Frequently Asked Questions
My local veterinarian said that my dog/cat has cancer (thinks they have cancer). Now what?
Answer: An accurate diagnosis is very important to treatment decision-making. Discuss with your veterinarian having a fine-needle aspirate or biopsy performed. Ask about the possibility of referral to a specialist if your pet’s case looks complicated at the beginning. If your veterinarian is not clear on the best course, ask him/her to consult with an oncologist.
When should I get a second opinion?
ANSWER: The best way to get a second opinion is working through your family veterinarian. Ask them for a referral to a board-certified specialist in oncology and ask them to help you with the appointment by providing records and a referral request, if necessary. You may also contact an oncologist directly to request an appointment to have your pet evaluated.
What if there are no oncologists in my area/state/country?
Answer: Oncology is a growing specialty area of veterinary care and there are private practices and veterinary schools offering this service throughout most areas of the USA. In some areas this may involve considerable distances to travel to seek out specialty care. Your veterinarian can call specialists at these schools and practices on your behalf to ask about what the best treatment option would be for your pet with cancer. Depending on the nature of the treatment, some therapy may be able to be offered in your local practice or your pet may need to travel for a specific treatment. It is worth asking whether your pet could stay at a center throughout its therapy e.g some radiation clinics will offer boarding facilities for pets during a course of radiotherapy.
VCS has a searchable database for member professionals that you may access. It includes our members in the US as well as Canada and other countries across the world. We recommend that you only put in your state or country to get a list of professionals in your state or country and then determine how far you are willing to travel for a consult or potential treatment. You will want to look for members whose membership type says PROFESSIONAL MEMBER. If you are in Europe, you may email the European Society of Veterinary Oncology (ESVONC) at email@example.com. They will have many more contacts for you in European countries. Japan also has a veterinary cancer society.
How do I find a reputable oncologist in my area? How do I know if they are really qualified? How important is it to consult a “board certified” oncologist?
ANSWER: Veterinarians certified by the ACVIM in oncology have undergone specialty training, demonstrated their knowledge by passing a challenging examination, and contributed to knowledge of veterinary oncology through scientific publication. These doctors are best trained to manage challenging cancer cases. Board-certified veterinary oncologists can be found in your area at ACVIM.org or on our website at vetcancersociety.org.
If I call an oncologist on the phone about my pet, will they talk to me or do I have to bring the pet in?
I just want some general information and typically the front desk people don’t have that information.
ANSWER: Different specialty clinics handle this differently, although in general you will need to have an appointment at the clinic to speak to an oncologist. Many clinics will have a referral coordinator or veterinary technician that can answer general questions about testing that may be done and costs for assorted tests, as well as how a clinic visit works and what you can expect during that visit.
What should I bring with me to that first appointment with my oncologist?
ANSWER: Please bring a copy of the relevant medical records, all labwork, and any imaging studies that have been made of your animal to the appointment.
What can I expect at a first appointment with an oncologist? What tests might they want to do?
ANSWER: The oncologist will ask you a thorough history and perform a very careful physical examination on your pet. Typically, the treatment plan for your animal will depend on the specific diagnosis, grade, and stage of the cancer. This may mean collecting tissue (biopsy), fine needle aspirates, radiographs, ultrasound, or even CT or MRI scans to identify the aggressiveness of the tumor (grade) and extent of the tumor in the body (stage). It will be important that your pet be healthy enough to undergo therapy, so blood tests will also likely need to be collected, if not performed recently. These may include a complete cell count prior to chemotherapy, a serum chemistry profile to assess organ function, and a urinalysis or culture to assess kidney function and screen for infection.
Will the veterinary oncologist communicate with my local veterinarian? Will they send reports to my veterinarian?
ANSWER: Communication is most typically by phone and referral letter. This may vary somewhat by practice or area, but communication between the specialist and primary health-care team is important. Be sure to specify all the members of your primary health-care team if you see more than one veterinarian regularly so that all can be kept on the same page.
What should I ask the oncologist when I see him/her?
ANSWER: Be sure to ask for information that you need to know to make the best decisions for your pet. For some, as frank a discussion about prognosis as possible is necessary for decision-making. For others, a clear understanding of the risks and effects of the treatment is most important. Request the information that you need to feel you are making the right decisions. Keep in mind that the future of any patient is unknown. The best oncologist will not be able to tell you exactly what to expect. However, experienced specialists are good at helping you understand the range of possibilities to anticipate.
What resources exist that might help me further understand my pet’s illness?
Answer: The best resource for understanding your pet’s illness is your oncologist. He or she has access to the newest and most innovative information about the diagnosis, treatment, and management of cancer in animals. He or she also belongs to a large professional network of colleagues whose expertise is shared through regular scientific meetings and an active list-serve.
There are many websites and books available that share information and experiences relating to cancer in dogs and cats. Resources authored by board certified veterinary oncologists usually contain the most reliable information. For instance, the Veterinary Society of Surgical Oncology website contains information specific to many canine and feline cancers: http://www.vsso.org/Cancer_Information_1.html
Because research is ongoing, it is not possible to keep this information up to date at all times and the information may not apply to your pet’s situation. Treatment options and estimates of prognosis often vary significantly between patients depending on cancer subtype, the presence of cancer spread, and treatment option chosen. Please always consult with your oncologist about whether this information applies to your pet’s situation or whether newer information is available.
What does an oncologist do that my own local vet can’t do?
ANSWER: Oncologists have both specialized knowledge and specialized equipment. They are expert at understanding the status of your pet’s disease and helping you make decisions to maximize quality and quantity of life. They have experience handling the medicines that are used to treat cancer, and minimizing the risks of severe side-effects from those medicines. They have equipment to thoroughly diagnose and safely treat your pet.
Are there resources available to help me pay for treatment?
ANSWER: Many institutions have funds available to help for treatment. There are foundations that offer support for certain diseases and specific treatments. Institutions that conduct cancer clinical trials may have partially or fully funded therapy options for participating in the advancement of cancer care.
What can I expect to pay for an oncology consult? What are typical costs for chemotherapy or other treatment?
Answer: Consultation fees for oncologists vary by hospital or clinic and even where in the country they are located. You can expect to pay anywhere from $125-$250 for an initial consultation. You should be able to get an accurate cost by calling the clinic or hospital directly and asking them what their charge for a consultation and follow up appointments are. Chemotherapy costs can have a wide range as well from as little as $150 per dose up to about $600 per dose. This fee will certainly depend upon the drug used and whether it is oral or IV. Typically, that fee includes all portions of the visit: recheck exam fee, blood work, chemo prep and administration costs, etc. but be sure to ask for specifics when you call or visit. Radiation costs range from $1000- 1800 for a palliative protocol and about $4500-6000 for a curative intent protocol. Surgeries are highly dependent on tumor type and location. Be sure to consult with the surgeon that will likely perform the procedure.
When is it too late to get insurance and will it cover cancer treatment?
Answer: Most veterinary insurance policies do not have an age restriction on when they can be purchased. Insurance policies vary widely both in terms of coverage and in terms of costs. It is important to shop around to see which policy best fits your budget and at the same time provides the best benefits. Ask specific questions of the agent. Read reviews. Most importantly, be informed about what it is that you are purchasing. The best insurance policies are those that cover preventive services (vaccination, fecal exams, spay/neuter) and more common problems such as allergies/ears/eyes/skin etc. A cancer rider can sometimes be purchased separately.
My doctor feels that my pet should take a drug that we can’t get where I am. How do I find/get it?
ANSWER: First, ask your doctor for their recommendation on addressing this concern. It seems that they may have a solution to the problem, as it is unusual to recommend a drug that cannot be obtained. Do they not carry it, or is it that it is not available in your country? If your clinic does not have it, you could ask your doctor for a referral to a clinic that does. Alternatively, ask for other treatment options that your doctor does have.
Are there herbal or holistic remedies for pets who have cancer? What about acupuncture? Are there any studies about these methods in dealing with pets?
Answer: (Referrence: Robinson NG. Complementary and Alternative Medicine for Cancer: The Good, the Bad, and the Dangerous. In Small Animal Clinical Oncology, 5th ed. Editors: Withrow, Vail, Page. Elsevier, 2013.)
There are many types of “herbal or holistic” approaches to cancer. Pet owners seek out various integrative therapies to enhance their pet’s quality of life. It is very important to seek out Veterinarians who are certified in those modalities (Chinese herbal medicine, Homeopathy, Acupuncture) and that Veterinarian must work closely with the pet’s medical oncologist and primary Veterinarian for optimal results and most important “to do no harm.” Many animals have benefitted from an integrative approach of alternative and complementary medicine along with conventional treatment. Most studies on use of various modalities are from the human literature (ex. See NIH website).
Acupuncture has many indications as adjunctive therapy for treatment of cancer. It is very important to be referred to a boarded veterinary oncologist if possible who will perform appropriate diagnostics, make a diagnosis, and give recommendations for treatment options and provide prognosis of your pet. Acupuncture can be used for multiple aspects of cancer care including pain management, appetite stimulation, control of nausea and a variety of other symptoms. Certified Veterinary Acupuncturists can be found in your area through the International Veterinary Acupuncture Society (IVAS) or the American Academy of Veterinary Acupuncture. The Chi Institute and IVAS are sources for Veterinarians certified in Veterinary Herbal Medicine.
It is important to let your veterinarian know of all supplements your pet is taking. They must be evaluated to avoid possible serious reactions with drugs that you pet is currently taking!
What are the most common types of cancer in pets?
Answer: The most common cancers in dogs is mammary tumor. Fortunately, this type can be prevented by spaying. Often, veterinary school or specialty referral hospital websites have information on some of the more common tumors that are seen (lymphoma, osteosarcoma, mast cell tumor, mammary cancer, bladder cancer, to name a few).
Are there environmental factors that contribute to cancer in dogs/cats?
Answer: (reference: Henry JH. “The Etiology of Cancer. Chemical, Physical, and Hormonal Factors” in Small Animal Clinical Oncology fifth ed. Editors Withrow S, Vail D, Page R. Elsevier, 2013)
The 2011 Report on Carcinogens released by the Secretary of the United States department of Health and Human services listed 240 potential carcinogens. Although there is no report for companion animals, it’s reasonable to assume an overlap in pets.
Environment tobacco smoke ETS (second hand smoke) has been studied in dogs and cats. There is mounting evidence suggesting that ETS increases risk of lymphoma in dogs and cats as well as oral squamous cell carcinoma in cats.
Pesticides, herbicides, and insecticides: Results on studies on herbicide 2,4- dichlorophenoxyacetic acid (2,4-D) and incidence of lymphoma in dogs have been mixed. Hayes et al indicated a relationship between disease incidence of lymphoma and number of lawn applications of 2,4-D per year (Environ Res 70:119, 1995). A study in Italy found that living in industrial areas and owner use of chemicals (paints and solvents) was significantly and independently associated with lymphoma (J Vet Intern Med 15:190, 2001). An increased risk of transitional cell carcinoma TCC of the urinary bladder was found in dogs treated with topical insecticides with enhanced risk in overweight dogs (J Toxical Environ Health 28:407, 1989). Bertone et al reported an increased risk of oral squamous cell carcinoma in cats wearing flea collars (J Vet Intern Med 17:557, 2003). In studies of Scottish terriers, exposure to lawn and garden products containing phenoxy herbicides is associated with increased risk of TCC (J Am Vet Med Asso, 224:1290, 2004). It’s recommended to limit exposure of pets to phenoxy herbicides.
Sunlight: Light skin pigmentation and chronic sun exposure are associated with development of squamous cell carcinoma SCC on the face, ears, and nose of white or partial white cats. This may also be the case in some skin SCC in dogs. Pets are at greatest risk of exposure to ultraviolet light at midday and should be protected against sun exposure at this time especially if they are light pigmented breed.
Magnetic fields: Extremely low frequency (<60 Hz) magnetic fields are generated by household appliances, industrial machinery, and electric power lines. Potential link between chronic exposure and development of human childhood cancers has been studied extensively. In one study, the risk of development of lymphoma in dogs was found to be highest in dogs from homes with highest exposure to magnetic fields. Risk was related to both duration and intensity of exposure and was highest in dogs spending more than 25% of the day outdoors. The National Research Council reviewed over 500 studies on cancer risk and exposure to electromagnetic fields in humans and concluded that although there is a weak association between childhood leukemia and exposure to electromagnetic fields, there is no clear evidence of true threat to human health. NRC reported that other factors, including air quality and proximity to high traffic density are more likely to cause cancer than low frequency magnetic fields.
Asbestos: Asbestos exposure is a known risk factor for development of mesothelioma in people and a similar association has been found in dogs whose owners have an asbestos-related hobby or occupation. One study revealed more asbestos bodies were found in dogs with mesothelioma than in control dogs. Pericardial mesothelioma has also been reported in 5 Golden Retrievers unrelated to asbestos exposure.
Do most dogs and cats with cancer end up having surgery?
Answer: Although more cancer is cured with surgery than any modality, it is very important to understand that surgery is not always the best modality (treatment) for every cancer in every individual. Some tumors may respond better with one or a combination of surgery, radiation, chemotherapy, and/or immunotherapy. Some tumors may have “fingers” or “tentacles” that are microscopic. If these extensions are not removed, the tumor most likely will grow back. A tumor must ALWAYS be sent for histopathology after removal to determine the diagnosis and whether the tumor is malignant or benign. Sometimes a simple biopsy before complete removal can make a huge difference in whether or not a larger surgery is even necessary. Also, a simple needle aspirate can make a diagnosis. Histopathology helps answer questions like: Will this grow back? Will this tumor spread? Is there a cure? What additional treatment is necessary to control regrowth or spread of the tumor? What can I do to help make my pet feel better for as long as possible? What if I do nothing?
Are there any statistics available regarding numbers of dogs/cats that are diagnosed with cancer each year?
Answer: It is difficult to determine the exact incidence of cancer in dogs and cats because not all pets obtain medical care or even a definitive diagnosis for cancer. It is estimated, however, that almost 50% of dogs over the age of 10 will develop cancer and approximately 1 in 4 dogs will, at some stage in their life, develop cancer. Generally, there is more information known about cancer in purebred dogs and less information about cancer incidence cats. Below are some articles on this topic.
Review article written in 2013 summarizing the literature on cancer incidence in dogs with a focus on breed specific cancer diagnoses. http://www.hindawi.com/isrn/vs/2013/941275/
Review article written in 1996 summarizing the literature on cancer incidence in dogs. http://epirev.oxfordjournals.org/content/20/2/204.long
Abstract of a publication from 2008 describing cancer incidence in dogs based on a tumor registry in Italy. Data is likely to be different in the US due to higher spay rates, which reduces mammary cancer risk significantly. Access to the full text of the article requires subscription to the Journal of Veterinary Internal Medicine. http://www.ncbi.nlm.nih.gov/pubmed/18564221
Are there breeds of dogs/cats that are more likely to get cancer?
Answer: This is a very good question and one to which the answer is varied. For instance, while golden retrievers seem to be overly represented in the population of pets with cancer, they are a very popular breed hence are frequently seen by veterinarians. Other examples are bladder cancer and histiocytic sarcoma, which is more commonly seen in Scottish Terriers and Bernese Mountain dogs, respectively.
How can I help my pet through cancer related therapy?
Answer: Be an advocate for your pet and always feel comfortable seeking a second opinion. Define what “good quality of life” is for your pet is early in the process that way, it will be easier to assess if your pet starts to lose interest in things that it once enjoying doing. Tell your pet’s veterinarian about any supplements that you are giving your pet that they might not know about. It is important that your veterinarian know about all your pet is being given to ascertain whether there could be harmful interaction with other treatments that are being prescribed.
How do dogs/cats typically respond to treatment? What should I expect? Will they react like humans do to chemotherapy treatments?
Answer: The decisions surrounding the treatment of your pet for cancer can be very challenging but your pet’s oncologist is trained to help you make the correct decisions and support you and your pet through a course of treatment. The response to treatment depends on the type of cancer that your pet has and what treatments are available for it. As there are many forms of cancer there is no general rule on how well an individual patient will respond to therapy but for some cancers, treatment can be very successful. Good quality of life on treatment is paramount for your pet and the side effects of chemotherapy are not comparable to those in humans. Calculating and adjusting doses of chemotherapy drugs, providing supportive care for any side effects and discussing with you about how your pet is feeling and coping with its treatment are part of the special relationship that you and your pet’s oncologist will share throughout the duration of its care.
How do I find out if clinical trials that may be available? Will my doctor know of the trials? Is there a fee to participate or is it free?
Answer: Veterinary Colleges that have an oncology department, as well as a growing number of private referral practices, are involved in some of the most up to date research into cancer in companion animals through their clinical trial programs. Your local veterinarian will know the veterinary colleges and practices in your area and details of clinical trials are usually listed on the university or practice website. There should be a summary of the range of clinical trials ongoing with details about what each involves, the criteria that may make your pet eligible to take part in a particular study and what your responsibilities and commitments (including financially) would be.
The Comparative Oncology Trials Consortium is another very useful resource managed by the National Institute of Health-National Cancer Institute’s Comparative Oncology Program. They have a dedicated website describing their work in supporting clinical trials in over 20 veterinary colleges nationwide into new therapies for canine and human cancer.
VCS also has a searchable clinical trials database that you can access.
What organizations exist that actually fund research in veterinary oncology? Who can I donate to that will fund research?
Answer: There are many organizations that fund research in veterinary oncology. The largest of these are listed below and all accept donations from the public. Additionally, most if not all of the US veterinary schools with oncology programs fund veterinary cancer research. Donations directly to these programs can usually be made by visiting the websites of the individual cancer centers or oncology clinics or by contacting the school’s development officer.