2. Cancer is the major cause of death in pets greater
than 10 years old
45% of all dogs older than 10 years of age die of
cancer
23% of all dogs die of cancer
3. James EWING & BJ Kennedy-
Father of Oncology
TERMINOLOGY
Neoplasms: defined as growth of new cells that
proliferates without control, serves no useful function
and has an orderly arrangement.
Tumour: neoplastic masses that causes swelling on the
body surface.
Cancer: it is specifically referred to the malignant
tumours
Oncology: defined as field of medicine which deals with
cancerous tumors, monitoring its development, diagnosis
and the course of the treatment and follow-up
4. Characteristic Benign Malignant
Shape Round, wart like or Irregular
pedunculated
Metastasis Not present Present
Mitotic figures Less More
Blood supply Less Marked
5. Mesenchymal tumours: tumours derived from connective
tissue (cartilage, bone, muscle, fibrous tissue)
Benign : Name of the tissue (suffix oma) e.g. fibroma
Malignant: name of the tissue (suffix -sarcoma) e.g. fibrosarcoma
Epithelial tumours: tumours derived from embryonic cell
layers viz. mesoderm, endoderm and ectoderm
Benign: Papilloma –Epithelial surface
Polyp -Mucosal surface
Adenoma – Glandular surface
Malignant: name of the tissue (suffix -carcinoma)
6. Undifferentiated tumours: these tumours give no clue
about their cell of origin
Mixed tumours: contains multiple cell types derived
from single or multiple germ layers. E.g.
• Teratomas – contain more than one germ layer
• Mixed mammary tumour – contains epithelial elements
+ mesenchymal elements (Fat, bone, cartilage)
7. Anaplasia of cells (poor cellular and nuclear
disintegration)
Cells are hyperchromatic because of increased DNA
content
Increased nuclear : Cytoplasmic ratio (Becomes 1:1
instead of 1:4 / 1:6)
Numerous mitotic figures (are the chromosomal
aggregations in the mitotic cells)
Basophillic cytoplasm: because of large number of
ribosomes
8. Cancers result because of transformations of
normal proto oncogenes to its mutant form –
ONCOGENES
Target of genetic damage
Growth promoting proto-oncogenes Genes that regulate apoptosis
Growth inhibiting cancer suppressor genes
GENETIC DAMAGE MUST BE NON-LETHAL
9. Self sufficiency in growth signals – coz of production
of oncoproteins which don’t depend on external
signals
Evasion of apoptosis
Limitless replicative potential coz of increase
production of enzyme Telomerase – this enzyme
restores the length of DNA and makes the cell
immortal and continuously dividing.
Sustained angiogenesis
Ability to invade and metastize.
10. Trans coelomic
lymphatics
Localised tumour
Haematogenous
Invasion of extra cellular Matrix
Detached tumour penetrate basement membrane
Integrins helps to bind to ECM Invasion is assisted by secretion
Further Migration also occurs of Proteases
in same manner
11. CELL MEDIATED RESPONSE
Three type of cells are involved
NK cells: first line of defense against tumour cells
Cytotoxic T-lymphocytes (CD8 + T-cells) by recognising
MHC class-I antigens expressed on tumour cells
Activated macrophages
12. HUMORAL RESPONSE
By ADCC (antibody dependent cellular toxicity) - by NK-
CELLS
By activation of complement.
13. 1.)By altered MHC expression
2.)By antigen masking – when complexed with
gyycocalyx molecules
3.)Tolerance
4.)Immunosuppression – tumours produce TGF –
alpha which inhibit proliferation of lymphocytes and
macrophages
14. Heriditary factors:
DOGS : Heriditary multifocal Renal cystadenocarcinoma &
nodular dermatofibrosis in German Shepherd.
Brain Tumors :Boston Terrier & Bull Dog.
Chemicals: Toxins from bracken fern causes urinary
bladder
Radiation : UV-Rays:
Squamous Cell Carcinoma. In ear in white cats.
Squamous Cell Carcinoma in eyes in Herford Cattle
16. CACHEXIA: Loss of body weight, loss of body muscle
& fat.Due to annorexia, nutritional demand of cancer
tissue.
Hypertrophy osteopathy in dogs & cats.
Thrombocytopenia is seen in one-third of all dogs
suffering with cancer.
Anemia & DIC are seen in dogs with
hemengiosarcoma.
Parneoplastic Syndrome: Related to hypercalcemia &
hyperglycemia.
18. Samples can be taken by
Biopsy
Fine needle aspiration
Cytological smears
Exfoliative cytology
19. Tumour associated enzymes, hormones and other
tumour markers in the blood are estimated
Two tumour markers in the blood are –
Carcino-embryonic antigen (CEA)
Alpha-foeto proteins
20.
21. PCR
FISH technique (Flourescent Insitu Hybridisation)
DNA micro array analysis
Gene chip technology
Southern blot analysis
Flow cytometry
Immunocytochemistry
DNA probe analysis
23. What about extent?
What about its stage?
Number of LN involvement
Whether it is metastatic or not?
Lets see….
24. T = primary tumor size or extent
Tis: preinvasive tumor (in situ)
T0: no evidence of tumor
T1: tumor <5 cm in diameter but confined to primary site
T2: tumor >5 cm in diameter or ruptured tumor
T3: infiltrative tumor
a: no bone invasion
b: bone invasion
N = nodes
N0: no evidence of lymph node enlargement
N1: moveable ipsilateral nodes enlarged
N2: moveable contralateral/bilateral nodes enlarged
N3: fixed nodes
M = metastasis
M0: no metastasis
M1: metastasis detected
28. Risks increase with age of patient
Most mortalities resulting from surgery are associated with:
pulmonary emboli
Pneumonia
cardiovascular collapse
primary disease
Other complications include:
Abscesses
wound infections
blood loss
incomplete wound healing
29.
30. Brain tumors
Curative: small pituitary tumors
Longer survival time: intracranial tumors and
spinal lymphomas
Tumors of the nasal cavity
Thyroid tumors
Soft tissue sarcomas
Mast cell tumors
31. Survival of cancer cells at the center of larger
tumors
Local effects to skin, lining of GI tract, and hair
Long term effects:
Necrosis
Non-healing ulcerations
Organ dysfunction
blindness
32. Used prior to surgery to shrink tumor size
Used following surgery to destroy remaining cancer
cells that were left behind
Limitations:
Radiation must be postponed until surgical incision has
completely healed
Cancer cells in the area of scar tissue are often more
resistant to radiation
33.
34. As sole agent As adjunct
Systemic
therapy
cancers Given to
hematologic patients with
malignancies no overt
metastatic evidence of
carcinomas residual cancer
Metastatic sarcomas following
surgery or
radiation
35. Toxicities are particularly against cells of the bone
marrow, GI lining, and hair follicles and can result in:
Immunosuppression
Anemia
Nausea and vomitting
Delayed wound healing
Hair loss
36. Chemotherapy + Radiation Chemotherapy + Surgery
Certain drugs are Shrink large tumors
radiosensitizers prior to surgery
This increases the Help eradicate
efficacy of the radiation microscopic cancer cells
which remain after
Help slow down surgery
metastatic growth
Help slow down
metastatic growth
37.
38. Most effective in the treatment of localized tumors in
combination with radiation or chemotherapy
Used to treat small (<1.0 cm in diameter) benign and
malignant superficial tumors
39. Equally damaging to both cancer and normal cells
Frequency of skin burns and infarcts can be as high
as 45%
40. Hyperthermia + Hyperthermia + Chemo.
Radiation
Some drugs work more
In humans, combining efficiently above normal
these two therapies to body temperatures
treat cancer was found
to double the number of
complete responses Hyperthermia may offer
a protective effect for
In dogs, this normal tissues against
combination improved drug toxicities
the rate of complete
response in primary Some studies have
tumors resulting in shown that combining
prolonged survival time
these therapies actually
However, many dogs increases toxicity
later succumb to
metastatic disease
41.
42. Has been used limitedly in veterinary medicine
Used in dogs with localized, superficial, and
minimally invasive tumors such as those affecting
skin and linings of urinary bladder and oral cavity
43. Inability of light to penetrate deeply into tumor tissue
Tissue retention time of photosensitizers
Patient must remain in subdued light for 4-6 weeks
Not all tumors absorb photosensitizers at same rate
and at same concentration
44. Gene therapy
Anti-angiogenic drugs
Immunotherapy
Alternative therapies
Acupuncture
Massage
Herbal and botanical medicine
46. Inhibit tumor growth by cutting off tumor’s blood
supply
Many of these drugs are in the early stages of clinical
development in the treatment of both human and
canine cancer
48. Acupuncture
Palliative treatment
Pain
Post-op & chemo-induced nausea and vomiting
Massage
May be contraindicated
Herbal and Botanical Medicine
Herbs are used in conjunction with chemotherapy or radiation
to help strengthen the individual and mitigate side effects
49. Often ignored aspect of cancer treatment
Important in treating cancer cachexia
May control growth of certain tumors
Decrease side effects of cancer treatments
50. Animals with cancer have alterations in metabolism
which results in clinical alterations
This occurs early in all cancers and decreases
quality and quantity of life
Broken in four phases
51. Specific nutritional requirements of animals with
cancer is unknown
Nutrients in order of importance
water
calories and protein
minerals and vitamins
52. Carbohydrate metabolism
Tumors preferentially metabolize glucose for energy by
anaerobic glycolysis forming lactate
buildup of lactate results in net energy loss by the body
and net gain by the tumor (uses ATP to convert lactate
to glucose)
53. Protein metabolism
Good source of energy for tumor
Can result in clinically significant deficiency in AA
decreased immune function
surgery healing
decreased GI function
54. Benefits of certain AA
Arginine- decrease tumor growth and metastatic rate in
some rodents
Glycine-shown to decrease cisplatin induced
nephrotoxicity
others as well…
55. Lipid metabolism
Some tumors cells have problems utilizing lipids as fuel
source
fats are usually last to be depleted
type of lipid verses amount of lipid
polyunsaturated n-3 fatty acids
56. Vitamins- some evidence indicate might be helpful in
cancer patients
Retinoids, beta carotene, Vitamin C, D, and E
Minerals- May be helpful
Zinc, Cu, Se, etc…
57. Fiber- insoluble and soluble
Garlic- may help cancer patients
Green/Black tea- Black tea may have soothing
properties associated with radiation-induced oral
mucositis.
Shark cartilage-NO
58. Food aversion- a common outcome of side effects of
cancer and cancer treatments in humans
Difficult to prove it occurs in animals
59. What food to feed?
How to feed the food?
Monitor and reassess feeding plan constantly
(Is the patient getting better)?
60. Ideal diet would have
minimal simple carbohydrates, fiber
highly bioavailable protein with certain AA
higher fat levels with polyunsaturated n-3 fatty acids
adequate levels of antioxidants
a great smell and taste great!
Achieve with homemade diets or various commercial diets
61. Should be discussed constantly with client
Educate client on options
Final humane treatment
62. •Meningioma is the most common primary brain tumor in dogs
and cats.
•Glioma is the most common primary brain tumor in
brachycephalic breeds.
•Seizure is the most common clinical sign of brain tumors in dogs
•Lymphoma is the most common spinal cord tumor in cats,
whereas meningioma is most common in dogs.
• Dogs with peripheral nerve sheath tumors commonly present
with chronic lameness and severe muscle atrophy.
63.
64. Melanoma, squamous cell carcinoma (SCC),
andfibrosarcoma are the most common malignant
oral tumors in dogs;
Approximately 5% of oral tumors in dogs are
benigndental tumors (epulides), which do not
metastasize and warrant an excellent prognosis.
The presence of loose teeth in a patient with
otherwise good dentition warrants a search for oral
neoplasia.
66. Dogs with intranasal tumors are often presented
for unilateral or bilateral nasal discharge that
may be hemorrhagic and is often initially
antibiotic responsive.
Radiation therapy is the primary treatment for
canine intranasal tumors, with a median survival
time of approximately 1 year.
71. • Laryngeal tumors encompass a wide variety of
histologic types but nearly identical clinical signs
ofvoice changes, dyspnea, and cough.
Primary tracheal tumors most frequently lead to
development of chronic cough, stridor, and wheezing.
Advanced diagnostics, including laryngoscopy,
bronchoscopy, and CT or MRI, are often necessary to
definitively diagnose laryngeal and tracheal tumors.
72. Lateral cervical radiograph of a dog with a This bronchoscopic image from a dog demonstrates
spaceoccupying soft tissue mass within the laryngeal a large mass that extends from the wall of the
lumen (arrow). Biopsy of this mass revealed a trachea and nearly occludes the entire tracheal
rhabdomyosarcoma.
lumen.
73.
74. Identification of a solitary, well-circumscribed lung
parenchymal mass with plain radiography in a
middle- aged to older dog or cat should raise
suspicion for a primary lung tumor
Surgical excision is the treatment of choice for
primary lung tumors. Those amenable to complete
resection are associated with longer patient post-
surgical survival time
Thymoma and lymphoma are the most common
tumors of the cranial mediastinum.
88. Most common tumours in female dogs
Can be prevented upto a higher extent by OH
Found with greatest frequency in poodles, boston
terriers, fox terriers, daschunds.
Most commonly occur in middle aged in old dogs
Most common site is caudal mammary gland
89. Normally seen intact and aged bithes (which is due
to hormonal imbalance)
Gross swelling which can be bleeding.
Cytology can also be done but not usually preferred.
Radiographs are taken to rule out malignancy
93. 5-FU (150 mg/m2 IV and cyclophosphamide (100
mg/m2 IV) once weekly for 4 weeks to that of dogs.
Successful in human beings but still unexplored in
canines
94.
95.
96. Dogs less than 6 years of age are more commonly
affected
Usually present in prepuce or vagina but can also be
found on nose or on skin.
Endemic in free roaming dogs
The glans penis and prepuce are often concurrently
affected.
Masses may have a cauliflower-like appearance or be
friable and bleed easily.
These tumours have low metastatic rate.
97. First neoplasm to be successfully transmitted from
one animal to another done by M A Novinsky
Tumour transmitted at coitus by transfer of intact
tumour cells
It is tumour of young dogs (1-6 years of age)
More common in females
Present in vaginal mucosa protude from vulva and in
males protude from prepucial cavity
98. H/O: Stray roaming
Continuous dribbling of urine and frequent licking of
penis by dog
Oozing of blood may be there from prepucial cavity
Cauliflower like friable masses are found on vaginal
or prepucial examination.
99. Cytopathologic sample of a canine TVT. Note the discrete round cells,
somewhat eccentric nuclei, moderate amount of cytoplasm, and characteristic
multiple discrete clear cytoplasmic vacuoles.
101. Most effective approach remains monotherapy with the
tubulin binding agent vincristine.
Vincristine is relatively safe, inexpensive, and provides a
complete and durable response in over 90% to 95% of
treated dogs, typically following two to six weekly treatments.
Vincristine is generally administered at a dosage of 0.5 to
0.75 mg/m2 IV once weekly for three to six treatments.
The anthracycline doxorubicin, at 25 to 30 mg/m2 IV every
21 days for two to three cycles (used in Vincristine resistance
cases)
The genetic damage or mutations must be – Genetic damage must be non-lethal Three classes of regulatory genes
Until recently, nutritional management of cancer patients has not been considered important. This despite the fact that patients not eating is one of the biggest problems facing cancer patients. Therefore, It is now recognized that proper nutritional management is important in treating cancer cachexia (which is a clinical condition due to severe malnutrition) In addition, proper nutrition can control the malignancies of cancer and certain nutrients can help limit the side effects associated with chemotherapy and radiation therapy.
Cancer severely alters the metabolism of proteins, carbohydrates, and lipids in the patient. This results in inefficient uses of nutrients. This occurs early in all cancers and decreases quality and quantity of life. The metabolic and clinical alterations in cancer have been described in four phases…
So to prevent and reverse clinical conditions like cachexia, we need to give the best nutrients available to our patients. Specific nutritional requirements of animals with cancer is unknown but we do know in general what nutrients are needed for healthy animals. What is different in cancer patients is the change in metabolism that occurs as mentioned earlier.
So, Cancer affects carb metabolism. Bottom line on carb metabolism; Tumors preferentially metabolize glucose for energy by anaerobic glycolysis forming lactate. This forces the body to waste energy converting lactate to glucose.
Tumors preferentially use protein for energy at the expense of the host. When protein degradation and loss exceed synthesis you see decreased immune function, decreased GI function, and surgery healing.
However, research has shown that increases in the consumption of certain AA can be beneficial to cancer patients. I’ve just listed a few above, but as more research is done, the benefits of different AA will be discovered So the bottom line is that a diet with moderate amounts of highly bioavailable protein may be of value to the cancer patient.
So, tumor cells readily utilize protein and carbs but tend to have problems utilizing lipids as a energy source. Therefore, they are usually the last to be depleted in the patient. Some research indicates that the type of the fats consumed is more important than the amount of fat, specifically n-3 fatty acids.
Okay, vitamins and minerals. There has been some research on that certain vitamins and minerals (as listed above) can have some positive effects for cancer patients. Although, it seems like as one research study say Vit X does this, another study comes out saying that it does nothing so in my personal opinion that in moderation, supplementation of vitamins and minerals wouldn’t hurt, and may improve the QOL of the patient.
Can’t forget adequate amount of fiber to maintain normal bowel health. Garlic is also commonly mentioned in helping prevent and treat cancer in humans and animals (by inhibiting carcinogens),but no concrete studies on the efficacy. Similarly, there is absolutely no proof that shark cartilage works so we shouldn’t recommend giving that to patients since its expensive and maybe we can save a few sharks in the process.
Okay food aversion . A common phenomenon in human patients, it is the act of the patient associating eating, sight or smell of food (or all three) with unpleasant side effects such as nausea and pain). There has been a lot of anecdotal evidence it occurs in animals and it should be assumed that they do experience food aversion. Food aversion can be avoided by created a feeding plan.
So we have all this wonder nutrition information so now we need to develop a feeding plan. The three main things we want to ask ourselves is what the best food to feed, how to feed the food, and is the patient getting better on this feeding plan we chose? Also, don’t forget none of this matters unless the clients are educated about the importance of nutrition in the management of the cancer.
The ideal diet would have minimal simple carbs, highly bioavailable proteins with the aforementioned AA, and higher fate levels with n-3 fatty acids. It also helps that the food taste great and has a pleasant aroma. There are several commercial veterinary therapeutic foods that provide the key nutrients in appropriate levels. In addition, these requirements can be achieved by homemade diets (sources available in books, online).
Euthanasia should be discussed constantly with the client; before and during cancer treatment is occurring. The client should be educated on all their options available besides euthanasia. Although, sometimes doing everything medically possible is not the best choice for the patient and owner. Therefore, once the client makes the decision for euthanasia, we as doctors should support their decisions in their final kind act toward their pet.
