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Small Animal Oncology

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Prostate tumors. Oropharyngeal tumors. Skin cancers. GI tumors. Lung tumors. Bone tumors ... Massage. May be contraindicated. Herbal and Botanical Medicine ... – PowerPoint PPT presentation

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Title: Small Animal Oncology


1
Small Animal Oncology
  • Vance Kawakami
  • Kristin Kender

2
Cancer Statistics
  • Cancer is the major cause of death in pets
    greater than 10 years old
  • 45 of all dogs older than 10 years of age die of
    cancer
  • 23 of all dogs die of cancer

3
Feline Cancer Facts
  • Lymphoma is the most frequently diagnosed tumor
    in cats
  • Spaying female cats decreases the incidence of
    lymphoma by 40-50

4
Canine Cancer Facts
  • Skin cancers are the most frequently diagnosed
    tumors of dogs.
  • Mastocytomas account for 23
  • Mammary tumors are the most common tumors in
    female dogs.
  • Spaying a dog prior to her first heat cycle will
    decrease the risk of developing mammary cancer by
    7-fold.

5
Contributors to an IncreasingIncidence of Cancer
  • Larger population of geriatric pets
  • Advances in health care
  • An improved recognition and diagnosis of cancer
  • Increased willingness of both veterinarian and
    owner to treat cancer
  • Environmental changes

6
What is cancer?
  • Cancer is a group of neoplastic diseases in which
    there is a transformation of normal body cells
    into malignant ones.

7
PTH 551
Thank you Dr. Patterson!
8
AVMAs Signs of Cancer
  • Abnormal swelling that persists or cont. to grow
  • Sores that do not heal
  • Unexplained weight loss
  • Loss of appetite
  • Bleeding or discharge from any body opening
  • Bad odor, especially from the mouth
  • Difficulty eating or swallowing
  • Reluctance to exercise or loss of stamina
  • Difficulty breathing, urinating, defecating
  • Change in behavior

9
Diagnostic Tests and Procedures
  • CBC
  • Serum chemistry profile
  • Urinalysis
  • Radiographs
  • CAT scan
  • MRI
  • Ultrasonography
  • Biopsy
  • Tumor staging

10
Biopsy
  • Excisional
  • Complete removal of the tumor
  • Feasible if mass is moveable
  • Lymph nodes, small cutaneous nodules, mammary
    gland and CNS tumors, and tumors found during
    exploratory surgeries
  • Nonexcisional
  • Removal of only a portion of the tumor
  • Cytology from a fine-needle aspirate, brush
    samples, or impression smears or effusions
  • Histopathology of cutting forcep biopsies,
    cutting needle biopsies, punch biopsies, and
    incisional biopsies

11
Tumor-Node-Metastasis System
  • T primary tumor size or extent
  • Tis preinvasive tumor (in situ)
  • T0 no evidence of tumor
  • T1 tumor primary site
  • T2 tumor 5 cm in diameter or ruptured tumor
  • T3 infiltrative tumor
  • a no bone invasion
  • b bone invasion
  • N nodes
  • N0 no evidence of lymph node enlargement
  • N1 moveable ipsilateral nodes enlarged
  • N2 moveable contralateral/bilateral nodes
    enlarged
  • N3 fixed nodes
  • M metastasis
  • M0 no metastasis
  • M1 metastasis detected

12
Curative vs. Palliative Treatment
  • Curative
  • The likelihood that a given tumor type will be
    controlled for at least one year following
    treatment.
  • Palliative
  • Designed to reduce pain or functional
    difficulties such as swallowing, urinating, etc.
    without attempting to cure the tumor

13
Methods of Treatment
  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Hyperthermia
  • Photodynamic therapy
  • Others
  • Gene therapy
  • Anti-angiogenic drugs
  • Immunotherapy
  • Alternative therapies

14
Surgery
15
Surgery-Indications
  • Mammary tumors (except inflammatory mammary
    cancer)
  • Prostate tumors
  • Oropharyngeal tumors
  • Skin cancers
  • GI tumors
  • Lung tumors
  • Bone tumors

16
Surgery-Limitations and Complications
  • Risks increase with age of patient
  • Most mortalities resulting from surgery are
    associated with
  • pulmonary emboli
  • Pneumonia
  • cardiovascular collapse
  • primary disease
  • Other complications include
  • Abscesses
  • wound infections
  • blood loss
  • incomplete wound healing

17
Radiation
18
Radiation-Indications
  • Brain tumors
  • Curative small pituitary tumors
  • Longer survival time intracranial tumors and
    spinal lymphomas
  • Tumors of the nasal cavity
  • Thyroid tumors
  • Soft tissue sarcomas
  • Mast cell tumors

19
Radiation-Limitations and Complications
  • Survival of cancer cells at the center of larger
    tumors
  • Local effects to skin, lining of GI tract, and
    hair
  • Long term effects
  • Necrosis
  • Non-healing ulcerations
  • Organ dysfunction
  • blindness

20
Radiation Surgery
  • Used prior to surgery to shrink tumor size
  • Used following surgery to destroy remaining
    cancer cells that were left behind
  • Limitations
  • Radiation must be postponed until surgical
    incision has completely healed
  • Cancer cells in the area of scar tissue are often
    more resistant to radiation

21
Chemotherapy
22
Chemotherapy-Indications
  • As sole agent
  • Systemic cancers
  • hematologic malignancies
  • metastatic carcinomas
  • Metastatic sarcomas
  • As adjunct therapy
  • Given to patients with no overt evidence of
    residual cancer following surgery or radiation

23
Chemotherapy-Limitations and Complications
  • Toxicities are particularly against cells of the
    bone marrow, GI lining, and hair follicles and
    can result in
  • Immunosuppression
  • Anemia
  • Nausea and vomitting
  • Delayed wound healing
  • Hair loss

24
Chemotherapy as anAdjunctive Therapy
  • Chemotherapy Radiation
  • Certain drugs are radiosensitizers
  • This increases the efficacy of the radiation
  • Help slow down metastatic growth
  • Chemotherapy Surgery
  • Shrink large tumors prior to surgery
  • Help eradicate microscopic cancer cells which
    remain after surgery
  • Help slow down metastatic growth

25
Hyperthermia
26
Hyperthermia-Indications
  • Most effective in the treatment of localized
    tumors in combination with radiation or
    chemotherapy
  • Used to treat small (and malignant superficial tumors

27
Hyperthermia-Limitations and Complications
  • Equally damaging to both cancer and normal cells
  • Frequency of skin burns and infarcts can be as
    high as 45

28
Hyperthermia as anAdjunctive Therapy
  • Hyperthermia Radiation
  • In humans, combining these two therapies to treat
    cancer was found to double the number of complete
    responses
  • In dogs, this combination improved the rate of
    complete response in primary tumors resulting in
    prolonged survival time
  • However, many dogs later succumb to metastatic
    disease
  • Hyperthermia Chemo.
  • Some drugs work more efficiently above normal
    body temperatures
  • Hyperthermia may offer a protective effect for
    normal tissues against drug toxicities
  • Some studies have shown that combining these
    therapies actually increases toxicity

29
Photodynamic Therapy (PDT)
30
PDT-Indications
  • Has been used limitedly in veterinary medicine
  • Used in dogs with localized, superficial, and
    minimally invasive tumors such as those affecting
    skin and linings of urinary bladder and oral
    cavity

31
Photodynamic Therapy-Limitations and
Complications
  • Inability of light to penetrate deeply into tumor
    tissue
  • Tissue retention time of photosensitizers
  • Patient must remain in subdued light for 4-6
    weeks
  • Not all tumors absorb photosensitizers at same
    rate and at same concentration

32
Other Treatment Options
  • Gene therapy
  • Anti-angiogenic drugs
  • Immunotherapy
  • Alternative therapies
  • Acupuncture
  • Massage
  • Herbal and botanical medicine

33
Gene Therapy
  • Suicide gene therapy
  • Genetic immunotherapy
  • Tumor suppressor gene therapy
  • Drug resistance gene therapy

34
Anti-Angiogenic Drugs
  • Inhibit tumor growth by cutting off tumors blood
    supply
  • Many of these drugs are in the early stages of
    clinical development in the treatment of both
    human and canine cancer

35
Immunotherapy
  • Biologic Reponse Modifiers
  • Nonspecific immunomodulators
  • Lymphokines/monokines
  • Adoptive cellular therapy
  • Antibody therapy
  • Growth factors
  • Indications
  • Lymphoma
  • Melanoma
  • Mastocytoma
  • Oteosarcoma
  • Soft tissue sarcomas, including fibrosarcoma and
    hemangiosarcoma

36
Alternative Therapies
  • Acupuncture
  • Palliative treatment
  • Pain
  • Post-op chemo-induced nausea and vomiting
  • Massage
  • May be contraindicated
  • Herbal and Botanical Medicine
  • Herbs are used in conjunction with chemotherapy
    or radiation to help strengthen the individual
    and mitigate side effects

37
Nutritional Management
  • Often ignored aspect of cancer treatment
  • Important in treating cancer cachexia
  • May control growth of certain tumors
  • Decrease side effects of cancer treatments

38
Assessment of Nutrition status
  • Animals with cancer have alterations in
    metabolism which results in clinical alterations
  • This occurs early in all cancers and decreases
    quality and quantity of life
  • Broken in four phases

39
Phase 1
  • Clinical changes
  • Preclinical, silent phase, no obvious signs.
  • Metabolic changes
  • Hyperlactermia
  • Hyperinsulinemia
  • Altered blood amino profiles

40
Phase 2
  • Clinical changes
  • Early clinical signs
  • Anorexia, Lethargy
  • Mild weight loss
  • More susceptible to side effects from
    chemotherapy, sx, etc..
  • Metabolic changes
  • Similar metabolic changes

41
Phase 3 (cancer cachexia)
  • Clinical changes
  • Cachexia
  • Anorexia
  • Lethargy
  • More susceptible to side effects from
    chemotherapy, sx, etc..
  • Metabolic changes
  • Similar changes but more profound

42
Phase 4 (recovery or remission)
  • Clinical changes
  • Recovery, Remission
  • Metabolic changes
  • Metabolic changes may persist
  • Changes secondary to surgery, chemotherapy, or
    radiation therapy

43
Nutritional management
  • Specific nutritional requirements of animals with
    cancer is unknown
  • Nutrients in order of importance
  • water
  • calories and protein
  • minerals and vitamins

44
Cancers effect on metabolism
  • Carbohydrate metabolism
  • Tumors preferentially metabolize glucose for
    energy by anaerobic glycolysis forming lactate
  • buildup of lactate results in net energy loss by
    the body and net gain by the tumor (uses ATP to
    convert lactate to glucose)

45
Cancers effect on metabolism
  • Protein metabolism
  • Good source of energy for tumor
  • Can result in clinically significant deficiency
    in AA
  • decreased immune function
  • surgery healing
  • decreased GI function

46
Cancers effect on metabolism
  • Benefits of certain AA
  • Arginine- decrease tumor growth and metastatic
    rate in some rodents
  • Glycine-shown to decrease cisplatin induced
    nephrotoxicity
  • others as well

47
Cancers effect on metabolism
  • Lipid metabolism
  • Some tumors cells have problems utilizing lipids
    as fuel source
  • fats are usually last to be depleted
  • type of lipid verses amount of lipid
  • polyunsaturated n-3 fatty acids

48
Other important aspects of nutrients
  • Vitamins- some evidence indicate might be helpful
    in cancer patients
  • Retinoids, beta carotene, Vitamin C, D, and E
  • Minerals- May be helpful
  • Zinc, Cu, Se, etc

49
Other ingredients
  • Fiber- insoluble and soluble
  • Garlic- may help cancer patients
  • Green/Black tea- Black tea may have soothing
    properties associated with radiation-induced oral
    mucositis.
  • Shark cartilage-NO

50
Food Aversion
  • Food aversion- a common outcome of side effects
    of cancer and cancer treatments in humans
  • Difficult to prove it occurs in animals

51
Therefore..Develop a feeding plan
  • What food to feed?
  • How to feed the food?
  • Monitor and reassess feeding plan constantly (Is
    the patient getting better)?

52
What food to feed?
  • Ideal diet would have
  • minimal simple carbohydrates, fiber
  • highly bioavailable protein with certain AA
  • higher fat levels with polyunsaturated n-3 fatty
    acids
  • adequate levels of antioxidants
  • a great smell and taste great!
  • Achieve with homemade diets or various commercial
    diets

53
Key na Information is not published by the
manufacturer. Nutrients are expressed on dry
matter basis. Values were obtained from
manufacturers' published information.
Table 25-5. Nutrient profiles of selected
commercial pet foods that can be used in cancer
patients.
Canine products Hill's Prescription Diet
Canine/Feline a/d, moist Hill's Prescription Diet
Canine n/d, moist Hill's Science Diet Feline
Maintenance Seafood Recipe lams Eukanuba
Maximum-Calorie/Canine, dry lams Eukanuba
Maximum-Calorie/Feline, dry lams Eukanuba
Maximum-Calorie/Canine Feline, moist Purina
Feline CV-Formula, moist
Products
Protein Fat
Carbohydrate n-3 fatty Arginine
45.7 38.8 45.1 40.1 44.2 43.3
28.7 32.0 25.4 29.0 29.6 41.1
16.5 20.0 20.1 22.7 19.1 7.6
2.6 7.2 0.82 0.9 0.93 0.78
2.04 2.9 2.83 na na 2.6
42.5
26.8
23.1
na
na
Feline products Hill's Prescription Diet
Canine/Feline a/d, moist Hill's Prescription Diet
Feline p/d, moist lams Eukanuba Maxim
um-Calorie/Feline, dry lams Eukanuba
Maximum-Calorie/Canine Feline, moist Purina
Feline CV-Formula, moist Select Care Feline
Development Formula, moist
45.7 48.8 44,2 43.3
28.7 31.5 29.6 41.1
16.5 11.1 19.1 7.6
2.6 0.42 0.93 0.78
2.04 2.66 na 2.6
26.8 32.2
23.1 12.1
na na
na na
42.5 48.0
54
Feeding method
  • Enhance palatability and aroma of the food
  • whatever works
  • Drug therapy- stimulate appetite
  • Benzodiazepine derivatives (valium, oxazeoam)
  • cyproheptadine
  • Megestrol acetate

55
Feeding method
  • Enteral route- preferred route of nutritional
    support vs. parental administration
  • safer
  • less expensive
  • other physiologically beneficial effects

56
Enteral route
  • Appropriate when
  • Appetite stimulating efforts fail or if long term
    nutritional support (more than a few days) is
    needed
  • Can be used proactively
  • inserted during surgery
  • or before radiation therapy

57
Feeding method
  • Parental nutrition- not covered here
  • best reserved for cases in which patients are not
    able to assimilate nutrients or with intractable
    vomiting

58
Monitor feeding plan
  • Monitor the effects of
  • Cancer on patient
  • Treatment and nutritional management of tumor
  • Treatment and nutritional support on the patient
  • --Check body weight, and body conditioning scores
    with previous assessments
  • --Assess appetite and caloric intake

59
Quality of Life and Cancer
  • How do you measure quality of life?
  • As defined by the Veterinary oncologist at
    Animal Medical Center- five factors
  • alertness/mental status
  • appetite
  • weight/body condition
  • activity/exercise tolerance
  • elimination

60
Measuring QOL cont..
  • Is the patient enjoying painless and carefree
    days?
  • Playing with his/her favorite toys or eating
    their favorite foods?
  • Add your own measurement here

61
Euthanasia
  • Should be discussed constantly with client
  • Educate client on options
  • Final human treatment

62
References
  • Ettinger, Stephen, and Edward Feldman. Textbook
    of Veterinary Internal Medicine. 5th edition.
    Vol. 1. Philadelphia W.B. Saunders Company,
    2000.
  • Nelson, Richard, and C. Guillermo Couto. Small
    Animal Internal Medicine. 2nd edition.
    Chicago Mosby, 1998.
  • Ogilvie, Gregory, and Antony Moore. Managing the
    Veterinary Cancer Patient. Trenton, NJ
    Veterinary Learning Systems, Co., Inc., 1995.
  • Schwartz, Cheryl. Four Paws, Five Directions A
    Guide to Chinese Medicine for Cats and Dogs.
    Berkley, CA Celestial Arts, 1996.
  • Withow, Stephen, and E. Gregory MacEwen.
    Clincial Veterinary Oncology. Philadelphia
    J.B. Lippincott Company, 1989.

63
Web Sites
  • Comparative Oncology Research Exchange (CORE) at
    Cornell University
  • http//www.web.vet.cornell.edu/index5Finternet/ca
    ncer/index.html
  • The Animal Medical Center
  • http//www.amcny.org
  • OncoLink at University of Pennsylvania Cancer
    Center
  • http//www.oncolink.com
  • Wing-n-Wave Labradors
  • http//www.labbies.com/cancer3.htmsurgery
  • Canine and Feline Cancer Links
  • http//www.thensome.com/petcancer.htmlinks

64
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