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Small Animal Oncology

Small Animal Oncology. Vance Kawakami Kristin Kender. 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. Feline Cancer Facts.

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Small Animal Oncology

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  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. AVMA’s 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. Excisional Complete removal of the tumor Feasible if mass is < 3 cm in diameter and freely 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 Biopsy

  11. Tumor-Node-Metastasis System • T = primary tumor size or extent • Tis: preinvasive tumor (in situ) • T0: no evidence of tumor • T1: tumor <5 cm in diameter but confined to 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 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 Curative vs. Palliative Treatment

  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. 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 Chemotherapy-Indications

  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 + 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 Chemotherapy as anAdjunctive Therapy

  25. Hyperthermia

  26. Hyperthermia-Indications • Most effective in the treatment of localized tumors in combination with radiation or chemotherapy • Used to treat small (<1.0 cm in diameter) benign 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 + 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 Hyperthermia as anAdjunctive Therapy

  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 tumor’s 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. Clinical changes Preclinical, silent phase, no obvious signs. Metabolic changes Hyperlactermia Hyperinsulinemia Altered blood amino profiles Phase 1

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

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

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

  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. Cancer’s 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. Cancer’s 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. Cancer’s 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. Cancer’s 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

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