Dip. American College of Vet Internal Medicine (oncology)
Chavat Daat, Beit Berl








Requirements: DVM degree and internship
Began in the US
Today in Europe as well
3 yrs of working under supervision of specialists in different fields
Tumor biology studies
Publication, presentations
Specialty examination



Large Animals (horses, ruminants)

Internal medicine, Surgery, reproduction
Small Animals

Internal Medicine, oncology, cardiology, neurology






Surgery
Imaging
Emergency medicine
Ophthalmology, Dermatology, anesthesia
Exotic animals (birds, reptiles, ferrets, rodents)
Pathology – clinical and histopathology



No accurate incidence rates (IR)
Dorn et al. 1968 – new cancer cases a yr in 2 counties in CA



Dogs – 382/100,000
Cats – 156/100,000
IR today probably much higher

Estimated lifetime risk of cancer


Dogs – 50%
Cats – 30%

Humans Dogs
Breast/prostate Breast*
Lung
Colorectal
Skin
(non-melanoma)
Sarcoma
Cats
Lymphoid
Skin
(non-melanoma)
Breast*
Testicular (intact) Sarcoma
Lymphoid, oral tumors






Golden Retriever


1 in 5 – Hemangiosarcoma
1 in 8 - Lymphoma
Boxer

Lymphoma (T-cell)
Bernese Mountain Dogs

Histiocytic Sarcoma
Scottish Terriers

Transitional Cell Carcinoma
Sharpei

High grade Mast Cell Tumors



Ovariohysterectomy

Before 2.5 yrs of age in dogs and 1 yr in cats is protective of mammary tumors
Castration

Reduces risk of testicular cancer

Esp. in cryptorchids

Increases risk of prostate cancer (still uncommon)





Exposure may be higher in indoor pets
Exposure to passive smoke


 risk for lung cancer – short and medium length nose (weak)
 risk for nasal cancer – long-nosed breeds
Insecticides in shampoos or dips  risk of
TCC, esp. if obese

But not spot-ons like Frontline or Advantage
Herbicides and insecticides on lawns  risk of
TCC in Scottish terriers



Oral Squamous Cell CA (SCC)


 risk with:


High intake of canned food (RR – 3.6) and canned tuna fish (RR – 4.7)
Flea collar use (RR – 5.3)
 risk with flea shampoo use
Lymphoma

 risk with exposure to passive smoking






Cancer is perceived by many to be a serious and often fatal disease
Treatment in people is commonly associated with side effects leading to poor QOL
Therefore treating pets with similar treatment is perceived as cruel and selfish
This perception represents total misunderstanding of the treatment of cancer in animals
The main goal of treating animals with cancer is to extend a good quality of life for the patient (and family) for as long as possible.


Life without pain & daily normal activity

Happy when owners come home, plays


Wants to eat and drink
Has control of eliminations

Quality is more important than quantity

Life without QOL means prolonging unnecessary suffering of the animal


We try to prevent treatment’s side effects

Before treatment is begun risk vs. benefit is considered

Often animals treated for cancer live longer and better than animals treated for other chronic disease (i.e - diabetes, chronic renal or heart disease)




If the animal develops significant treatment toxicity

We can lower drug dosages


Use other drugs
Consider stopping treatment
Treatment can be with a curative intent or palliative
Know when to quit


Treatment options depend on




Tumor type
Location in body
Tumor stage (TNM)
Comorbidities








Surgery
Radiation therapy (not in Israel  )
Chemotherapy
Small molecule inhibitors (TKI’s)
Cancer Vaccines

Melanoma
Multimodality Tx
Symptomatic Tx



Owners ultimately choose the treatment after hearing

Different options



Prognosis for each option
Possible side effects
Cost
Should they choose not to treat, they are making an educated decision






Abnormal swellings that persist or continue to grow
Sores that do not heal
Weight loss
Loss of appetite
Bleeding or discharge from an opening





Offensive odor
Loss of energy, tire easily
Persistent lameness
Difficulty breathing, chewing, urinating, defecating

Aural SCC


7 yr old spayed female Golden Retriever


Presented with enlarged lymph nodes, fever, unwell and diagnosed with lymphoma on cytology





With no treatment median survival is 4-6 weeks and QOL is poor most of this time.
With CHOP based chemotherapy median survival is extended to 12 months and about
25% are alive @ 2 yrs.
Drug dosages is lower than in humans. Only
20% develop grade 3-4 toxicity.
Baaci’s owner chose to treat with chemo.


Achieved complete remission

Treatment continued for one yr

One episode of vomiting & diarrhea requiring supportive care.

Still alive and happy today > 4 yrs from diagnosis.



4 yr old female Great Dane
Diagnosed with osteosarcoma (OSA)



Many similarities to human OSA



Affects large to giant breed dogs
Metaphyses of long bones most affected
Most stage negative at presentation


90% are high grade
Common hematogenous lung metastases
Two main differences

10 times more prevalent in dogs

Mean age

Dog – 7rs human – 14 yrs





Dogs


Are an outbred species
Have innate immune system

Their cancer progresses more rapidly
Combined with similarities in tumor behavior they can serve as an excellent model for research of this disease
Dr. Steve Withrow - pioneer in the field
Clinical trials in dogs serve a dual purpose





Had forequarter amputation

To control primary tumor and relieve pain
Post-operatively entered into a clinical trial


5 treatments with doxorubicin
Followed by the oral trial drug vs. placebo
No side effects at all
Enjoyed an excellent QOL for 18 months after treatment

Median survival with amputation and chemo is 10 months



Presented with unilateral nose bleed from the left nostril (Sept 2008)
CT and biopsy – left nasal adenocarcinoma




Treated with Radiation

12 X 4 Gy, 3 days a week
Tumor shrunk by 30%, was stable for 2 yrs then started growing very slowly
Receives low dose prednisone permanently for nasal congestion




Common skin cancer
Can be benign to malignant
May swell up and shrink due to surges of histamine release




Fairly easy to diagnose by cytology
Biologic behavior highly correlated with histologic grade
Treatment depends on tumor grade and stage


33% of MCT express mutation in c-kit
Toceranib Phosphate
(Palladia™)
Masitinib Mesylate
(Masivet ® )
KIT
PDGFRβ
VEGFR2
Flt3
KIT
PDGFR
FGFR3
FAK (focal adhesion kinase)



The main goal in treating animals with cancer is good QOL for as long as possible
Every case should be evaluated individually


Owners should be given all options
The decision is theirs to make after weighing risk vs. benefit and cost