Cancer management – is it ever too late?
At Fitzpatrick Referrals Oncology and Soft Tissue, we can offer patient-tailored treatments for dogs and cats with all forms of cancer. Every animal’s individual situation is assessed, and a unique plan is created.
Specialist Michael Macfarlane, one of our senior oncology clinicians discusses the differences and similarities between individual investigations, and tells the story of Monty – a much loved Labrador with bags of energy who, despite metastases, received multiple treatments to manage his cancer, and sustained a longer quality of life as a result.
How do you assess the extent of a cancer?
‘Staging’ is the process of evaluating where in the body cancer is located. This process is tailored to suit the likely pattern of spread of certain cancers. Mast cell tumours are a common type of cancer we see; aggressive variants can metastasise to lymph nodes, and then the liver and spleen, but rarely to the lungs. Another common type of cancer, osteosarcoma, rarely metastasises to lymph nodes or the liver and spleen but commonly metastasises to the lungs and bones.
Therefore, depending on the type, size and location of the tumour, staging can involve:
- Palpation and needle biopsy of lymph nodes
- Imaging of the chest with CT scan or radiographs- our fantastic CT scanner (Toshiba Aquilion 160 slice) can do this quickly and in detail, radiographs are less detailed, but can sometimes be performed without sedation
- Imaging of the abdomen, either with ultrasound or CT scan, possibly sampling any suspicious areas with a needle
- Other, less common tests such as bone marrow sampling or blood tests
Finding the ‘draining lymph node’ of a tumour is important to be able to correctly identify whether spread has occurred. Sometimes there are many possible draining lymph nodes. This previously made it difficult to identify the right one. We are now able to use a technique called lymphangiography to do this reliably.
We can then sample or remove the identified draining lymph node as appropriate. This technique is helping to improve outcomes, especially with tumours such as melanomas and mast cell tumours.
Is staging essential?
Some tumour types are not likely to spread, or we know that the identification of tumour spread will not affect the outcome or plan. Therefore, staging is often recommended, but not essential. Small mast cell tumours with no concerning features of growth (redness, swelling, rapid growth) are an example of where we proceed without staging. If these tumours are removed and results from the lab are favourable, the procedure is very likely to have been curative. Staging will always be discussed on an individual basis.
What do we do with the results of staging?
The over-arching philosophy we apply to treatment of dogs and cats is the same regardless of the type and location of their cancer. This is to take steps to improve or maintain a good quality of life above focusing solely on curing or treating cancer.
‘Clear’ staging often means that we can recommend treatments which have a good chance of allowing a favourable long-term outcome. On the other hand, many dogs and cats that we see will be diagnosed with metastatic cancer, either at the hospital or prior to their arrival. This is often not as bad news as feared and there are typically several options that can be pursued.
To do this, we may use one or a combination of cancer treatments, supportive or palliative medication tailored to the staging results. Many dogs can live with and be well with cancer for some time with the correct support.
Is surgery still an option if cancer has spread?
For certain cancers, we will operate if cancer spread is identified and if we know that there is a good probability that it will contribute to allowing a happy life for a reasonable time.
Excellent examples of this include anal sac tumours, where we frequently remove affected lymph nodes, knowing it will help dogs to defecate more easily and mast cell tumours, where outcomes are improved when tumours are removed, even if there is spread. In addition, if there is a lump which is causing pain or discomfort and it can be removed easily – this is an option, even if cancer spread is identified.
What about other options?
Palliative care is the provision of treatments to improve quality of life. Although we have classically thought of this as mostly being pain relief, there are a whole host of treatments which can be used to provide an improved quality of life. Even if there is advanced cancer, small changes to routine, medications or supplements can make a difference and we welcome referrals of dogs and cats with all stages of cancer.
Every animal is unique and what’s right for one, may not be suitable for all. We promise to never advise treatment just because it is possible, but only when it is right for that particular animal at that moment in time.
What if it is difficult to travel to and from Fitzpatrick Referrals?
After staging, we are able to formulate a treatment and care plan. If this involves continued care at the primary care practice, we are more than happy to share the care and to provide ongoing advice as needed.
Labrador Monty lived life to the full despite advanced cancer
Monty was a beautiful Labrador who received treatment with us for just under three years. He was referred after removal of an anal sac tumour at his primary care practice. An increased calcium level is a common problem with anal sac tumours. Monty’s high calcium level continued to rise after surgery, which arose suspicion that the cancer may have spread.
The tumour was indeed found to have spread to lymph nodes in his abdomen and surgery was performed to remove them. This had the effect of reducing the hypercalcaemia caused by the tumour which had been making him feel unwell.
As Monty’s cancer had the potential to recur after surgery, he was given chemotherapy. Although he remained well, a routine CT scan identified the tumour regrowing and another surgery was performed. He was then started on a drug which has recently shown to be effective at controlling this cancer- Palladia.
This did appear to be more effective and the next CT (11 months after diagnosis) was clear. Then, 19 months after his initial diagnosis, further recurrence was identified and removed.
Monty continued treatment with Palladia although this was eventually stopped and the tumour grew back, 26 months after the initial appointment. It was decided at this time that surgery was not the best option. Without any ‘anti-cancer’ treatment but with a lot of love and care from his family (including five-star dinners from roast lamb to gammon) and a combination of medications to reduce the effects of the cancer on his body, Monty remained well for a further nine months.
Monty brightened our day when he came to visit us, and we are fortunate to have been able to have looked after him for such a long time. He is a good example of using advanced methods to detect cancer and carefully selected multimodal therapy in order to prolong a good quality of life for longer than we would have expected.