Dog Fancy Questions Feb 2014

Starting in January 2014, I write a monthly column in Dog Fancy magazine about cancer. Each month I answer client’s questions or discuss a topic relating to the diagnosis, treatment or prevention of cancer in dogs. Here are some questions from Dog Fancy readers that I was unable to answer in my column.

Q: After reading your article in March 2014 regarding cancer types and breeds, I have this question.  One of my four legged buddies is a Bernese Mountain Dog Mix (Bernese Mountain Dog/Collie-English Cocker cross[very handsome boy] ) and I have read that the Bernese breed is at high risk for lymphoma, if you have a mix breed dog, does this decrease the chances of the dog getting cancer?

A: Bernese Mountain Dogs, Collies and English Cocker- your pet must be beautiful. The answer to your question as to whether mix breed dogs have a lower risk of certain cancers is yes, they do--sometimes. If you have two breeds that have a high predilection for developing any cancer, crossing these two breeds may or may not decrease the risk of cancer in the offspring. The reason for this is that veterinarians and geneticists are still unsure as to which specific genes predispose the breeds to the various types of cancer. In a very large study (see http://avmajournals.avma.org/doi/abs/10.2460/javma.242.11.1549) evaluating over 27,000 dogs, researchers at University of California-Davis School of Veterinary Medicine found no difference in the predisposition of cancer in purebred dogs when compared to mixed-breed dogs. However, there are specific cancers where mixed-bred dogs do have a lower predisposition than do certain pure breeds.

The most important consideration when deciding which breed of dog to get or whether to get a purebred or mixed breed is personal preference. Having a dog you love is THE most important factor.

Q:  I read your article in Dog Fancy concerning common cancers in dogs.  I was interested in the story concerning Maddy, the Border Collie diagnosed with lymphoma and that she is still in remission after 4 years.  I was wondering what type of chemotherapy she received.  My poodle was diagnosed last year but came out of remission after only 9 months.  He underwent the CHOP protocol the first time and is currently undergoing the same treatment. I have been told he may have survive another 4 -5 months on this current treatment. What type of treatment do you recommend?  Thank you.

A: Maddy was a spectacular dog and one of my favorites patients. She was treated with both chemotherapy and a bone marrow transplant. While not widely available, bone marrow transplants can improve the prognosis for dogs with lymphoma. The other therapies that we are currently using at The Veterinary Cancer Center in Norwalk, CT are chemotherapy alone and chemotherapy in conjunction with radiation therapy. The three major protocols we use are CHOP (cycylophosphamide, Hydroxydaunorubicin (doxorubicin), Oncovin (vincristine), Prednisone), MOPP (mustargen, Oncovin (vincristine), Procarbazine and Prednisone) and Lomustine (CeeNU, CCNU). These three protocols form the basis for many of our lymphoma treatments. There are certainly variations of these with the CHOP-MA protocol, one that I helped develop (see http://www.ncbi.nlm.nih.gov/pubmed/20230577), giving dogs with B cell lymphoma a prolonged survival time, 622 days, compared with most other variants.

The protocol that is best for your particular dog depends upon a variety of factors and your local veterinarian or veterinary oncologist would be the best person to advise you.

Why Veterinarian's Refer

I just finished reading a really good article, the first of its kind in the veterinary literature. The article talked about why veterinarians in Ontario Canada referred dogs with either osteosarcoma or lymphoma to a veterinary oncologist. The main findings were that there were multiple factors associated with their decisions. One of the most significant factors was the veterinarian's confidence in the referral center. We at The Veterinary Cancer Center in Norwalk, CT certainly believe this and we try everyday to ensure that our referring veterinarians have confidence in us. Two of the other factors that influenced whether a referral was made were the general health status of the dog and whether the client had a strong bond to their dog. Assessment the health status is certainly important and is generally a very objective measure. On the other hand, the measure of a client's bond to their dog is much more subjective and sometimes quite difficult to measure. Yet despite this, a veterinarian's assessment of the strength of this bond was a very influential factor in determining whether they referred or not.

This article just talks about dogs and only two forms of cancer, it would be very interesting to see if these trends are the same for cats and for all other cancers.

The Veterinary Cancer Center has built its reputation on earning the communities trust and confidence every day. With this article in print, we now have proof of how important this truly is.

How to Strengthen Your Creative Skills - Simon Sinek

Very interesting video on how to be more creative and some very interesting thoughts on building upon your strengths.

Melanoma Tumor Board Meeting and ACF

I just returned from a Melanoma Tumor Board Meeting in Washington, DC and I do not remember being more excited by the outcome of a conference. There were close to 50 people in attendance ranging from medical oncologists to molecular biologists to geneticists to veterinary medical and radiation oncologists to pathologists-both veterinary and human. This group of people represented the “best of the best” in terms of melanoma researchers and clinicians.

This conference, supported by the Animal Cancer Foundation, will result in the publication of a “white paper” describing a consensus statement espousing the value of canine oral malignant melanomas as a model for certain types of melanomas in people. People from both sides of the “human and veterinary aisle” passionately and eloquently described the need for developing this model.

The organizers of this conference have done what no one has been able to do for 20 years—effectively guide such a diverse group of cancer researchers to reach a consensus statement.  They have truly allowed me to see a dream of mine move towards fruition. Since starting the Animal Cancer Foundation in 1999, I have hoped to galvanize the cancer community in this manner. It is such a wonderful feeling to

What I would change about the Veterinary Education System

I was at a conference recently with two colleagues of mine and we started talking about veterinary education. I am not sure how the topic came up, what we all started discussing the same point almost in unison. The topic was communication and how veterinarians discuss options with pet owners.

 

All three of us had graduated from different veterinary schools, gone through different internships and residencies –and yet we all agreed that veterinary students everywhere need to re-organize their communication priorities. 

 

What do I mean “communication priorities”—I mean medical/surgical options need to be prioritized above finances. Don’t get me wrong, finances are AN important consideration when discussing any medical therapy, but they should not be the primary one. Information about options- ALL the options available, should be THE most important consideration.  Once a veterinarian and pet owner both understand what options are available for the pet, then, and only then should finances-or whatever other constraints –time, emotional, finances, etc.--may be pertinent to that pet owner be discussed. 

 

By prioritizing information and options first and finances second, we can better insure that the pet will get the best care possible AND that everything will be done that the pet owner can afford. If the priorities are stay as they are, clients will continue to feel that optimal care was not recommended or given, veterinarians will feel they need to be accountants, bankers and financial managers first and medical professionals second.

 

We, the veterinary profession, need to trust pet owners. Trust that they can make the best decision for their family and their pet. This requires accurate and complete information. Veterinarians need to allow the owners to hear ALL of their options and then help them make choices, rather than only communicate those options the veterinarian THINKS the owner’s can afford.  Veterinarians need to be medical professionals not financial professionals. Pet owners come to us for medical information and guidance. 

 

Survey after survey over the past 25 years have shown that owners would have done more for their pet if their veterinarian had recommended it. The impetus to change the way we as veterinarians communicate needs to start at the veterinary schools throughout the country, this is where we learned the current communication prioritization.

 

Empowering the pet owners and informing them of all the options available—as a starting point for discussion –may not be easy, but it is the right thing to do for the pets that have been entrusted into our care.

Bladder Cancer in Dogs

From Petside.com

Did you know that both dogs and people get bladder cancer? Did you know that some breeds are almost 20 X more likely to get bladder cancer than other breeds? And did you know that there is a test that can help determine if your pet does NOT have bladder cancer?

Bladder cancer is not an uncommon cancer in either people or pets. In people somewhere between 1 in 28 to 1 in 84 will develop the disease. In dogs, 2% will develop the disease, but certain breeds—Scottish terriers, Shetland sheepdogs, beagles, and West Highland white terriers—have a much higher risk of developing bladder transitional cell carcinoma. Of these breeds, Scottish terriers have the highest risk, with an almost 20-fold increased risk compared with mixed-breed dogs. In addition to breed, another risk factor in dogs is the exposure to herbicides and / or pesticide s on the lawn. 

The signs of bladder cancer in dogs are straining to urinate, increased frequency of urination, and blood in the urine. These signs are very similar to the symptoms people report. Because our pets cannot talk to us, we often detect bladder cancer at a more advanced stage compared to people.  There is a test—the Bladder Tumor Antigen (BTA) test-that can be used. This test is very sensitive—meaning it is very good at detecting the disease if it exists, but it is not very specific—meaning it is NOT very good at telling us that a positive tests actually means that they have the disease. The BTA may, however, be very useful for screening young dogs of at risk breeds. If  Scottish terriers, Shetland sheepdogs, beagles, and West Highland white terriers were screened with the BTA,  a negative result would inform the owner with a high probability that the dog was free of bladder cancer at that time.

So the bottom line, and best advice for decreasing the risk of bladder cancer in your pets is to: 1) restrict their exposure to herbicides and pesticides and 2) if you have a breed that has a high risk (or you are a very concerned owner) you may want to start yearly screenings your dog with the BTA test at a young age.

Cancer is NOT a death sentence

Recent advances in human and veterinary medicine are increasing survival rates for both people and animals with cancer. Both human and veterinary oncologists treat cancer traditionally using methods including surgery, chemotherapy, radiation therapy and immunotherapy. Over the past 20 years in oncology practice, I have seen some wondrous advances in treatment options. These newer modalities include cancer vaccines and targeted chemotherapy, which will be explored in future columns.
Today, veterinary surgeons are using innovative techniques such as limb sparing surgeries that can help pets with bone cancer avoid amputation. When surgery is combined with chemotherapy, veterinary oncologists achieve significant improvement in extending the lives of our pets. In addition, the pet’s quality of life is maintained with new chemotherapy dosing regimens and advanced methods to mitigate the side effects of chemotherapy. Veterinary oncologists anticipate and prevent side effects such as vomiting, diarrhea, anorexia (loss of appetite) and lethargy (loss of energy level), rather than address them as they occur. New Information from European cancer centers that certain antibiotics can be used to help alleviate many of the side effects of chemotherapy is being used in veterinary hospitals as well.
The melanoma vaccine, produced by Merial, is another example of how much progress researchers and clinicians are making in cancer treatment. This vaccine helps pets with the most aggressive form of melanoma—those that arise in the mouth or on a digit—to live much longer than previous treatments. I experienced this first hand in 2003 when my own dog, Smokey, a miniature schnauzer, developed a digital melanoma at age 12. Not only did Smokey have a tumor on his toe, but the cancer had spread to his lungs as well. I knew that the prognosis was grave—3 months. Smokey was given the melanoma vaccine, which was in experimental phase at that time. With this therapy, he enjoyed wonderful quality of life and lived 2 ½ more years. You can read more about Smokey’s experience at http://www.acfoundation.org/dedications/smokey.php.
I just completed filming an informational video for the Riedel and Cody Fund that provides more evidence that pet cancer is not a death sentence; you can find it online at http://www.ustream.tv/riedelcody.
Pets with cancer are enjoying longer and better lives than ever before; there is a plethora of treatment options available to insure that every dog and cat with cancer gets a chance at therapy.

Gerald Post, DVM, DACVIM (Oncology)