On an almost daily basis, clients at my oncology practice will ask if I think they should treat their dog's cancer. This is a decision that many people struggle to make. They are worried that treatment may make their dog feel worse, wondering if treatment will actually work, worried about how much treatment will cost and wondering if it's logistically feasible to bring their dog to the clinic for ongoing treatment.
Thankfully, most cancer treatments for dogs are very well-tolerated. That being said, deciding whether to treat your dog's cancer is an incredibly personal decision.
When I'm helping a family make this decision, I typically advocate for treatment if I feel that it (1) will improve a patient's quality of life, (2) will help to extend the length of their life, provided their quality of life is adequate, (3) is affordable for the family.
In most cases, when I first meet a family during a consultation, I don't have enough information to help them make this decision. We might have a diagnosis which tells us the general type of cancer the patient has, but this is usually just a small piece of the puzzle.
In order to truly know which treatments might benefit a patient, how long they may live with various treatments, and if it's worth pursuing treatment, we have to know: Has cancer spread to other parts of the body? In some cases, we have to know the grade of the tumor. And finally, Is the patient otherwise healthy?
Let's break each of these down.
Has Cancer Spread To Other Parts of the Body?
In order to determine if cancer has spread to other organs (or if it's just confined to its original location), we perform staging tests. Staging a patient means looking for evidence of cancer in other places in the body, based on where we know that specific type of cancer might travel. The staging tests recommended for a lung carcinoma are different than for a mast cell tumor, which are different than for hemangiosarcoma. So we must first have a diagnosis, then we stage the patient and look for cancer elsewhere.
Appropriate staging is essential. If we find evidence of cancer in other organs (this is called metastasis) it will change the treatment options recommended for your dog, and it will often change the prognosis.
Staging tests can include a lymph node aspirate, 3-view thoracic radiographs (chest x-rays), abdominal ultrasound, blood work and urinalysis and in some cases CT scan.
There are many scenarios in which patients live for years only because we perform appropriate staging tests, find that cancer has spread elsewhere, allowing us to change the treatment recommendations accordingly.
If we find evidence that cancer has spread to a distant organ such as the lungs or the liver, we will typically advise against surgery as a treatment, because it does not typically prolong a patient's life. This is why it is critical to have appropriate staging tests performed prior to surgery - we never want a dog to have unnecessary surgery.
What is the Grade of the Tumor?
Some types of cancer are graded. The grade can help to determine (1) how likely the tumor is to spread to other organs, (2) how likely the tumor is to return in the skin after surgery, (3) will chemotherapy help the patient live longer.
Is Your Dog Otherwise Healthy?
Not every treatment is appropriate for every dog. Part of our work-up is aimed at making sure that the patient doesn't have any pre-existing conditions that would take certain treatment options off the table. For an older patient, these tests may include full blood work and a urinalysis, 3-view chest x-rays (thoracic radiographs), and abdominal ultrasound. There are many cases where an abdominal ultrasound will uncover a tumor in the spleen that we didn't know about and thoracic radiographs will reveal a lung tumor. These tests are important and help ensure that if surgery is pursued, there shouldn't be any surprises.
After we complete the full work-up and have a better understanding of (1) where the cancer is and isn't, (2) how healthy the patient is, and (3) what the grade of the tumor is (if the tumor requires a grade), we have a better idea of suitable treatment options for a particular patient.
An oncologist's job is then to go through these options with the family so that they understand (1) the odds that each will be successful, (2) the potential side effects associated with each option, and (3) the cost associated with each option.
In most cases, there's going to be one treatment that is more likely to help a dog live the longest, but if it's not in the client's budget (and they don't have pet insurance), then it's not the right treatment for that dog. Then we simply discuss other options with the family that we think will help.
If you think there's a chance that you would treat your dog's cancer if there could be a good prognosis, I'd recommend seeing an oncologist to get more information. Typically having more facts (and questions answered) makes the best decision more obvious.
If you ultimately decide not to treat, then focus on doing everything you can to keep his quality of life as good as possible at home. Schedule regular quality of life visits with your oncologist, your regular vet, or a palliative care vet that can come to your home. These visit can help ensure that he is comfortable, not losing weight and that adjustments are not needed in any of his medications.
Always remember that there are no 'wrong' or 'right' treatment decisions, as long as we are focused on making sure that he still has a good quality of life.
Dr. Lori Cesario
Board Certified Veterinary Oncologist
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