Small Animal Services: Medical Oncology
The Oncology Service at North Carolina State University offers a full range of diagnostic and therapeutic options for pets with cancer, including surgery, chemotherapy, radiation therapy, electrochemotherapy, immunotherapy, and bone marrow transplants.
Our medical oncology service is staffed by a dedicated team of veterinarians, veterinary technicians, and clinician-scientists. Our mission is to be a premier veterinary oncology program in the US, as evidenced by our commitment to compassionate patient care, collaborative research, and innovation in cancer diagnostics and therapeutics.
Our teaching hospital provides a comprehensive range of specialties, located conveniently within the same building. The medical oncology team partners with other departments including clinical pathology, dentistry, dermatology, emergency/critical care, histopathology, internal medicine, neurology, ophthalmology, radiology and surgery. Emergency and critical care services are available 24 hours a day, 365 days a year should your pet require emergent care.
We work closely with the Family and Community Services team to provide support for owners dealing with difficult medical decisions and end of life care. Our hospital is one of only a handful of veterinary facilities in the country to include a social worker on the veterinary medical team with the goal of providing family-centered care.
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.
Classification of Bone Tumors?
Bone tumors can arise directly from bone or may occur as a metastatic lesion from an underlying cancer outside of the skeleton. The most common primary bone tumor in dogs is osteosarcoma. Other bone tumors include chondrosarcoma, fibrosarcoma, hemangiosarcoma, liposarcoma, histiocytic sarcoma, multiple myeloma, and metastatic tumors.
Osteosarcoma tumors of the appendicular skeleton (long bones of the limbs) are locally invasive and have a high rate of metastases (most commonly lungs and other bones). Osteosarcoma tumors can also occur in the axial skeleton (the bones of the skull, spinal column, pelvis, and ribs). Tumors of these locations tend to have a decreased rate of metastasis compared to those of the limbs.
It is important to differentiate osteosarcoma from other tumor types and diseases that occur within bones, such as bacterial, viral, or fungal infections. With infection, there is usually history of exposure to the infectious agent or traumatic injury to the affected region. Identification of the underlying cause is important, as this will influence the recommended therapeutic regimen.
What is Hemangiosarcoma?
Hemangiosarcoma is a highly malignant cancer arising from cells that normally create blood vessels. It most commonly affects the spleen, liver, right atrium of the heart, and skin. Tumors can occur in any part of the body, however. In most cases, the cause of hemangiosarcoma is unknown. Exposure to sunlight can cause skin tumors in some dogs, especially in thinly haired regions including the belly, inner thighs, and eyelids. Breeds with a predilection for non-cutaneous hemangiosarcoma include golden retrievers, Labrador retrievers and German shepherds, but any breed can be affected.
What are Mast Cell Tumors?
Mast cell tumors are comprised of mast cells, which are immune cells normally involved in allergic reactions. They are the same cells that cause the itchy, red bump you get after a mosquito bite, or the more serious reactions that occur in people allergic to peanuts or shellfish. Mast cells contain granules packed with chemicals including histamine. Release of chemicals from granules leads to the allergic reactions. Mast cell tumors occur most frequently in the skin, but other sites include the liver, spleen, gastrointestinal tract and bone marrow.
Mast cell tumors vary in appearance. Some may look like raised bumps within, or just below the surface of, the skin. Others appear as red, ulcerated, bleeding, bruised, and/or swollen growths. Some tumors appear and remain the same size for months or years, while others…
What is Urothelial carcinoma?
Urothelial carcinoma (also called transitional cell carcinoma (TCC)) is the most commonly diagnosed cancer of the urinary tract of dogs. Transitional cells make up the epithelial lining of the urinary tract. The areas most frequently affected include the bladder, the urethra (the tract along which urine exits the body), and the region of the trigone (the region where the bladder connects to the urethra). All regions of the urinary tract can be affected given the infiltrative nature of this cancer. Breeds at risk for developing urothelial carcinoma include Scottish Terriers, West Highland White Terriers, beagles, and Shetland sheepdogs. In male dogs, the prostate may be secondarily affected.
What is Feline Injection Site Sarcoma?
Feline injection-site sarcoma arises from connective tissues. The most common injection site sarcoma in cats is a fibrosarcoma. Regardless of underlying tissue type, all injection site sarcomas behave as locally aggressive tumors with a modest chance of spread to distant sites in the body.
Injection site sarcomas arise at sites where the cat previously received an injection. Tumors are caused by vaccines (feline leukemia virus and rabies vaccines), microchips, injections of long-acting antibiotics, long-acting glucocorticoids, lufenuron, and reaction to nonabsorbable suture. Cats may be genetically predisposed to developing injection site sarcomas, though the exact nature of this relationship is unclear.
Despite the association with vaccination, the risk of not vaccinating for certain diseases may be much higher than the risk of tumor development. Vaccine protocols and injection methods continue to be evaluated. Cat owners should talk with their family veterinarian about which vaccines, including boosters, are recommended. Cats with a history of injection-site tumors should not receive future vaccinations.
What is Canine Apocrine Gland Anal Sac Adenocarcinoma (AGASACA)?
Apocrine gland anal sac adenocarcinomas (AGASACA) are malignant tumors of the anal glands. These are paired glands located on either side of the rectal opening. Anal glands are sweat glands that contain a brown, malodorous liquid that is eliminated upon defecation.
AGASACAs are locally invasive tumors with a high rate of metastasis to regional lymph nodes (including sublumbar and medial iliac lymph nodes inside the abdomen and inguinal nodes located in the groin). Tumors can also spread to distant sites including the liver, spleen, and lungs. Metastasis is possible even in cases where the primary tumor is only a few millimeters in size. Tumor cells sometimes secrete a hormone that causes blood levels of calcium to rise above normal. Dogs affected with high blood calcium levels show increased thirst, urination, lethargy, and in some cases this can lead to severe heart and kidney damage.
Spaniels are affected more frequently than other breeds. Typically, only one gland is affected, however disease can occur in both glands either simultaneously or several years apart.
What is Feline Lymphoma?
Lymphoma is a cancer of the cells of the immune system called lymphocytes. Lymphocytes are present throughout the body, so cats can develop lymphoma in multiple organs. Lymphoma is classified by the location of the disease (e.g. gastrointestinal tract, nasal cavity, mediastinal) and the size of the lymphocytes (large cell versus small cell). Feline lymphoma is specific to cats.
What are the Rescue Protocols for Canine Lymphoma?
Most dogs with lymphoma treated with CHOP chemotherapy achieve a complete remission, meaning we can no longer detect cancer cells in their body. The duration of remission varies from a few months to a year or more after completion of treatment. Remission does not equal cure, and 95% of dogs have detectable disease at some point following chemotherapy. When this occurs, the dog is “out of remission” because their disease relapsed.
Some dogs achieve only a partial response to CHOP chemotherapy. This means their disease burden decreases, but never to the point where we cannot detect it. Alternatively, some dogs initially show a complete response, but their disease becomes detectable before finishing the 6-month course of treatment. The cancer cells of these partially/initially responding dogs have developed resistance to CHOP chemotherapy.
Relapse and resistance are devastating, but expected, consequences of having lymphoma. When they occur, we recommend treatment with “rescue” chemotherapy. Common rescue protocols are listed below. We will discuss the pros and cons of each protocol as they relate to your dog and your goals and assist you in choosing the best plan of action.
With rescue treatment, we aim for at least a durable partial remission, therefore the remission rates below include both partial and complete responses. Should you decide to pursue further chemotherapy, we will recheck lab work (complete blood count, serum chemistry panel, and urinalysis) to ensure your dog is good candidate for treatment. Other diagnostics are recommended on a case by case basis.
Appointment Policy and Resources
The Medical Oncology service is a referral-only service. Your primary veterinarian can contact our service via telephone (919 513 6690) or email to initiate the referral process. You can also ask your veterinarian to provide you with a referral to our service at any point. If your pet was recently seen by our service, or you were directed to our service after seeing another specialty service at our hospital, you can call to directly set up your appointment.
- Hours: Monday-Friday, 8AM-5PM
- Drop-off hours: 7:30AM-8:30AM
- Discharge hours: 4:30PM-6PM
What will happen during my appointment?
An initial consultation consists of a complete review of your pet’s medical history, including all previously performed labwork and imaging tests. You will meet your attending veterinarian, who will ask further questions about your pet’s history and clinical signs, perform a physical examination, and make recommendations for further diagnostic and treatment options. All of the resources of the Veterinary Hospital at North Carolina State University are available for use, if needed.
What will it cost?
The fee for the consultation with the oncology service is approximately $208. There are additional costs associated with emergencies. A typical visit including the clinical evaluation of extent of disease (which can include radiographs (x-rays), ultrasound, aspiration of lymph nodes) can range from $800-$1200. If advanced imaging techniques are recommended (e.g. CT scan), costs will be higher. Treatment costs vary widely. We will provide owners with an estimate of prognosis and explain both curative-intent and palliative care options. Owners can expect a discussion of potential benefits and side effects as well as an estimate of costs for any therapies proposed.
There are research treatment protocols which can provide financial assistance to owners. A pet must be evaluated by the service before we can determine eligibility for one of the funded options.
- What caused my pet’s cancer? Cancer most often results from a combination of genetic and environmental factors. Evidence for a genetic cause of cancer in companion animals is supported by the many examples of breed predispositions to certain tumor types. The majority of genetic alterations that eventually lead to cancer occur because of spontaneous mutations. These mutations may occur as a result of chronic exposure to known cancer-causing substances. Nutrition, hormones, viruses, carcinogens, pesticides, UV light, and asbestos, are all factors that might increase the risk of cancer in pets.
- Will performing a biopsy cause the cancer to spread/become more aggressive? While tumor cells can disseminate into the bloodstream during surgery, the ability of these cells to implant within other tissues is extremely poor, and most circulating tumor cells are rapidly destroyed by the host’s immune system. Biopsies should be planned so they can be obtained from a region of the tumor that can be entirely removed with a more definitive surgical excision or be included in the radiation field, should that be recommended as treatment.
- Will my pet become sick from chemotherapy? Less than 25% of all animals receiving chemotherapy will experience side effects from therapy. This generally entails mild and self-limiting gastrointestinal upset and/or lethargy that occur in the first few days following treatment. These signs can usually be controlled using over the counter or prescription medications. Less than 5% of patients have severe side effects that require medical attention. With appropriate management, the risk of these side effects causing the death of a patient is less than 1%. In general, the quality of life for patients receiving chemotherapy is excellent. Studies show the majority owners are happy with their decision to pursue treatment for their pets and would elect to pursue treatment again after seeing how well their animals did during therapy.
- Will my pet lose his/her fur? 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 fur is lost during chemotherapy, it will typically grow back when chemotherapy is finished. Cats and dogs will often lose their whiskers during chemotherapy.
- Can my pet be around family members or other animals while undergoing treatment? Pet’s receiving chemotherapy can interact with all family members. Depending on the chemotherapy protocol the pet is receiving, there may be certain times after a treatment that your pet would be considered at a higher risk for infection, so specific precautions may be necessary for certain time periods following administration. When oral chemotherapy drugs are given at home, it is important that capsules or pills are kept out of the reach of children. If anyone on the household is pregnant, trying to become pregnant, nursing, or considered immunocompromised, they should not handle chemotherapy drugs. If chemotherapy is to be administered at home, chemotherapy approved gloves should be worn and the person handling the drugs should wash their hands afterwards. Chemotherapy pills should never be cut into pieces and capsules should not be opened.The metabolites of the chemotherapy drugs can be present in the urine and/or feces for a few days after treatment. Dogs should be walked away from public areas. Gloves should be worn when handling an animal’s feces, litter, vomit, etc. Hands should be washed thoroughly after handling and potentially contaminated fluids/waste. See Safe Handling of Chemotherapy for Pet Owners.
- How much will treatment cost? The cost of the initial consultation with the medical oncology service is $208. This includes a thorough review of your pet’s medical record, including all previous test results and your veterinarian’s notes, a comprehensive physical examination, and complete discussion of further recommendations, including treatment cost estimates. Treatment costs vary and your oncologist will work with you to create a customized plan for your pet. Your veterinarian will explain all available options and associated finances prior to initiating any plan.
- How long will my pet’s appointment last? You should prepare for a half to full day for your pet’s first appointment. Our service works in conjunction with other hospital services in a team approach to help your pet to ensure optimal care is delivered. This team approach takes time and we appreciate your patience.
- Do you offer clinical trials? Yes. Please go here for available clinical trials.
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