Oncology for pets at BluePearl Pet Hospital in Cary, NC.
What to expect at your first visit.
When you arrive, you will be asked to fill out a new patient form if you have not already submitted one through our website. A veterinary technician will then escort you and your pet to an examination room. The veterinary technician will review the reason for your visit and your primary concerns.
One of our board-certified specialists will review your pet’s history with you, look over any prior medical records including laboratory work and radiographs and perform a complete physical examination. During the consultation we will discuss all aspects of your pet’s medical condition, address your concerns and work with you to determine the right course of treatment based on our initial assessment and conversations with your primary care veterinarian. We want to provide the best treatment possible for your pet and respect your wishes and goals.
Expect this initial consultation to take 30-60 minutes, although you may be asked to leave your pet for the duration of the day so that additional tests may be performed if needed. Follow-up visits may also be scheduled for a later date. This process is aimed at providing you with the most accurate information about your pet’s medical condition, diagnostic and treatment options and anticipated prognosis as well as potential costs of diagnostics and treatment.
Radiation therapy uses ionizing, or high-energy, x-rays to target and kill cancer cells. By destroying their ability to divide, radiation prevents the tumor cells from continuing to grow. In some cases, these cells may actually shrink. A focused beam of radiation is aimed directly at the area where the tumor is located, thereby minimizing the effects on the surrounding normal cells. The standard device for administering radiation therapy is called a linear accelerator or LINAC.
Several types of cancer have responded favorably to radiation therapy, including brain, nasal and oral tumors. Radiation is also commonly used for cancers of the extremities or body (such as osteosarcoma) and has resulted in many positive outcomes. Hospital stays are minimized as well.
Radiation therapy can be classified as either curative, with the aim of increasing survival time and offering a better quality of life (or in some cases, remission), or palliative, which is intended to reduce pain and make the pet as comfortable as possible in cases where cancer has progressed beyond curative treatment.
Radiation therapy is used alone or in combination with surgery and/or chemotherapy and may be administered before, after or concurrent with these other treatments. In some instances, radiation destroys cancerous cells that could not be removed by surgery alone or is effective at treating cells that have proven resistant to chemotherapy.
What to expect.
One of our board-certified oncology specialists will work closely with your primary veterinarian to determine if radiation therapy would be beneficial for your pet. If so, our specialist will develop a treatment plan based on factors such as type of cancer, size/location of the tumor and the general health of your pet. We will meet with you to review the specifics of the plan, discuss both the benefits and risks associated with the treatment and potential side effects.
The side effects of radiation vary from patient to patient but are typically mild. They may include red or moist skin, as well as hair loss, in the region being treated. Pets experiencing these side effects might try to scratch at the area, but it is not advisable. Your primary veterinarian can help you manage this problem. Nausea, vomiting or diarrhea are not usual outcomes of radiation therapy; however, some pets can still experience weight loss based on the treatment protocol that requires them to skip certain meals. All of these issues are likely to resolve within a week or two after therapy is completed.
Prior to starting radiation therapy, you will meet with the medical oncology team to discuss the benefits and side effects of radiation therapy for your pet. Our doctors oversee the treatment of all pets undergoing radiation therapy. Nursing technicians trained in radiation therapy treatments assist our veterinarians. They will be involved in assisting with the daily treatment of your pet and with daily communications and updates regarding the status of your pet.
Soft tissue sarcoma.
Soft tissue sarcomas are relatively common. They are tumors that originate form structural and connective tissues such as cartilage, blood vessels, muscles, nerves or fat. They tend to be masses in the skin or subcutaneous tissues. Examples of soft tissue sarcomas include liposarcoma, nerve sheath tumor, fibrosarcoma, hemangiopericytoma, liposarcoma and leiomyosarcoma. Soft tissue sarcomas are locally invasive tumors and have finger-like projections that invade adjacent normal tissue.
Signs and symptoms.
Symptoms of soft tissue sarcomas depend upon the tumor’s location and the degree of invasion to adjacent areas. Tumors are most often noticed initially as a hard lump on the trunk, limb or oral cavity of a pet. If the tumor is located in the gastrointestinal tract, a pet may experience weight loss, vomiting and diarrhea. Tumors in the mouth may cause a pet to experience difficulty swallowing and lack of appetite.
It is important to gather as much information as possible about a tumor before initiating any type of treatment. Information such as the tumor’s tissue origin, size, location, level of aggressiveness and whether it has spread to other organs can be obtained through the following tests and procedures:
- Complete blood count (CBC)
- Serum biochemistry panel
- Urinalysis (U/A)
- Lymph node evaluation
- Thoracic radiographs
- Imaging studies (ultrasound, CT scans, etc.)
There are three main treatment options for pets with soft tissue sarcoma. We will discuss all three with you and make recommendations based on your pet’s diagnosis and your wishes.
- Radiation Therapy
For tumors that are located at their original sites, we may recommend surgery alone or a combination of surgery and radiation.
For tumors that are known to be highly aggressive, we may recommend chemotherapy to prevent or slow down the process of metastasis.
Osteosarcoma is the most common bone tumor found in dogs and tends to affect the limbs of larger breed dogs. The disease is aggressive and typically spreads to other parts of the body quickly.
Signs and symptoms.
Dogs with osteosarcoma may experience swelling at the tumor site, lameness and joint or bone pain. Some dogs may become lethargic and have little appetite. In some cases, dogs will develop a mass or display painful inflammation around the site of the tumor.
Because osteosarcoma rapidly spreads to other parts of the body, we recommend the following diagnostic tests to determine which sites in the body may be affected:
- Bone biopsy
- Complete blood count (CBC)
- Serum biochemistry panel
- Urinalysis (U/A)
- Lymph node evaluation
The goal with treatment is to surgically remove the tumor, delay the spread of the disease to other parts of the body and preserve quality of life for your pet.
In most dogs, amputation is necessary to remove the tumor. Dogs tend to do quite well with amputation after an adjustment period. Systemic chemotherapy is recommended several weeks after surgery to delay metastasis. Four to six treatments are given at two- to three-week intervals.
When treatment is given for the first time, there may be some side effects which your oncologist will discuss with you. We immediately treat any side effects and adjust the dosage for future treatments. If no side effects are present after the first treatment, your dog should have no problems with subsequent treatments.
Most dogs experience a good quality of life with surgery alone. In cases where systemic chemotherapy is not pursued, metronomic chemotherapy (chronic low-dose oral chemotherapy in conjunction with other medications) may be considered to delay tumor growth.
Palliative radiation therapy may be an option when amputation is not. Palliative radiation therapy consists of two consecutive twice-daily doses of radiation therapy to alleviate pain, inflammation and swelling. If there is no disease or symptom progression, this treatment can be repeated a month later.
Lymphoma is one of the most common cancers diagnosed in dogs and cats. It is derived from white blood cells called lymphocytes which serve as part of the body’s immune system. Lymphoma is a disease that typically originates in the lymph nodes but may also involve other organs such as the spleen, liver and bone marrow. Some types of lymphoma progress rapidly and can quickly become life-threatening without treatment while others progress slower and can be managed as a chronic disease.
Dogs: Lymphoma generally affects middle-aged to older dogs although it can occur at any age. The exact cause is not known, although environmental factors and genetics may contribute to the development of lymphoma. Some breeds tend to be at higher risk than others. Scottish and Airedale Terriers, Chows, German Shepherds, Poodles, St. Bernards, Bulldogs, Beagles, Boxers, Rottweilers and Golden Retrievers are commonly affected. Dogs typically exhibit initial swelling in lymph nodes under the neck, in front of the shoulders and behind the knees.
Cats: Lymphoma has been linked to young cats with feline leukemia (FeLV) and feline immunodeficiency virus (FIV) although it can affect cats of all ages with or without FeLV or FIV. We generally see lymphoma in cats in the lymph nodes, kidneys, chest and digestive tract.
Signs and symptoms.
Dogs: General signs include painless swelling of lymph node(s). Other signs can include vomiting, diarrhea, increased thirst, depression, lethargy, loss of appetite, weight loss and increased urination. Because lymphoma can affect any part of the body (such as skin, gastrointestinal tract, lungs, etc.), symptoms can vary based on the organ system involved. For example, diarrhea and vomiting can be signs of a gastrointestinal form of lymphoma. A skin rash that progresses to hairless lesions could be a sign of skin lymphoma.
Cats: Because lymphoma can develop in multiple areas, each location can present different symptoms. If lymphoma is present in the chest, cats may have difficulty breathing, loss of appetite and have a cough. If the kidneys are affected, they may display weakness, increased thirst/urination and vomiting. General symptoms include swollen lymph nodes, lethargy, vomiting and weight loss. Cats typically experience more severe symptoms than dogs.
Dogs: The first step in diagnosing lymphoma often involves cytology (obtaining a sample of cells for examination under a microscope by a pathologist). In some cases, a biopsy provides additional important information. Once the diagnosis is confirmed, we stage the cancer to determine the extent of the disease in the body. Staging can involve blood work, urinalysis, radiographs, ultrasound and bone marrow cytology Other diagnostics (flow cytometry, PARR, IHC) can provide information regarding B- or T-cell origin. Staging enables us to determine a course of treatment that is right for your dog.
Cats: As with dogs, the best way to diagnose lymphoma involves cytology or biopsy of cells taken from the affected tissues. Blood work, urinalysis, radiographs and ultrasound will confirm a diagnosis, help us identify abnormalities and determine how widespread the cancer may be. These tests can also help determine the best treatment for your cat.
Dogs: Although not curable, lymphoma in dogs is treatable. Systemic chemotherapy is the preferred treatment but in some cases radiation and surgery may be recommended. With treatment, most dogs experience remission with few side effects. Treatment that has the highest rates of remission involve administering a combination of chemotherapy drugs given over the course of several weeks to months.
Cats: As with dogs, lymphoma in cats is treatable. Chemotherapy and radiation can be effective forms of treatment that we can discuss with you based on the type of cancer diagnosed. In some cases, surgery is also an option. Cats tend to tolerate chemotherapy quite well with few side effects.
Dogs: In general, dogs receiving chemotherapy participate in normal activities and have a good quality of life. Our goal is to achieve complete remission while maintaining this good quality. Once your pet completes treatment, we will want to monitor them closely for signs of relapse.
Cats: As with dogs, our goal with treatment is complete remission. Survival and remission rates depend on a number of factors including your cat’s FeLV status, location of tumor and how quickly lymphoma was diagnosed and treated. Cats should be monitored during and after treatment for a recurrence of symptoms.
Mast cell tumor.
Mast cells are formed in bone marrow but mature in surrounding tissue. Although mast cells are located in tissue throughout the body, they are mainly found in the skin, respiratory and digestive tracts. They are an important part of the body’s response to inflammation and allergens. Mast cell tumors originate from these mast cells and range from low-grade to high-grade malignancies.
With certain tumors, there are high local recurrence rates as well as a greater chance the tumors will spread. Once a diagnosis is made, we will perform tests to determine the grade (aggressiveness) and the stage (to what extent the tumor has spread). This will help us determine the best treatment for your pet.
Dogs: Mast cell tumors in dogs are relatively common. They can occur at any age, but most cases often develop in middle-aged dogs. Some breeds appear to be more susceptible such as Bull Terriers, Boxers and Labrador Retrievers.
Cats: Mast cell tumors are less common in cats than in dogs and are usually diagnosed in cats over 4 years of age. Tumors may develop in the skin, where multiple nodules are most common and tend to be benign. Siamese cats tend to be more susceptible to skin mast cell tumors than other breeds. Internal mast cell tumors originating in the spleen, GI tract or other locations can also develop.
Signs and symptoms.
Symptoms for both cats and dogs are dependent on the location and aggressiveness of the tumor. Tumors may fluctuate in size or start growing rapidly after months of inactive or subtle growth. Redness and fluid build-up may also be present. Pets may scratch tumors due to higher levels of histamines present.
Some tumors may start out resembling a small wart, an allergic reaction or even a bug bite. Lymph nodes near the area of the tumor may be swollen. If tumors have spread, your pet’s liver and spleen may be enlarged. Depending on the stage of the disease, loss of appetite, diarrhea and vomiting may occur.
When you come in for your appointment, we will go through your pet’s medical history including when you first noticed symptoms. This information is important as it may give us insight into which organs may also be affected. The best way for us to test for mast cell tumors is a fine needle aspirate of the tumor. We can test for the presence of abnormal amounts of mast cells in the blood.
For a definitive diagnosis and important grading information, we will need to perform a surgical biopsy, which will be useful in determining a specific treatment plan. We may recommend additional tests such as cytology or biopsy of lymph nodes, liver, spleen or bone marrow as well radiographs and ultrasound images to determine the possible extent of disease spread.
Anytime you manipulate a mast cell tumor, histamines will be released into the bloodstream. Therefore we tend to prescribe antihistamines to alleviate some of the symptoms prior to any procedure. Surgery is the preferred treatment for mast cell tumors in the skin. Removal of the spleen is recommended for mast cell tumors of the spleen. We may need to perform cytology or biopsy of lymph nodes or other suspicious internal organs and in some cases surgically remove lymph nodes near the tumor.
Follow-up radiation therapy and/or chemotherapy may be beneficial for some pets. We will discuss all options based on your goals and your pet’s evaluation.
Once your pet completes treatment, we will want to monitor for signs of recurrence, spread or the development of any new masses on a regular basis.
Chemotherapy is the use of drug compounds to kill growing cancer cells. These drugs disrupt the cellular processes important for the growing and dividing of cancer cells. This treatment can have many positive outcomes, such as tumor shrinkage or stabilization, reduced risk of spreading and decreased rate of local recurrence, or possibly even a cure. In general, the goal of chemotherapy is to extend life while also improving its quality.
Chemotherapy drugs can be administered in many ways: intravenously (through an IV catheter), by injection (either into the muscle or under the skin) or orally. The approach taken depends on the type of cancer, where it is located in the body and the particular drugs that will be used in treatment. Administration is not painful and is done mostly on an outpatient basis.
What to expect.
Our oncology specialists will review your pet’s medical history in consultation with your primary veterinarian and ensure that all needed tests are performed to determine the recommended chemotherapy options. The length and frequency of treatment will vary depending on the disease being treated and the recommended chemotherapy protocols. These treatment options, possible side effect concerns and treatment costs will be thoroughly discussed so that you can make an informed decision about your pet’s treatment. Injectable chemotherapy requires outpatient administration, but oral chemotherapy can be administered at home.
Cats and dogs tend to tolerate chemotherapy very well and have low side effects risks. The two most common risks are irritation to the gastrointestinal tract (which may lead to decreased appetite, nausea, vomiting and/or diarrhea) and lowering of white blood cell counts, which can affect the ability to fight off infections and/or form blood clots. Most dogs do not lose their hair, but a few dog breeds are prone to significant hair loss. Cats are likely to lose their outer coats and their whiskers. More serious complications are rare, but all side effects are monitored, and treatment adjusted as necessary.
Prior to starting treatment, you will meet with one of our medical oncologists to discuss the plan for your pet’s chemotherapy. Our oncology specialists and oncology nurses work closely together. Our oncologists oversee all treatments, and our nursing technicians are trained in administering chemotherapy. A member of our oncology team will keep you updated on your pet’s response at every visit. The effectiveness of the treatment will be determined through diagnostic testing (such as bloodwork or imaging) and through regular physical examinations.