Sunday, January 22, 2023

Bladder Cancer In Dogs Treatment

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Pearls Of Wisdom About Bladder Tumors In Dogs

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I know it can get overwhelming when you and your sweet dog are facing a scary diagnosis like bladder cancer. So let me leave you with a few parting pieces of advice from my years as a veterinarian:

  • You know your dog. If your vet is treating your dog for a UTI and it doesnt seem like your dog is getting better as fast as expected, reach out to your veterinarian. Let him or her know what you are seeing. Be willing to do more diagnostics to get to the bottom of the issue.
  • If your veterinarian suspects a bladder tumor, ask about a CADET BRAF test. It is probably the least stressful way to diagnose a TCC and will find 85% of tumors .
  • Although treatment for transitional cell carcinoma is rarely curative, medications such as Piroxicam and/or chemotherapy can help your dog have a good quality of life for many more months.
  • Stay in close contact with your vet during the treatment period. Ensure you keep him or her informed of any changes with your dog.
  • If you have a high-risk breed of dog such as a Scottie, ask your vet if it would be wise to run the CADET BRAF test as a screening tool every four to six months. Early detection of a TCC allows you to start treatment sooner.

Finally, dont lose hope. I know that no one wants to hear the word cancer in reference to their sweet dog. You cant change the fact that your dog has bladder cancer. But you can try to enjoy every remaining day together to the fullest.

What Treatments Are Available For Bladder Cancer In Dogs

If your dog is diagnosed with bladder cancer your vet may recommend surgery, chemotherapy, radiation or a combination of these treatments. Due to the location of bladder tumors the full surgical removal of the tumor is typically not possible, although in some cases it may be possible to remove part of the tumor in order to temporarily relieve your dog’s symptoms. That said, it’s important to note that the tumor will regrow after a time.

Emerging Diagnostic Tools And Therapies For Bladder Cancer In Canines

Tumor cells and metabolites can be shed into the urine and these molecules may be used for tumor detection.

Bladder cancer represents 2% of all cancers in dogs. Transitional cell carcinoma is the most common type of bladder cancer in canines and is especially malignant. Irrespective of treatment, the long-term prognosis is generally very poor. Its pathology is not well understood, and limited treatment options are available. Recent advances in identifying tumor markers have prompted the introduction of targeted therapies. In the Journal of Veterinary Sciences, the authors detail these advances while focusing on small animal oncology.1

Risk factors such as obesity, female sex, exposure to herbicides and older topical insecticides, and certain breeds are thought to play a role in TTC. Clinical signs of TCC are nonspecific and can include pain or discomfort when urinating, blood in the urine, and frequent urination. These signs mimic urinary tract disorders and concurrent urinary tract infections are often seen. TCC is highly invasive and tumor growth can completely block the passage of urine. Urinary tract obstruction is often lethal and even a normal physical exam cannot rule out the presence of TCC.

Isabella L. Bean is a 2022 PharmD Candidate at the University of Connecticut in Storrs.

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Are Other Tests Necessary

Complete staging is required. Testing includes thoracic radiographs to rule out the spread of cancer to the lungs, lymph node aspirate/biopsy if any lymph nodes are noted to be enlarged, CBC, chemistry panel, and free-catch urinalysis to determine general health, and ultrasound of the bladder and entire abdomen . A free-catch or catheterized urine sample is preferred over a sample obtained by cystocentesis as seeding of the tumor cells can occur with this needle method.

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Frequently Asked Questions By Pet Owners

Bladder Cancer in Dogs

What is bladder cancer?

The most common cancer of the dog urinary bladder is invasive transitional cell carcinoma of intermediate to high grade. TCC is also called urothelial carcinoma. TCC is a malignant tumor that develops from the transitional epithelial cells that line the bladder. In dogs, this tumor invades into the deeper layers of the bladder wall including the muscle layers. As the cancer enlarges in the bladder, it can cause obstruction to the flow of urine from the kidneys to the bladder or from the bladder to the outside of the body. Canine TCC also has the ability to spread to lymph nodes and to other organs in the body . TCC is most frequently found in the bladder, but it can also develop in the kidneys, ureters, prostate, and urethra. In regards to human bladder cancer, most cases fall into two general categories: lower grade, superficial tumors, and higher grade, invasive tumors. It is fortunate that the majority of people with bladder cancer have the lower grade, superficial form of the disease, which typically does not spread beyond the bladder. Dogs, on the other hand, most often develop the higher grade, invasive form of bladder cancer that can grow more quickly and can spread throughout the body.

What causes TCC in dogs?

What clinical signs or symptoms do dogs with TCC have?

How is TCC diagnosed?

What evaluation is needed for a dog with TCC?

How is TCC treated?

What is the prognosis for dogs with TCC?

What symptomatic care can be given to dogs with TCC?

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How Bladder Cancer Is Diagnosed In Dogs

More than 50% of dogs diagnosed with bladder cancer have TCC that involves the urethra. A tumor in the urethra can block urine flow, causing the affected pet to strain while attempting to urinate. If urine is unable to pass through, it can eventually lead to damage to the kidney and possibly kidney failure.

The tumor usually develops in the lower neck of the urinary bladder, which makes surgical removal impossible. This causes a partial or complete obstruction to the flow of urine during urination.

The tumor may be felt by a veterinarian through the abdomen wall if its already large. A digital rectal exam may also reveal tumors in the abdominal lymph nodes if metastasis has occurred. If the tumor has spread to the bones, lameness and/or bone pain can be observed.

After a thorough physical exam, your vet may recommend the following tests to confirm the initial findings:

Types Of Bladder Cancer And Metastatic Disease Potential

Transitional cell carcinoma and leiomyosarcomas are two types of bladder cancer in dogs. Transitional cell carcinoma is the most common, representing 90% to 95% of all bladder tumors. These tumors develop in the transitional epithelial tissue . Leiomyosarcomas arise from smooth muscle tissue, also found in the bladder wall. Bladder cancer can metastasize to the lymph nodes, lungs and liver. As the mass grows, it can crawl up toward the kidneys via the ureters or can grow down into the urethra. If the dog is male, this type of cancer can affect the prostate, as well. In the latter stages of bladder cancer, it can spread to the lungs. An uncommon though benign bladder mass, called a polyp, should also be considered when working up a patient for bladder cancer.

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Treating Bladder Cancer In Dogs

In the past, dogs diagnosed with bladder cancer were usually euthanized because the odds of survival were extremely low. The life expectancies vary, and it’s apparent that the earlier treatment is given, the longer a dog will live. Studies have found dogs die within weeks of their diagnosis while others may live fora few years. It all depends on how much the cancer has progressed and what treatments are given.

If the tumor hasn’t spread to other areasof the body, removal of the tumor is advised. However, this is not always a possibility because the tumor may be in areas where surgical intervention creates additional problems, such as near the urethra.

Radiation has proven effective at slowingtumor growth. There are problems, however, with scarring in the bladderand irritation to other body organs. Therefore, chemotherapy is the most likely treatment method.

There is growing interest in the use of NSAIDs to treat bladder cancer in dogs. Purdue University led a trial where a number of dogs with fourth stage cancer were treated with NSAIDs. Two dogs had the cancer go into full remission. Nine dogs had the tumor shrink by more than 50 percent. Therefore, some veterinarians may mix the use of Chemo with NSAID use.

Standard Treatments For Invuc In Humans And Dogs

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Some of the key features concerning the treatment of InvUC in humans and dogs are summarized in Table 4. In humans, the standard treatment for bladder-confined InvUC is cystectomy, usually combined with neoadjuvant chemotherapy . In half of patients, distant metastases emerge over the next 1â2 years and sometimes later, and the metastatic disease is treated with chemotherapy or immunotherapy . For patients who are not eligible for cystectomy, bladder sparing therapies combining radiation therapy and chemotherapy have been defined .

Table 4. Treatment options for invasive urinary bladder cancer in humans and dogs.

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How Is Bladder Cancer Diagnosed In Dogs

In many cases bladder cancer is first suspected when the veterinarian feels the presence of a tumor in the dog’s abdomen during a routine examination. Tests that can be used to confirm a diagnosis of bladder cancer include:

  • urinalysis to look for cancer cells in the pet’s urine
  • bloodwork to check for impaired kidney function
  • Abdominal ultrasound to look for tumors within the bladder
  • CADET Braf testing

What Can Owners Do To Prevent Bladder Cancer

If you own a high-risk breed, youre probably wondering if there is anything you can do to lower your dogs risk factors.

Dr.Thalheim says that while there isnt anything definitive that will prevent the development of bladder cancer, owners can limit exposure to herbicides and insecticides. She also points to a study that found a link between feeding vegetables three times a week and reduced bladder cancer risk in certain breeds, although owners should be careful to only feed safe vegetables to their dogs and to work with their veterinarian to come up with a dietary plan.

As for breeders, she recommends not breeding dogs diagnosed with TCC/UC and suggests that breeders ask buyers to let them know if their dogs present with TCC/UC later in life.

Dr. Arteaga says that she tells her clients that the same preventative measures human doctors tell patients also apply to dogs. Good exercise, low stress, no secondhand smoke, keeping weight down, and testing any masses that come up, as well as keeping up on a good dental routine may help prevent and catch problems early. She also advises owners and breeders to be diligent about chronic inflammation, like urinary tract infections, as chronic inflammation is a serious concern.

One of the best things owners of senior, at-risk breeds can do, however, is screen their dogs every four to sixmonths using the CADET Braf test.

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How Does Bladder Cancer Progress

Because transitional cell carcinomas are usually located at the neck of the bladder, urinary obstructions are common as the tumor progresses to the final stages. The tumor may block a ureter so urine from the kidney cannot enter the bladder. Or the tumor may block the urethra so that the patient cannot urinate.

A urinary obstruction can quickly become a life-threatening emergency. If at any point, you think your dog cannot urinate, please make an emergency vet visit immediately.

In other cases, the tumor causes so much inflammation and irritation that it affects the patients quality of life. Sadly, I euthanized one of my canine patients a few months after diagnosis because she felt like she had to urinate every twenty minutes. She was so uncomfortable that she wasnt able to sleep.

Some patients may also become sick because of metastatic spread of disease to other parts of the body. TCC can metastasize to lymph nodes, the lungs, bone, and prostate. In the final stages of metastatic bladder cancer, you may see pain, breathing problems, or swelling of limbs due to blockage of the lymphatic vessels.

Monitoring The Immune Response In Dogs With Invuc

An update on diagnosing and treating urinary bladder transitional cell ...

Although the fairly extensive âtool kitâ available to assess immune cells and the activity of the immune system in humans is much more limited in dogs, methods do exist to analyze immune cells and cytokines in circulation and in the tumor masses. A few of those used to study the immune infiltrates in the tumor will be highlighted in this review.

Immune cells infiltrating the tumor can be visualized with IHC . While all of the markers for various immune cells in humans are not available for dogs, CD3 IHC is a popular approach to assess tumor infiltrating lymphocytes in canine cancer, including application to formalin fixed tissues . IHC protocols have also been described to detect regulatory T cells in canine tumors . More specific immune cells can be detected in frozen sections of canine tumors . Using IHC, the pattern of TILs in human InvUC have been classified in some studies as: immune desert , immune excluded , or immune infiltrated , with further distinctions made for the presence of TILs in the stroma in and around the tumor or between tumor cells in the tumor mass . An effective immune attack is expected to require TILs within the tumor mass, and there is great interest in developing strategies to convert the immune desert or immune excluded state to an immune infiltrated state. It is therefore important to note that these same patterns of TILs have been observed in canine InvUC .

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What Is The Prognosis For Bladder Cancer In Dogs

As with any disease, the prognosis is dependent on the extent of the disease, its location and the treatment chosen.

With surgical intervention, an attempt is made to remove as much of the tumor as possible to increase survival time.

Chemotherapy, in addition to surgery, often further improves survival times. Chemotherapy alone may also have benefits.

Palliative treatments like laser ablation , radiation therapy, and urethral stenting can all help improve a pets quality of life.

With appropriate treatment, many dogs with bladder cancer will survive for 6-12 months after diagnosis.

It is important to recognize that with time, transitional cell carcinoma is almost invariably fatal.

What Happens When A Dog Gets Bladder Cancer

In the early stages of urinary bladder cancer, there are usually no serious signs and symptoms. As the disease progresses, it starts to show signs identical to those of a urinary tract infection. The signs include frequent urination, painful urination, bloody urine, producing larger volumes of urine, and more accidents in the house.

Symptoms will improve with anti-bacterial treatment but will soon reemerge. In the event of a bladder infection whose signs persist after treatment, you should seek medical advice and ask your vet to test for bladder cancer.

If treatment for bladder cancer doesnt start in time, it will start to spread to other organs outside the urinary system like the lungs, regional lymph nodes, bones, and others. Over 20% of bladder tumors are caught after metastasis which further worsens the prognosis.

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Other Cellular And Molecular Features

In addition to similarities in the pathologic findings between dogs and humans with invasive TCC, there is evidence for similarities in other cellular and molecular features studied to date . Genomic, cytogenetic, proteomic, metabolomic, and lipidomic analyses are ongoing with initial findings published . The expectation is -omics analyses will subsequently lead to new strategies to improve detection of TCC and preneoplastic lesions, intervene earlier in the course of disease, predict individual patient outcome, and more effectively manage the cancer overall. For example, understanding changes on the surface of epithelial cells that occur in the transition from normal to dysplasia to carcinoma in situ could allow the development of better assays to detect early changes in the cancer process. -Omics analyses are also expected to lead to the identification of new targets for therapy that have not yet been exploited in bladder cancer. Evidence for this comes from a recent report on an integrated genomic analysis that included whole-exome sequencing of 130 human TCC samples and matched normal samples . The investigators reported that the analyses identified potential therapeutic targets in 69% of the tumors and included targets that had not previously attracted attention in TCC treatment approaches.

How Do You Treat Bladder Cancer In Dogs

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The most common treatment options for bladder cancer are surgery, chemotherapy, and radiation therapy. Here is a closer look at different cancer in dogs treatment options.

Surgery. Due to the location of the cancer of the bladder, surgical removal of the tumor is not always an option. Namely, bladder cancer tumors are usually on the lower neck of the bladder , which means there is a high risk of damage. If full surgical removal of the tumor is not possible, surgery is still performed to reduce the size of the bladder tumor . Debulking temporarily improves the dogs quality of life, but the tumor will grow back.

Chemotherapy. Chemo is rarely effective for bladder cancer in dogs. Currently used intravenous chemotherapy protocols are working in only 20% of the pet dogs with bladder cancer. Certain anti-inflammatory medications have anti-neoplastic effects, especially when used in conjunction with chemotherapy.

Radiation Therapy. Radiation therapy is efficient in managing bladder tumor growth. However, the treatment is linked with serious side effects such as shrunken bladder and damage to nearby organs and tissues. This is mainly because the bladder is a fluctuating organ whose size and location vary based on how much urine it holds at the moment.

The best treatment for a dog is very dependent on factors like the type of tumor, location of the tumor, and costs. Your veterinarian should be able to determine the best course of treatment after examining your dog.

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