local vet cut off most of the ear and sent it out to be analyzed and found out it was melanoma. The next week all her blood work came back normal, even her kidney enzymes which had been elevated. But a few days after that she stopped eating. I said, “but the blood work was normal”. So, my vet took an x-ray of her lungs and there were all little spots on the lungs which is where melanoma spreads to next.

    Lastly is Oliver who is 17. Oliver has been on tapazole for a few years now for hyperthyroidism. So, we regularly check his blood and he gets weighed. About a month ago he went in for his blood work and he had lost quite a lot of weight so she did full blood work. His thyroid level was fine and his kidney values were fine but high white count and anemic, so she said it might be cancer. My local vet put him on Baytril for 2 weeks and wanted me to bring him back two weeks after that for another check of his blood and weight. Well that appointment was 2 days ago and he had gained 2 ounces, but she decided to do an x-ray. The x-ray shows he probably has lung cancer. So she suggested I try Veterinary Specialty Emergency Center in Philadelphia for an oncologist since they would be the closest for me to drive to. So I’m going there this Wednesday for a consultation. After reading up on lung cancer in cats the best treatment if it is caught early is surgery. So, we’ll see what they think is best for a 17 year old cat. He doesn’t seem to be in pain and eats well and still jumps high and his breathing sounds normal, so perhaps it is early or perhaps it isn’t even cancer.

  4. Brisa, Boxer x, had mast cell. he clinic came highly recommended but the experience for both dog and human was not good. No gentleness with dog, who was obviously afraid of small room and a bunch of strange men poking and talking loudly, no options, just do it the way I say or go away. I opted for chemo, not radiation or more surgery. I don’t know if it extended her time or not.

    I did share the experience with my vet as an FYI.

  5. I have been to an oncologist 3 times, with different experiences:

    1) Bubbles my first foster. The vet discovered a teensy mass on the roof of her mouth while intubating her for something else. It turned out to be inoperable because it was between the hard and soft palates (you can remove one or the other but not both) and it was fast-growing. 2 radiation doses did nothing so we stopped that and just spoiled her for whatever time she was left. Time from the intubation discovery to being PTS = 10 weeks. She was a happy girlie until the end, though.

    2) Twiggy, my foster shih tzu. She had bladder cancer, and I took her to Purdue for a clinical trial. I believe her life was extended a bit and their TLC with her bladder infections improved her quality of life. I had her for six months and as her vet, Dr. Knapp, said she never knew she had cancer.

    3) Karly, my diabetic girlie that had NINE mammary tumors. My local vet removed all nine at the same time as her spay, which I did not want to do, but she needed the spay to control the diabetes. She was losing 1 lb a week so I let the vet do it because “one anesthesia is better than two.” She had two additional anesthesias in the next week due to complications anyway! Later tumors grew back and I went to Purdue, and it was determined surgery was not an option because too little original tissue remained. Dr. Knapp, it turns out, knows a thing or two about mammary cancer too, and she put Karly on a COX-2 inhibitor. They had discovered that dogs on anti-inflammatories for arthritis who also had cancer sometimes had stable disease when progression was expected. Karly’s tumors did not grow, and she eventually died from something else (spinal meningitis) (Dr. Knapp was studying canine mammary cells in mice at the time: http://www.ncbi.nlm.nih.gov/pubmed/21848619 )

    My next dog also had mammary cancer, and my local vet gave her the same COX-2 inhibitor, since she had arthritis so it was indicated anyway. She died from interstitial pneumonia, not cancer.

    I’m not sure if taking my sweet Murphy boy to an oncologist would have made a difference. He had a melanoma lump removed from his lip, and the path report said he had clean margins. I had to put him to sleep seven months later for pericardial effusion, which was probably from a melanoma on his heart bursting and bleeding into the pericardium. He had been doing so well it took me by surprise. A recheck at six months with an oncologist might have found it, but I took him to an expert in the procedure for pericardial effusion and she gave me very low odds for success.

    Murphy’s sister MacKenzie has a huge mass in her abdomen and I couldn’t afford a trip to the oncologist. Her vet discovered it after I found a new lump on her skin (lump mapping for old-timers is essential so you know what’s new) He said prednisone should shrink it if it’s lymphoma, and indeed it’s less than half the size. She just had a check-up and in general she’s doing better than a typical 16-year-old dog so I’m satisfied. Surgery would be too risky for her.

    The side benefit of there being veterinary oncologists is that your local vet (who pays attention!) knows more about cancer than they used to. I bet 20 years ago MacKenzie would just have been put to sleep after discovering that mass.