Monday, June 2, 2014

Guide to Canine Cancer: Your Most Common Questions Answered

From signs and symptoms to what to do if your dog's been diagnosed, get the important dog cancer information you need. While too many dogs still get diagnosed with cancer each year, new research and treatments are helping increase the quality and quantity of life for dogs with the disease. Education also works as a powerful tool in preventing and dealing with canine cancer. In observance of Pet Cancer Awareness Month in May, the doctors at The Veterinary Cancer Center in Norwalk, Conn., offers information on the disease that can benefit both you and the dogs in your life.
 
Do Dogs Get Cancer?
Answer By Gina Olmsted, D.V.M.
 
Not only do dogs get cancer, but cancer is sadly one of the most common diseases affecting aging pets. Estimates indicate that at least 4 million dogs develop cancer each year. In addition, 45 percent of dogs that live to 10 years or older die of cancer, according to one survey of data for more than 2,000 dogs. A 2005 Morris Animal Foundation survey revealed that cancer was the largest health concern among dog owners at 41 percent, with heart disease the No. 2 concern at only 7 percent.


What Types of Cancer Affect Dogs?
Answer By Gina Olmsted, D.V.M. 

Our pets get many of the same cancers that humans do, and a lot of these cancers behave very similarly in pets as they do in people. Some of the most common cancers seen in dogs are skin tumors, lymphoma, and mammary cancer (breast cancer). The cause of cancer in our pets is much the same as in people, with genetics playing a large role and environmental factors serving as a contributing element in some cases.


Can Dogs Be Treated for Cancer?
Answer By John Farrelly, D.V.M., M.S., DACVIM (Oncology), DACVR (Radiation Oncology)

Pet Cancer Awareness Month is a time when we like to draw attention to things we can do to identify cancer in our pets. With cancer, an early diagnosis is important to give dogs the best chance of success. However, another key step lies in knowing how and where to get treatment for your pet with cancer. I find it amazing that patients’ owners and many other people that I meet still say, "I didn’t know that you could treat a pet for cancer” or "I didn’t know that oncologists existed for dogs and cats.”
This is shocking because animal cancer treatment is a field that has been growing since the 1960s and continues to expand, providing many different options for care when your pet has cancer.
Did you know that there are more than 300 oncologists, board certified by the American College of Veterinary Internal Medicine, and over 40 radiation oncologists, board certified by the American College of Veterinary Radiology? Also, in a recent survey over 65 radiation facilities were identified in the United States. Many of these facilities provide the same type of radiation for pets that you would have if you went to your doctor to get treated for cancer.


What Is the Prognosis for Dogs With Cancer?
By Gina Olmsted, D.V.M. 

The good news is that just like in people, early detection of cancer can greatly improve a dog’s length and quality of life, as it allows for initiation of therapy early in the course of the disease. Routine exams and checkups with your veterinarian play a major role in the early detection and prevention of cancer in pets. These exams should be twice a year in any mature adult or senior pet. The other piece of good news is that more cancer treatments are available for dogs than ever before. These treatments can involve surgery, radiation therapy, chemotherapy, clinical trials, palliative medications, or a combination of these therapies. The aim of any pet cancer therapy is to improve the length of a dog’s life, and most important to also provide them with excellent quality of life.                                                                                          


Does My Dog Have Cancer? Signs Your Dog Needs a Vet Evaluation
By Dorothy Jackson, D.V.M.

Clients often ask veterinarians whether or not their pet needs to be evaluated based on certain changes noted at home. The answer can be difficult to determine over the phone, as vets gather a lot of information from a physical examination. Still, some clinical signs are more likely to warrant an evaluation by a veterinarian.
Severe lethargy, for example, where a dog is not willing or able to rise on her own, even to urinate or defecate, could signify weakness due to anemia or a neurologic problem. If your dog exhibits this symptom, she needs an evaluation and/or further diagnostics to determine the underlying cause of the lethargy.
Lack of appetite can also be a red flag. Dogs can miss a meal or two without experiencing detrimental effects. However, a decreased appetite that persists for two or three days despite a variety of food being offered warrants evaluation by a veterinarian. Other gastrointestinal signs, such as vomiting and diarrhea, especially when they occur without any recent change in diet or any dietary indiscretion, also justify evaluation.
Any changes in urination habits — for example, straining to urinate, urinating more frequently, or having blood in the urine — could be due to an infection or other abnormality within the urinary tract. Your vet should analyze your dog’s urine to rule out an infection and/or perform imaging procedures to see if the bladder has any abnormalities.
These recommendations are generalities and may not pertain to every case. If you notice any changes in your dog at home, voice them to your family veterinarian, who can give you further instruction, whether that be close monitoring at home or scheduling an appointment for assessment and further diagnostics.


My Dog Has Cancer — Now What? 5 Questions to Ask Your Vet After a Cancer Diagnosis
By Jennifer McDaniel, D.V.M.

Canine cancer is a scary diagnosis. The emotional stress associated with it can be made worse by getting misinformation or no information at all. What questions should you ask your veterinarian to ensure that your pet’s cancer treatment is on the correct path?
1. What type of cancer does my dog have?
Many types of cancer exist, from sarcomas to carcinomas to round cell tumors. Knowing your dog’s exact type of cancer can allow you to ask the right questions and do the right research.
2. What other diagnostic tests or staging tests should be performed?
Oftentimes, the diagnosis of cancer is just the beginning. Your dog may need further tests, such as ultrasounds, radiographs, or blood tests, to help better classify the disease and/or determine if it has spread to other locations.
3. What treatment options are available for this type of cancer?
Treatment for cancer often involves multiple therapies. Options may include surgery, radiation therapy, chemotherapy, and/or immunotherapy. Knowing all of the potential treatment options can help you make the most informed decision for your dog.
4. Should I seek the help of a veterinary specialist?
General practitioners are the central members of a pet’s medical team. Cancer, however, is a very complex disease with various and often rapidly changing treatment options. You might need to seek the help of a board-certified veterinary specialist, such as an oncologist or radiologist, to decide upon the best treatment plan for your pet.
5. Is my pet currently in pain? If so, what can we do about it?
Animals are very good at hiding their signs. Although your dog might not be acting like she’s in pain by crying, whining, etc., she might still be hurting. Your veterinarian can assess heart rate, respiratory rate, and other physiologic responses that may indicate pain. If your dog is showing signs of pain, there are many options for pain-relieving medications.


Can Dogs Receive Chemotherapy? What Are the Side Effects?
By Ian Muldowney, D.V.M.

When people hear the word "chemo,” they often think of hair loss, nausea, hours spent hooked up to IV drips, and other experiences of family and friends who have undergone treatment for cancer. For this reason, many dog owners are frightened by the idea of their furry best friends receiving chemotherapy. Although many of the same chemotherapy drugs people receive are also used in animal patients, however, it is uncommon for pets to experience these negative side effects. In fact, estimates suggest that about 85 percent of pets handle chemotherapy with little or no side effects.
When adverse effects do occur, they tend to be mild and self-limiting. On occasion, animals can experience gastrointestinal issues or side effects related to low white blood cell counts that require treatment at home with oral medications or, in rare, severe cases, hospitalization. Luckily, animals usually recover quite well from serious events, and care is taken to ensure that these side effects do not recur. As veterinary oncologists, our goal is to improve not only your dog’s quantity of life but also the quality, so that you continue to enjoy every moment you have together.


What Innovations Are Being Made in Cancer Care for Dogs?
By Michael J. Linderman, D.V.M., DACVIM (Oncology)

Radiation therapy has been saving the lives of people and animals since the late 19th century.  Since then, impressive advances in the field of radiation oncology have enabled both veterinarians and physicians to deliver incredibly precise doses of radiation with pinpoint accuracy.
Linear accelerators, the most common machines used for delivering radiation therapy, take up a large amount of space. This space requirement has limited the availability of radiation therapy. New technology developed over the past five years allowed the construction of much smaller radiation therapy units, allowing radiation therapy to be much more accessible.
These types of innovations enable us to fight cancer more effectively and at more locations. Our patients are experiencing higher quality of life for longer periods of time.
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Friday, January 24, 2014

The Veterinary Cancer Centers 2nd Year Anniversary!


We are quickly approaching The VCC’s second year of being open in our new building! It has been a very exciting ride, with lots of amazing advances and many opportunities still being pursued.

This time of year always brings back memories of the construction phase of the hospital, when we had to ask ourselves a lot of important questions. Some of the more interesting ones where: What is the local impact of our veterinary center on the community? How long would it take from planning to operation to launch our new hospital? What do we think the future holds for veterinary oncology in general?

These are all good questions and I feel compelled to share the answers with you because they helped to shape not only the physical presence of the building, but they have become the guiding principles by which The VCC operates.

What is the local impact of our veterinary center on the community?

Interestingly enough the impact on the local community involves not only Norwalk, but all of Fairfield County - if not the entire state of Connecticut and Westchester County in New York. The VCC is after all, the largest standalone veterinary cancer center in the World! Since all we do is oncology, all of our focus and all of our resources go towards finding better and more effective ways to both diagnose and treat cancer in animals. We now have so many more radiation therapy options-- Strontium-90 superficial probe, stereotactic radiation, IMRT, and full and half body radiation.. We also have access to the latest cutting edge clinical trials. This means there is now a truly comprehensive cancer center to the pet owners and veterinarians of the surrounding area. ()

How long did it take from planning to operation to launch your new hospital?

Anyone that has had any type of construction knows that nothing ever goes as planned. We started looking for the appropriate space back in 2007. Since our needs are very particular this process proved to be far more difficult than we had thought. It was not until December 31, 2011 that we had a signed lease and began creating a floor plan. The upside is that this gave us plenty of time to refine our plan into something that fit our needs perfectly. It was on February 15th 2012 that all of our planning and hard work bore fruit- we created something truly special in the veterinary oncology world – a facility that is truly world class.

What do you think the future holds for veterinary oncology?

I think the future is now; what we have built will revolutionize the industry, from our cutting edge technology to our new and innovated branding. I think the biggest change in veterinary oncology will come from partnerships like the ones we have with Animal Cancer Foundation, The Riedel & Cody Fund, and Animal Clinical Investigation. We believe this will facilitate a collaborative approach among pharmaceutical companies, cancer researchers, human oncologists and veterinary oncologists. This collaborative approach is the cornerstone of Comparative Oncology – studying spontaneous cances in cats and dogs as a model for cancers in people. Comparative oncology will likely yield amazing results for both pets and people over the next 5 to 10 years.  Cancers in dogs and cats are similar in both biology and type to cancers in people. Remember, dogs and cats share the same environment as people: they breathe the same air, drink the same water, and in some cases eat the same food. This new comparative oncology approach will not only bring new and exciting changes to the veterinary community, but to the human medical field as well.
 

Friday, January 3, 2014

Palliative radiation therapy


     One of the things that I have come to realize as a radiation oncologist is that palliative treatment is a large part of what we do for animals.  As a veterinarian who is trained to treat cancer, our tendency is usually to want to try to cure our patients.  For this we often recommend aggressive surgery, definitive radiation and/or chemotherapy to try to beat back our patient’s cancer as much as possible.  But when I looked back over the majority of patients that I treat I realized that about 65% of these patients were treated with palliative radiation.  By palliative radiation I mean using a small number of treatments with a large dose each time.  The goals of this type of treatment are to cause as little effects on the patient as possible with as little impact on their quality of life, while trying to either shrink or slow down their tumor or in many cases just providing pain control.  However, palliative radiation very rarely is enough to control the tumor for a significant period of time.  Many times owners elect this course of treatment because they just want to try to keep their pet comfortable and they do not want to go through the side effects that you can get with definitive treatments.  Some cannot afford to go through a definitive treatment course.  Definitive surgery, radiation and chemotherapy can be unaffordable for some pet owners. 

      Palliative radiation can help decrease pain in dogs with bone tumors, or any tumor involving the bone.  If animals cannot eat because of a tumor in the mouth palliative radiation may make it possible for them to eat for a period of time.  Tumors that are ulcerated and bleeding will often dry up with palliative radiation.  When owners cannot afford a definitive course of treatment, palliative radiation may help slow down progression of their pets tumor.  What I have found in treating so many pets with palliative radiation is that many pet owners tell me that they are so happy that the treatment was able to keep their animal comfortable for a period of time, without a lot of side effects.  What this has made me realize is that palliative treatment for animals is just as important, if not more important than trying to cure tumors because in the long run, keeping our animals comfortable for as long as we can is the most important goal.
 

Monday, December 23, 2013

Using technology to improve radiation treatment for animals


     As a radiation oncologist one of the tumors that I have disliked treating the most are nasal tumors in dogs.  Nasal tumors usually fill up one or both sides of the entire nasal cavity and sinuses.  In a dog’s head this means that the tumor is basically wrapping around the eyes and the brain and the tumor sits right above the mouth.  So when we treat these patients we usually have to include a great deal of the mouth the eyes and the brain.  In some dogs, treating these areas causes severe short-term side effects, and animals are usually very painful during and for a few weeks after radiation.  We have much better pain medications so it is possible to get these patients through their treatment, but for many pet owners and their animals treating a nasal tumor is a difficult decision and I feel that a lot of dogs were not treated because of these side effects. 

     With the advent of newer radiation technologies this has changed.  Intensity Modulated Radiation Therapy (IMRT) is a newer radiation technique that is becoming available to treat difficult tumors like nasal tumors.   With IMRT the patient is positioned in a positioning device so that their head is very still, and a CT scan is done not only to identify exactly where the tumor is, but also this CT scan is used by a three-dimensional treatment planning computer.  Radiation beams are aimed at the tumor from a number of different directions so that the radiation can approach from all sides. Then the radiation oncologist tells the computer what dose they want to give to the tumor as well as the maximum dose they want to give to the important normal tissues.  Then the computer figures out how to accomplish this.  For each field, small leaves up in the head of the radiation machine are used to deliver different doses of radiation to different parts of the field.  For example, if one of the fields is pointed at the tumor and the brain, the field might give little or no radiation to the brain while at the same time giving a high dose to the tumor.

     For dogs with nasal tumors this means that the radiation can be directed to the tumor and the dose to the normal tissues is minimal.  Dogs that are being treated with IMRT usually have small areas of redness and irritation in their mouths, but most of their mouths, eyes etc. have little to no significant side effects.  This means dogs are much more comfortable going through treatment, but also it most likely will decrease the number of permanent side effects, making radiation much safer.
 
 
Dr. John Farrelly

Friday, September 20, 2013

Sometimes the “where” matters.


When scientists write about themselves, others or our profession, the topics are often about the “whats”. What we do, what topics or areas of interest do we have, or what we produce in terms of research. However, sometimes, the “where” is the most important question.

 I recently had the fortune to travel to Tanzania to witness the Great Migration of wildebeest and other grazing herbivores across the Serengeti. It is truly one of the greatest spectacles in the natural world, being the largest land mammal migration on Earth. There are over one-and-a-half million wildebeest, about 200,000 zebra and 500,000 Thomson's gazelle in the herd.

 Millions of wild animals surrounded me and it was not only a visual spectacle but an auditory one as well. As I closed my eyes, I heard thousands upon thousands of baby wildebeest and zebra calling to their mothers and an equal number of mothers returning the call. The sound was almost deafening.

 This experience took me outside of my day-to-day life and myself. I am one of the lucky few that loves their job and truly, I have never worked a day in my life. Nevertheless, to experience the Great Migration, not just see it on television, but to truly be there, was a life affirming and life changing experience.
 
The most important words I have ever read about this wonderful phenomenon did not come from Science, Nature or for that matter any other respected scientific journal. The words that matter most, were written on an old T-shirt that our driver wore—“The Serengeti Shall Never Die”.

Dr. Gerald Post

Friday, September 6, 2013

“What does a Clinical Trial Coordinator do?”

While this blog may not be the most exciting, there are many more exciting blogs to come about clinical trials, our clinical trial patient success stories and interesting things happening in the comparative oncology arena! Comparative oncology?? If that’s what you’re thinking right now…. Here’s a fun homework assignment: search the internet (or Google “Dr. Gerald Post”)and then leave a comment on what you understood it to be. Anyone that comments regarding “comparative oncology” will receive a free gift from The VCC!  If that’s too much work and you hate free gifts, you can be in suspense until a future blog when I discuss it! J

Back to the “What does a Clinical Trial Coordinator do?” question. Who knows? Maybe someone out there will decide this is what they want to do! My job is to manage our clinical trials from start to finish. This process begins with informing our area veterinarians that a new trial is open and which types of cancers and patients are eligible (mailings, faxes, emails and calls). Once that happens, calls and emails come in from around the country (even Mexico!) to inquire about pet eligibility. 

Working closely with the doctors at The VCC, we determine which patients might benefit from the study and we begin a screening and enrollment process. If a patient passes all screening tests, they are officially enrolled. Many studies even pay for those screening tests to be done on the patient. Once a patient is enrolled, it is my job to oversee all of the study drug administrations, accurate documentation (very important when a drug is trying to get approved), side effects, lab work, ensuring that the protocol is strictly followed, close communications with ACI (Animal Clinical Investigations), VCC oncologists, and the pet owner. 

Each individual patient is monitored closely and if necessary, for the well-being of the patient, he/she may be withdrawn by our oncologist, by the study sponsor or by the owner at any time. While we are all serious about the data that we gather from the trials, our first priority is always the health and well-being of each patient. We will never compromise on what is best for our patients, so no need to worry about these beloved pets being “guinea pigs” or “lab rats”! We treat each patient as if it was our own family member and that never changes – clinical trial or not! There you have it. 

That’s the broad overview of what a Clinical Trial Coordinator at The VCC does. The truth is, it’s so much more and I hope you’re starting to catch a glimpse of why I love my job! As an example, my next blog will highlight a clinical trial patient from a few years ago. Even after Kobi passed away, his family was very excited to write a “Success Story” about his journey through a clinical trial. Check back soon for that story!
 
Maria Salas

Friday, August 23, 2013

Radiation Side Effects


In a previous blog I mentioned how we use technology to minimize side effects to our pets when treating them with radiation.  However, there are many situations where we cannot or do not want to completely avoid normal tissues.  Almost all tumors have microscopic cells that extend into the surrounding normal tissues.  We often use the analogy of an octopus to describe a cancerous tumor.  The body of the octopus is the part of the tumor that we can see either with our eyes, or by some imaging (such as ultrasound, CT scan, MRI etc.).  If we just needed to treat this cancer would be easy to cure with surgery.  The cancer cells that extend into the normal tissue, like the arms of an octopus, often cannot be removed with surgery and these are often what we are treating with radiation or chemotherapy.  When we treat these cells we usually have to treat the normal tissues that they are invading into and this results in side effects in the normal tissues.

Radiation side effects in animals can be severe in some cases, but we are able to manage them, to get pets through treatment.  They usually start around the middle of a course of radiation, but they can get worse for up to a week after treatment is finished.  When the skin, the lining of the mouth, the eye or the colon is treated these side effects usually include redness and irritation of the area.  This looks a lot like a sunburn.  It starts as mild redness and itch, but usually gets worse until the area is very red and/or ulcerated.  When this happens pets usually need pain medications, anti-inflammatories and antibiotics to help keep the animal comfortable.  Fortunately we have many more pain options available for dogs and cats to help get them through this time.  The area is usually itchy so it is also very important that animals not be allowed to lick or chew at the area, so sometimes they need to wear a cone type collar to prevent this.

Fortunately for cats the short-term side effects are usually much less severe than in people or dogs.  Most cats who are treated with radiation usually just get dry, flaky skin or mild redness in the radiation area and they usually are not very painful.

Long-term side effects from radiation usually do not cause problems, things such as changes in hair coat color or thin skin.  Fortunately dangerous long-term side effects, such as bone destruction or radiation induced tumors, are typically very rare and can take many years to develop.

Although side effects from radiation can cause significant pain and discomfort, the radiation protocols that we use to treat animals are designed to try to minimize these effects so that we can get pets through treatment with as little discomfort as possible.