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Oncology

Advanced Treatment Modalities

Overview

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It can feel scary to learn that your pet has been diagnosed with cancer, but it’s important to know that treatment options are available and they can improve quality and length of life, and in some cases offer a cure.

ONCOLOGY

The treatments used for cancer therapy in pets are very similar to those used in humans, including surgery, chemotherapy, and radiation therapy. It’s also comforting to know that the side effects of such treatments in pets, especially chemotherapy, are very different from those that humans experience. Although many of the drugs are the same, pets tend to respond well to therapy at the dosage and schedules used in veterinary oncology. Less than 20% of pets receiving chemotherapy show any clinical signs whatsoever, and most of those that do have minor symptoms that can be managed with medication. Our goal is quality of life above all else.

At Colorado Animal Specialty & Emergency (CASE), we offer surgical, immunotherapy, chemotherapy, and electrochemotherapy options under the guidance of a board-certified medical oncologist to target your pet’s cancer. We also have an assortment of clinical trials to aid in financial compensation as well as novel treatment options. Depending on your pet’s diagnosis, we may recommend any combination of these therapies to help get him or her back to living a comfortable life. We will always provide you with education and information you need to make an informed decision about your pet’s health, and will answer any questions you may have about your pet’s diagnosis. No matter what your time constraints or financial constraints we are here to help you through this uncertain time.

Perhaps the most important factor in successful cancer treatment is early detection, which is why it is important to keep close attention to your pet for early warning signs of cancer and to bring him or her to a family veterinarian for regular check-up examinations. Be sure to report any changes in your pet to his or her veterinarian and, if anything looks like it might be a sign of cancer, your veterinarian will recommend that your pet see a veterinary oncologist for further evaluation. From diagnosis to treatment and beyond, we are here to provide the support and care you and your pet need throughout his or her cancer recovery.

SURGICAL ONCOLOGY

Surgery is one of the most common modalities used to treat cancer in pets. In many cases, a well-planned and executed surgery can be curative. In other cases, surgery is more palliative in nature with the specific goal of alleviating discomfort. In all cases, whenever we consider surgery as a potential treatment option for your pet, our number one goal is to improve your pet’s quality of life.

Before considering surgery, Dr. Prpich will have a consultation with you to evaluate your pet and discuss your concerns. During this consultation, Dr. Prpich will provide information about how the tumor behaves (tumor biology) and what this means for your pet and your family. She will then discuss the different ways in which surgery can be utilized and what other modalities we may consider. Dr. Prpich will also discuss the risks of surgery, as well as what the recovery period will look like. The goal of this consultation is for you to walk away with a very clear understanding of all your options so that you can make an informed decision about how you would like to proceed.

Cancer surgery is often very intricate, and it can involve multiple body systems. In order to better visualize a mass and how it is associated with normal anatomy, advanced imaging is often performed pre-operatively to allow for surgical planning. This usually involves a CT scan, or occasionally an MRI, to allow the surgeon to visualize the mass in three dimensions. Having this information pre-operatively allows the surgeon to better plan for any additional measures that may be needed to maintain your pet’s safety and optimize results.

If you make the decision to include surgery as a treatment for your pet with cancer, you want to make sure that the surgeon you choose is very experienced in cancer surgery to achieve the best outcome. This will result in a higher chance for a cure, a smooth recovery process with minimal post-operative pain and discomfort, lower rates of complications and a superior cosmetic outcome.

How is a surgical oncologist different from a boarded surgeon?

A true veterinary surgical oncologist is a surgeon who has completed a surgical residency program and then went on to perform an additional year of training to become an ACVS Fellow of Surgical Oncology.

During a residency program, surgeons are focused on mastering anatomy, pathophysiology, and surgical techniques. During a surgical residency program, there is a requirement of how many mass removals that need to be performed to credential, but there is no requirement to spend time being mentored by a medical oncologist or radiation oncologist. This is really a key difference between a boarded surgeon and an ACVS Fellow in Surgical Oncology. The ACVS Surgical Oncology Fellowship is a very focused 1-year program that immerses the ACVS Diplomate in a training facility and mandates time spent with medical and radiation oncologists to enable the surgeon to embody a multidisciplinary approach to the art of cancer care. Finally, there is also a case log that is required during the ACVS Surgical Oncology Fellowship program which ensures Fellows perform a certain number of very highly specialized surgical oncology procedures to ensure mastery in these more challenging cases.

Currently, there are only 4 institutions worldwide that meet the strict requirements to train an ACVS Fellow in Surgical Oncology. There are less than 50 practicing ACVS Fellows in Surgical Oncology worldwide, which demonstrates the unique skillset and knowledge that an ACVS Fellow in Surgical Oncology can provide.

At the Pet Cancer Center at CASE, our surgical oncologist, radiation oncologist and medical oncologists collaborate on all cases to provide exceptional cancer care for your pet and family. We are one of only a handful of dedicated pet cancer centers in the United States of America that can offer this true multidisciplinary approach.

Medical Oncology

Medical Oncology offers a variety of services in pets with cancer, including chemotherapy, electrochemotherapy, and immunotherapy.

Chemotherapy

Considering treatment of your pet with chemotherapy can understandably sound scary. However, most pet patients go through chemotherapy treatment with minor side effects or no side effects at all. Compared to people undergoing chemotherapy treatment, pets have fewer and less severe side effects because we use lower dosages and do not want our pet-patients to be sick. In veterinary oncology, our goal is our patients' quality of life. Protocols and dosages can be tailored to your pet to help avoid unwanted side effects. While chemotherapy can attack cancer cells, certain parts of the body are also susceptible to the effects of chemotherapy. These sensitive tissues include the intestinal lining, bone marrow (immune system), and atypically the hair follicles. Therefore, side effects such as nausea, vomiting, diarrhea, decreased no appetite, and lethargy may occur typically 2-5 days following chemotherapy treatment. Chemotherapy's effects on bone marrow may cause a temporary decrease in the ability for the immune system to fight external diseases. This is expected to happen, but not to a severe degree. It will not effect your pet’s ability to enjoy the dog park or their favorite muddy puddle. Complete blood counts (CBC) are monitored throughout treatment to ensure that our pet patients' cell counts stay at a good level where they are not at increased risk of infection. If white blood cell counts drop too low, we can alter the dosage for subsequent treatments to avoid this in the future. It is not uncommon for chemotherapy to be delayed to allow the bone marrow more time to recover. Hair loss is minimal and may be seen in dogs that are non-shedding or wire-haired breeds, yet typically is not significant. Terrier or poodle breeds or mixes may experience more hair loss than other breeds. Chemotherapy is used or recommended in many different types of cancer in pets. It can be used alone or in combination with other treatments, such as surgery and radiation therapy. It can be used when surgery is not possible or cancer is advanced, to shrink large tumors prior to surgery, to treat certain cancer types (such as lymphoma) alone, or can be used following local treatment (surgery or radiation therapy) of a tumor to delay or prevent cancer spread to other parts of the body (metastasis).

Electrochemotherapy

Electrochemotherapy is an alternative local therapy when radiation therapy is not feasible or recommended in certain cases. This is typically used following surgery to prevent or delay regrowth of certain cancer types and sometimes can be used as a solo treatment. Electrochemotherapy combines traditional chemotherapy in conjunction with electrical pulses, which causes the cancer cells to be more permeable. This allows the chemotherapy to be absorbed into and kill the cancer cells. Patients are sedated for the procedure. This generally entails a systemic (intravenous) injection and a local injection (into the tumor site) of chemotherapy. This is followed by an electric pulse to help the cells in that area absorb the chemotherapy. Some redness or swelling can be seen after the injection for a day or two after the treatment. This can be a very effective treatment in some tumor types and in some situations. This is generally well tolerated and rarely, if ever, causes systemic side effects from the chemotherapy itself.

Radiation Oncology

CASE offers cutting-edge technology as one of the few veterinary hospitals utilizing a Varian Halcyon linear accelerator. This allows for delivery of advanced radiation with extreme precision, resulting in decreased radiation to the adjacent normal tissues and less side effects while still delivering accurate doses of radiation to the tumor.

We offer Intensity modulated radiation therapy (IMRT), Volumetric arc therapy (VMAT), Stereotactic radiation therapy (SRT), and Stereotactic radiosurgery (SRS).

Types of Radiation Therapy

There are 2 main intents of radiation therapy: palliative and definitive.

Definitive intent radiation is utilized when there is a potential for long-term control of a tumor.

  • Finely fractionated radiation consists of delivery of small daily doses given Monday through Friday over 3-4 weeks.
  • Stereotactic radiation is another definitive methodology that is highly specialized and typically delivered over 1-5 closely scheduled treatments.     

Palliative radiation therapy consists of fewer larger doses (fractions) of radiation with the intent to alleviate pain and clinical signs associated with the tumor. Palliative radiation therapy is used to improve the patient’s quality of life and typically does not have long term control.

The exception is Coarse Fractionated radiation therapy. This therapy uses larger doses per fraction, as in palliative therapy, however the goal is definitive/long term control. There are certain tumors that respond better to this type of protocol such as melanoma.

Advanced Treatment Modalities

Intensity-Modulated Radiation Therapy is a sophisticated form radiation planning. IMRT can be used when delivering definitive (finely fractionated or stereotactic radiation therapy) or palliative intent radiation therapy. CASE is currently one of only two veterinary hospitals in Colorado to offer the treatment. IMRT allows for the radiation dose to conform to the shape of the tumor by modulating (adjusting) the intensity of the radiation beams. The individualized radiation plan utilizing IMRT is intended to maximize the dose delivered to the tumor while simultaneously protecting the surrounding normal tissue.

IMRT also improves the ability to conform the treatment to tumor shapes, for example when a tumor is wrapped around a vulnerable structure such as the spinal cord, a major organ, or blood vessel. The net effect is that radiation doses can be “wrapped” around tumors, or “painted” within tumors, far more precisely than was previously possible. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. Radiation therapy in general is often used in conjunction with surgery and/or chemotherapy.

Stereotactic radiation therapy (SRT) is a highly specialized form of radiation delivery that delivers 1-5 highly conformal doses of radiation to a tumor with submillimeter accuracy.

Multiple terms have been used for stereotactic-based radiation that includes stereotactic radiosurgery (SRS), stereotactic ablative radiation therapy (SABR), and stereotactic body radiation therapy (SBRT). In a purest sense, SRS is used when describing a single high dose of radiation delivered to a lesion in the brain. Stereotactic body radiation is used to describe when delivering high dose radiation over 1-5 treatments outside the brain. 

Image guided radiation therapy (IGRT) uses images of the patient at the time of treatment to determine the accuracy of setup so that corrections can be made in real time before the treatment is delivered. Our system uses cone beam-CT scans (CBCT) to confirm patient positioning to within millimeters of error.

Volumetric modulated Arc Therapy is an innovative form of intensity modulated radiation therapy (IMRT) that delivers precise continuous radiation in a single or multi-arc treatment to patient. With conventional IMRT techniques like step-and-shoot, the machine must make repeated stops and starts to treat the tumor from a number of different angles generally over 5-10 minutes. In comparison, VMAT can deliver the dose to the entire tumor in a 360-degree rotation, typically under two minutes.

Our Doctors

BROOKE FOWLER

DVM, MS, DACVIM (ONCOLOGY)

ANNIE GALLOWAY

DVM, MS, DACVIM (ONCOLOGY)

LYNDSAY KUBICEK

DVM, DACVR (Radiation Oncology)

CASSANDRA PRPICH

BVSc, MANZCVS (SAIM), DACVS-SA, ACVS Fellow, Surgical Oncology

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