The delivery of chemotherapy treatment is more than just choosing a “recipe” from a textbook and dispensing the necessary drugs.
The experience of the medical oncology team is important to allow an appropriate and personalised treatment plan to be developed for each patient.
What is medical oncology?
We believe our pets deserve and can receive the same calibre of care that a person with cancer receives. A board-certified veterinary oncologist has thorough knowledge on the way cancer develops, behaves and how it can be successfully managed. Veterinary oncologists will tailor care specifically to your pet, their condition, and their response to treatment. They are trained to detect side effects early and will adjust therapy to try and alleviate them. A veterinary oncologist will also know how to detect cancer progression early, so that treatment can be adjusted to make every dose count.
The medical oncology team will use chemotherapy, vaccines or other non-surgical strategies to help control or palliate a tumour. They will also work in close communication with surgeons and/or radiation oncologists to identify the best combination of treatments for an individual patient.
Following a clinical evaluation, the medical oncologists at AURA will provide you with recommendations on various cancer treatment options. They will also be able to discuss the pros-and-cons of each approach and their associated prognosis.
We want our patients to be bright, active and happy, with good appetites and a continued enthusiasm for life.
The most important step is to achieve a confident cancer diagnosis and perform staging, which is where we try to determine how much cancer is within the body and if it has spread.
What can you expect from the medical oncology service?
The whole medical team are involved in the day-to-day administration of chemotherapy, immunotherapy, and other medical treatments. In many cases, particularly for advanced or complicated cancer conditions, the combination of drugs or the sequence of administration may have a profound impact on the patient experience and outcome. The expertise of the medical oncology nursing team also helps ensures the repeated visits to the hospital are as stress-free as possible for the patient, to ensure the experience remains a positive and affirming activity for the pet and owner. During and after treatment, we monitor cancer response and remission status. This is to confirm the treatment is working and to assess for progressive disease
We understand that cancer treatment may not be for everyone.
But every pet deserves palliative care to ease their symptoms. We can directly manage these or work closely with your own vet. At every step of the treatment journey, the medical team are available to discuss what to expect, and to answer to any questions you or your family may have about your pet’s condition.
Medical oncology treatments at AURA
Chemotherapy is considered the second arm of cancer treatment. Chemotherapy may be used as a sole treatment for some cancers, particularly haematologic cancers (e.g. lymphoma, leukaemia, etc). Chemotherapy may also be used to gain some control of a cancer prior to surgery (neoadjuvant treatment) or may be used after surgery has been performed when there is a risk of either local recurrence or metastasis (adjuvant treatment). Chemotherapy usually works most effectively on microscopic deposits of cancer; when used alongside surgery, there is usually close coordination with the medical team to determine the best strategy for an individual patient.
Giving chemotherapy in pets is very different to chemotherapy in people; we use the same drugs but at lower doses to keep quality of life as normal as possible. We want our patients to be bright, active and happy, with good appetites and a continued enthusiasm for life. We use anti-sickness drugs and carefully monitor their doses to make sure they live life to the full. Our chemotherapy goal is for your pet to look so well that none of your family or friends would even know they were receiving chemotherapy. However, every patient is unique and a small proportion of patients will experience some unpleasant side-effects. The medical oncology team will discuss these possible risks before starting treatment and, if they occur, discuss options to ensure that these side-effects can be reduced or prevented.
Targeted therapy drugs work by blocking known “targets” on cancer cells, stopping them from dividing and making new cancer cells. These targets can be a protein that the cancer cells is producing excessively or that has become altered by a gene mutation. By finding and blocking these specific changes in the cancer cells, targeted therapy is able to “target” cancer cells while sparing normal cells.
Two target therapies are currently approved specifically for pets: Palladia and Masivet. Both were initially designed for treatment of mast cell tumours. Because Palladia targets a series of growth factor receptors on the cancer cells, it has also been found effective against other cancer types such as anal sac adenocarcinoma, thyroid carcinoma, head/neck carcinoma, heart base tumour, metastatic osteosarcoma, insulinoma, GI stromal tumours, etc.
Dogs, cats and people share many similar cancer mutations. For this reason, veterinary oncologists have started using target therapies made for people to treat cancer in our pets. For example, lapatinib has recently been found effective against transitional cell carcinoma of the bladder in dogs. Because these newer treatment options may not have been fully studied in veterinary patients, complete understanding of their effectiveness and possible side effects may not be fully known. However, when other options are lacking, these therapies may be considered as part of the treatment strategy.
Immunotherapy uses the body’s own immune system to help fight cancer cells. Immunotherapy is often referred to as a cancer ‘vaccine’. To date, only melanoma has a licensed vaccine that can be given to animals and has been used for many years in advanced melanoma cases. Typically, the cancer vaccine is combined with surgery; this ensures the bulk of the tumour has been removed to help relieve any discomfort or disability due to the physical mass. The role of the vaccine is the stimulate the immune system to locate and target any microscopic tumour cells that may have spread elsewhere in the body.
In some situations, vaccines can be generated from the patient’s own cancer. Harvested tissue can be processed and packaged in-house, to generate an autogenous vaccine that helps bolster the animals’ own defences against the cancer.
Palliative care is treatment aimed at relieving symptoms and improving quality of life. Palliative care is not just for end of life. Every pet with a serious illness such as cancer can benefit from palliative care, whether it is during or after cancer treatment.
Different cancers may cause a variety of symptoms in our pets, such as pain, nausea, trouble breathing, bleeding, seizures and secondary infection. Medications are often available to help with these symptoms. We can prescribe them directly or work closely with your own vet over phone and email, depending on your preference. Some cancers like bone cancer can be particularly painful. Our medical oncologists and anaesthesiologists are specifically trained in multi-modal pain management for cancer patients, utilising oral medications that targets pain through different routes, injectable medications (e.g. bisphosphonate, ketamine, lidocaine), acupuncture, etc.
Palliative care is not just about medications. Our goal is to help you and your family understand your pet’s condition and make medical decisions. In the process, we hope to prepare you and perhaps help you become comfortable with the uncomfortable. Every pet’s condition is unique. Our medical oncology team can show you basic monitoring skills, so that you can properly monitor your pet at home. This may include an assessment of basic vital signs, breathing effort, pain levels, detection of any signs of internal bleeding, etc. We can also educate you about any special nursing care needs, nutrition, and hydration considerations of your pet.
Common cancers being managed
Lymphoma & Leukaemias
Lymphoma and leukamia are cancers of white blood cells. Lymphoma and is one of the most common conditions that the medical oncology team will treat at AURA. Lymphoma can affect anywhere in the body and there are a number of different forms of lymphoma (over 50), so it is a very varied condition. Most forms of lymphoma can be successfully controlled to stop your pet feeling unwell and it is most often treated with chemotherapy.
Lymphoma is not a single disease. It follows that treatment strategies will differ for individual patients, based on the unique characteristics of their cancer.
Although surgery alone provides success for many mast cell tumours, a proportion of tumours require a combined strategy with the medical oncology team.
Mast cell tumours
Mast cell tumours are more common in the older dog (mean age: 9 years). Some dog breeds have an increased incidence of tumour occurrence, including the English bull terrier, boxers, Boston terriers, Labradors, beagles and schnauzers. In the dog, mast cell tumours typically develop on the skin, with visceral disease occurring secondarily. Cutaneous mast cell tumours most frequently occur on the trunk (50%), with the remainder on the extremities (40%) and head (10%).
Osteosarcoma is the most common primary bone tumour of dogs. It more typically affects the large to giant breeds of dogs. Osteosarcoma may occur anywhere in the skeleton, with more than 75% of tumours developing on the limbs. The role of surgery is focussed on controlling pain in the affected limb. Because the cancer is highly malignant, the medical oncology team will usually assist with patient care with a course of chemotherapy following surgery.
Strategies to manage bone cancer focus on the need to control pain, but also to manage the inevitable spread of the cancer.
Malignant melanoma it is not sunlight-induced as in people, but is seen in highly pigmented breeds. It may arise on pigmented sites on the lips, gumline, mouth, tongue or digits.
Melanoma is relatively common in dogs accounting for 5-7% of all skin tumours, although it is rare in the cat. Breed differences are seen with an over representation of benign melanoma in Dobermanns and miniature schnauzers, and more malignant variants seen in Poodles.
The cancer can develop on the digits (where 50% are malignant), the skin, the oral cavity (including tongue and maxilla/mandible) and the eye.While surgery can often successfully remove the main mass, there is a high risk of spread in many patients. The medical oncology team can provide strategies to help control progression of this challenging cancer.
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Aubrey first visited us back in June 2019. As a puppy his Mum Joanne had regularly checked him over for any lumps and bumps. Back in 2018 he had suddenly gone off his legs, naturally she immediately rushed him to her local vet. Due to his breed she was concerned he could be experiencing an issue with his back.
On the way to the vet, as she was rubbing his paw for reassurance, she noticed a growth. It felt and looked like an extra pad had grown in the middle of his paw.
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