Small Animal Services: Medical Oncology
Medical Oncology is the study and treatment of cancer; veterinary oncology is the study and treatment of cancer in dogs, cats, ferrets, birds, and other exotic and domestic animals.
The Medical Oncology service sponsors the North Carolina Animal Cancer Program (NCACP), a comprehensive treatment, medical education, and research center. The NCACP, part of the Veterinary Hospital, is one of the few oncology services on the East coast with access to all types of cancer treatment–chemotherapy, radiation therapy, surgery, and canine bone marrow transplants.
What is lymphoma?
Lymphoma is a cancer of the cells of the immune system called lymphocytes. Lymphocytes are present throughout the body, so dogs can have lymphoma in multiple organs. Lymphoma most often affects lymph nodes, but can also affect the liver, spleen, bone marrow, and other sites.
It is typically initially diagnosed using small needle samples (aspirates) collected from enlarged lymph nodes. In some cases, diagnosis may require sampling of bone marrow or other organs, tissue biopsy, or molecular testing (flow cytometry, PARR). Once a diagnosis is made, staging tests are recommended to assess the extent of disease. Complete staging includes blood and urine testing, non-invasive imaging (chest X-rays, abdominal ultrasound/sonogram), and additional aspirates. This evaluation provides prognostic information, a baseline for monitoring, and information regarding organ function and involvement. Results may influence treatment recommendations or help anticipate potential complications.
Bone marrow is found within your bones and bone marrow stem cells are the source of all the blood cells needed
for life. We can cause these stem cells to leave the bone marrow (with a medication called Neupogen) and travel out into the peripheral blood, where we can collect them using a sophisticated apheresis machine. The apheresis machine painlessly takes blood out of the patient, removes the needed stem cells, and puts all the other blood cells back into the dog.
During apheresis, the dogs are anesthetized so they don’t move around for ~4-5 hours. Once cells are collected, the dogs undergo total body irradiation in an attempt to kill all the remaining cancer cells in the body. This treatment also kills all the bone marrow in the body, which is why we need to replace it with the peripheral blood stem cells we previously harvested. Once these cells are put back into the dogs with an IV catheter, the transplant is complete.
Appointment Policy and Resources
The Medical Oncology service is a referral-only service. Once the primary veterinarian calls and sets up the referral, the owner may call and arrange an appointment. If the patient has been seen by our service recently, owners may call Medical Oncology directly to set up an appointment.
Hours: Monday-Friday, 8AM-5PM
What will happen at an appointment?
An appointment includes taking a history, performing a physical examination, and a discussion of prognosis and treatment options. The patient will typically remain in the hospital for 1-2 days for purposes of evaluation of the extent of the tumor-called staging.
Options are presented to the pet owner describing what tests are necessary to reach the final diagnosis or, if the diagnosis is already known, what treatments are recommended. All of the resources of the Veterinary Hospital at North Carolina State University are available for use, if needed. At North Carolina State University, we are fortunate to have a highly educated and enthusiastic faculty of veterinarians to support the health care process. Additionally, very high quality diagnostic and therapeutic options are available. In the Oncology Service, we are very concerned that pet owners make the best possible decision regarding the care of their pet.
What will it cost?
The fee for the consultation with the oncology service is approximately $199. There are additional costs for emergencies. A typical visit including the clinical evaluation of extent of disease (which may include radiographs, ultrasound, aspiration of lymph nodes) costs $800-1000. If advanced imaging techniques are needed, such as a CT scan, the cost may be higher. Treatment costs vary widely, depending on the treatment plan agreed upon.
There are research treatment protocols which may pay for treatment or defray some of the costs associated with treatment. A pet must be evaluated by the service before we can determine if they are eligible for one of the funded protocols.
Will my pet be sick on chemotherapy?
Dogs and cats seem to tolerate chemotherapy much better than people, so it is unlikely that your pet will be extremely nauseated or be vomiting. Occasionally, an animal will be more sensitive, and in those cases appropriate steps are taken to minimize side effects.
Will my pet be bald?
Cats and most dogs will not become bald from chemotherapy as their hair is not continuously growing. Fur that is shaved may not regrow while on chemotherapy, and fur in the radiation treatment field may or may not grow back, or may grow back white. Certain breeds, such as poodles and Old English sheepdogs, may lose the majority of their hair during chemotherapy. When hair is lost during chemotherapy, it will typically grow back when chemotherapy is finished. Cats and dogs will lose their whiskers during chemotherapy.
Is my pet just going to be sick and miserable for the rest of his life if I treat him?
Our intention is to cure your pet of cancer, or, failing that, to give them as much good quality time with you as possible.
If I come in for a consultation, do I have to treat my pet’s cancer?
No. Our job as oncologists is to give you the most accurate information available on what you can expect with various treatment options, and to give you recommendations for treatment of your pet’s cancer. The final decision on which, if any, treatment option is chosen belongs to the pet’s family.
Is treating cancer expensive?
Some treatments are more expensive than others. When the oncologist discusses treatment options, they will also provide expected costs associated with those treatments.
The North Carolina Animal Cancer Program (NCACP) began in 1984, and is part of the Veterinary Hospital in the College of Veterinary Medicine, North Carolina State University. In addition to being multidisciplinary, the NCACP is multi-institutional, involving collaborative activities with Colorado State University, Duke University Medical Center, and the University of North Carolina at Chapel Hill.
The primary functions of the NCACP are:
- To provide a comprehensive treatment center for privately-owned pet animals with cancer
- To provide instruction in clinical and investigative oncology to professional students in the College of Veterinary Medicine
- To provide residency programs in medical and radiation oncology for graduate veterinarians
- To provide graduate study in fields relating to cancer biology and/or treatment
- To conduct high quality research in cancer-related fields
The NCACP has a long and productive history of studying tumor biology and new methods of cancer treatment. Through this effort, we hope that information will be provided that will be useful to veterinarians treating animal cancer and to physicians treating cancer in people. Ongoing research in the NCACP involves:
- Targeted drug delivery via gene therapy and liposources
- Cytogenetic abnormalities and abnormalities in protein expression of tumors
- Development of targeted radiotherapy
Occasionally, ongoing clinical trials provide funds to partially offset the cost of cancer treatment in pets.
Liaison with Duke University Medical Center
There has been fruitful collaboration with investigators at Duke University Medical Center since the inception of the North Carolina Animal Cancer Program in 1984. Drs. Mark Dewhirst and Jeannie Poulson, both veterinarians, and faculty members in the Department of Radiation Oncology at Duke University Medical Center, are intimately involved with investigations of new cancer therapy and studies of cancer biology in pets with cancer. Drs. Dewhirst and Poulson also hold Adjunct Faculty appointments in the College of Veterinary Medicine at North Carolina State University. Also, some faculty from North Carolina State University hold adjunct faculty appointments at Duke University Medical Center and are also members of the Duke University Comprehensive Cancer Center.
Collaboration with Duke University Medical Center allows the latest in scientific discovery to be brought to the North Carolina Animal Cancer Program.