24 Hour Emergency Care 215-750-2774

The “belly,” or the body area that contains the stomach, kidney, liver, intestines, gallbladder, pancreas, and so on.

A radiological technique that uses high-energy sound waves to create a picture called a sonogram. The sonogram shows the size and shape of organs and also their echogenicity. Variations from the expected norm can lead to a suspicion of an abnormality such as cancer. Ultrasound can be used for staging and also to help guide sampling of tumors via tru-cut biopsy and fine needle aspiration.

A rapidly progressing cancer derived from bone marrow cells that causes large numbers of white blood cells to infiltrate the bone marrow and blood.

An aggressive, rapidly progressing cancer of immature white blood cells called lymph cells (lymphoblasts). These cells infiltrate the blood, bone marrow, and other lymph organs.

An aggressive, rapidly progressing cancer of white blood cells that are not lymph cells. These cells are found in the bone marrow and infiltrate bone marrow and blood.

Cancer that begins in the linings of the internal organs that have gland-like properties. Breast and thyroid cancers are most often adenocarcinoma, as an example.

Cancer treatment given after the definitive treatment to remove the primary tumor. This is given to hopefully “mop up” residual disease and lower the risk of the tumor from recurring or spreading. Adjuvant therapy can include chemotherapy, radiation therapy, targeted therapy, or immunolical/biological therapies.

A drug used to treat many types of cancer, including lymphoma. This drug is also called doxorubicin.

A type of drug used to treat cancer that interferes with DNA and inbibits cancer cell growth. This is a large class of drugs that includes lomustine (CCNU), alkeran (melphalan), and cyclophosphamide (cytoxan).

The lack or loss of hair from areas of the body where hair is usually found. Alopecia can be a side effect of some cancer treatments.

These are treatments used in place of standard therapy. Most are not recognized by the standard medical community because data about effectiveness and safety are usually lacking in peer-reviewed medical journals. If these treatments were proven to be as effective as or more effective than the standard treatments available, then they would replace the standard treatments. The medical community may consider some of these treatments as complementary (used in addition to traditional treatment) if there is some potential benefit and very low risk.

Melanoma is usually pigmented (brown). 15-20% are not pigmented. These are called amelanotic.

Cancer cells that have little to no resemblance to normal cells. These tend to behave more aggressively.

Blood vessel growth and formation. Tumor angiogenesis means growth of new blood vessels to supply the tumor with nutrients needed to grow. Chemical factors are secreted by the tumor and surrounding tissues to signal a need for new blood vessel growth. Blocking tumor angiogenesis is one strategy for attacking a tumor, since tumors need blood vessels to grow larger.

Preventing new blood vessel growth.

A drug that prevents nausea and vomiting.

Substances that inhibit cell damage caused by free radical formation. Free radicals are unstable molecules that can damage DNA. While part of cancer prevention involves preventing free radical damage, oxidative or free radical damage is one mechanism by which certain treatments work. Therefore, always discuss with your veterinarian whether it’s appropriate to use antioxidants during treatment.

This is abnormal fluid accumulation in the abdomen and may occur with certain cancers in more advanced stages. A state called carcinomatosis where cancer cells line the surfaces of the abdomen can often lead to ascites. Treatment may include draining the fluid and using intracavitary chemotherapy - chemotherapy given directly into the abdomen.

A drug used for leukemia and lymphoma that is an enzyme from the bacterium Escherichia coli that breaks down the amino acid asparagine. Depleting the amount of available asparagine blocks tumor growth for tumors that need asparagine to grow that cannot produce their own. Also called Elspar

A type of lymphocyte. B cell lymphoma is the most common type of lymphoma and generally carries a better prognosis than T cell lymphoma. That being said, there are different types of B cell lymphoma, and prognosis and treatment can depend on the specific subtype.

This is a protein secreted by plasma cells and is found in the urine of most patients with multiple myeloma. It is one of the 4 criteria that help make a diagnosis of multiple myeloma.

Benign tumors are not cancerous. They may grow large but do not spread to distant sites.

This is a drug that is used to treat bone pain caused by certain tumor types such as osteosarcoma (bone cancer) .

An immature blood cell

A blood test used to check the number of red and white blood cells. It also gives a platelet count. Also known as a CBC.

A blood test that measures levels of electrolytes, kidney values, and liver enzymes in the body.

Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).

This is a procedure whereby a small sample of bone marrow is taken from the center of one of the bones for cytological evaluation. We apply local anesthetic and provide pain medication for the procedure as it involves inserting a needle into the center of a bone, and this can be painful. This test is most useful for lymphoma, leukemia and myeloma patients, though it is sometimes recommended for patients with abnormal cell counts, if the cause is unknown.

Bone marrow transplant is a procedure now available for dogs suffering from lymphoma. Bone marrow transplant procedures were originally optimized in laboratory dogs; only recently has it been offered as a clinical treatment option. Cost, toxicity risk, limited availability, and lack of published studies showing an outcome advantage in canine patients make this treatment still experimental and not for every patient and owner.

Bone marrow transplantation, in conjunction with chemotherapy, has significantly improved survival and outcome in human cancer patients. Our hope in the veterinary community is that the cure rate in canine patients can be improved to 40% or greater. Hopefully in 1 to 2 years, we will have more data to show whether this is the case.

Canine bone marrow transplants are currently offered at North Carolina State University. If we have an interested client, we work with Dr. Suter from NC State to make sure the procedure goes as smoothly as possible. For more information, please make an appointment to speak with us.

So what is a bone marrow transplant? A bone marrow transplant delivers healthy bone marrow stem cells into the patient. It replaces bone marrow that is either not working properly or has been destroyed (ablated) by chemotherapy or radiation.

Bone marrow is a soft, fatty substance in the middle of bones. Stem cells are immature cells in the bone marrow that can grow and differentiate into red blood cells, white blood cells, or platelets. With bone marrow transplant, you receive healthy stems cells to repopulate your bone marrow after it has been destroyed by medication or radiation.

Prior to transplant, high dose chemotherapy and/or radiation is used to kill cancer cells. After this, the bone marrow transplant occurs to allow blood cell lines to again grow.

It is important to note that bone marrow transplant is risky. Systemic infection, internal bleeding, diarrhea, nausea, vomiting, pain, damage to other organs, cataracts, and death are possible risks. Patients need to stay in the hospital and be closely monitored and treated. Blood transfusions are sometimes needed. Possible results include complete cure, prolonged remission of disease, or death.

Loss of body weight and muscle mass, and weakness that may occur in patients with cancer, AIDS, or other chronic diseases.

It is important to first know that cancer is a broad term for a large group of related diseases, each one having its own expected outcome, course, and treatment. The body is made of different cell types that normally grow, divide, and die in an orderly fashion to keep the body’s systems running smoothly (homeostasis). The body has a “check and balance” system to keep the processes orderly. However, sometimes this system breaks down. Cells form when the body doesn’t need them. Cells spread and invade tissues where they don’t belong. The systems that usually signal to have such cells die remain unheeded. This result is a growth of tissue that may be benign (not cancerous) or malignant.

What causes cancer?

The body has a “check and balance” system that regulates the growth and death of cells. This system is highly complex and involves multiple factors that can signal cells to grow or die. The body has a genetic code that ultimately controls everything. Sometimes, the genetic code is mutated in a fashion that affects these systems. Sometimes tumor suppressor genes become dysfunctional. Sometimes the molecules that bind to these genes and alter their behavior like “on” or “off” switches are disarrayed, leading to unchecked cell growth.

These processes can be disordered from birth, meaning genetics can play a role. Certain breeds are predisposed to certain tumor types. Dogs are more inbred than humans, and this element is likely quite strong. A common sire for many dogs may have carried a genetic mutation that, combined with additional factor, allowed his offspring to be more likely to develop cancer.

These processes can also be affected by environmental factors. Studies have shown that diet, exposure to cigarette smoke, exercise, exposure to sunlight (UV radiation), and exposure to carcinogens (such as pesticides or asbestos) can damage the genes that protect us from unregulated cell growth and promote the development of cancer. Even viruses, like feline leukemia virus, can increase the risk of cancer. Most likely, in each case there is a combination of factors.

Can cancer be prevented?

Yes and no. As a rule, cancer does what it wants. You can do everything right and still have your pet diagnosed with cancer. However, you can reduce the risk of cancer by:

• Not using tobacco products and exposing your pet to second-hand smoke
• Feeding a high quality diet low in carbohydrates and high in good quality protein.
• Keeping your pet in optimal body condition and allowing regular exercise
• For cats, vaccinating on an every 3 year schedule to reduce risk of developing injection site sarcomas
• Using the most recent and veterinary recommended pesticides for common parasites and pests
• Having your pet evaluated by a veterinarian 1-2 times per year or sooner if you note any new lumps or bumps. Early detection and diagnosis is key.

Cancer that originates from skin or tissues that line or cover internal organs. These cancers still have varied behaviors but as a group also have behavioral similarities.

A metric measure of length. There are 2.2 centimeters per inch.

Medical treatment with drugs that kill cancer cells. Many different classes of drugs fall under this umbrella category.

Clinical trials are research studies. They test hypotheses about new treatments for a specific disease. They are designed to answer scientific questions and, hopefully, find better ways to treat patients. Participating in a clinical trial allows you and your pet to contribute to the advancement of treatment for cancer patients. The hope is that the novel treatment may benefit your pet. However, there are no guarantees.

There are several types of clinical trials:

Prevention trials test new approaches. Prevention trials are rare in veterinary medicine but evaluate the use of supplements or medicines that may lower cancer risk. These are larger trials run over longer periods of time that start with healthy pets.

Diagnostic or Screening trials are designed to evaluate diagnostics to determine better ways to detect and monitor cancer. These often provide no immediate benefit to a patient but have large potential to positively affect treatment outcome of other patients in the future.

Genetics trials are often breed-specific and used to study a tumor type in a particular breed. Treatment trials involve patients diagnosed with cancer and are designed to specifically answer questions about a new treatment or new method of treatment.

How are patients protected?

Research is conducted according to strict scientific and ethical principles. Clinical trials should have a written protocol that serves as a unifying plan of action. This describes expected diagnostics and treatments, expected benefits and risks. This protocol is like a recipe that should be followed by every participating patient and veterinarian.

To participate, a client must have an eligible patient as specified in the study protocol. The client must be able to read and understand the client consent form and be aware of the potential benefits and risks of the study. Informed consent is crucial.

How are trials conducted?

Clinical trials are usually conducted in a series of steps, called phases.

Phase I studies are the first step. These are usually “dose finding” studies. The starting dose is usually lower than that expected to be toxic and, potentially, effective. The dose is then escalated as the study progresses to determine the maximum tolerated dose. Sometimes the starting dose is too high and de-escalation occurs.

Phase II trials study the effectiveness and safety of a treatment on a particular cancer.

Phase III trials are larger studies to compare a new treatment to the current standard treatment. Participants are randomly assigned to one arm of the study or the other. Phase III trials usually only start after phase I and II testing show promise for a particular medication and only after a standard starting does is known.

Phase IV trials are rarer but are used to conduct long-term safety evaluation and additionally confirm the effectiveness of a treatment.

What are some of the benefits of taking part in a clinical trial?

• Participants have access to potentially promising new treatments unavailable outside the clinical setting.
• Patients receive regular medical attention from a research team with testing that is often above and beyond that normally performed with treatment.
• Results from the study contribute to the larger body of cancer research and knowledge and may directly benefit others in the future who have the same disease.
• Sometimes there are financial rewards and coverage of the cost of treatment. While this is not the best reason to have your pet in a clinical trial, sometimes the financial benefits can help an owner to treat his or her pet.

What are some of the possible risks associated with taking part in a clinical trial?

• The new treatment may not be effective or better than the standard treatment.
• There may be unknown side effects or long-term risks, including death.
• n randomized studies, the client is not able to choose which treatment is received.
• More visits and follow-ups are usually required. Autopsies may also be required.

What are some questions you should ask?

• What is the purpose of the study?
• Do the researchers think this is an effective approach? Is there any previous data to indicate the treatment may be effective?
• Who sponsors the study?
• What are the obligations of the client in terms of frequency of appointments and costs?
• How is the safety of patients being monitored?
• How long will the study last?
• What are the expected short and long-term benefits? Risks?
• What are other treatment options available?
• What are the expected tests?
• Who is in charge of patient care?
• Is travel expected or involved?
• What if we change our minds?

Where can people find more information about clinical trials?

The best source is a good veterinary oncologist who is up to date on the latest clinical trials. At CARES, we Keep a list of trials that may be of benefit to our patients and can explain the benefits and risks. Essentially, if you are our patient, we want you to be aware of the benefits and risks so that you can make the best decisions for your pets, just as we would do for our own.

A method for providing the use of an investigational treatment to a patient not able to receive it otherwise and has a serious illness for which other treatment is not available

The disappearance of all signs of cancer after treatment. This does not mean cure. It means we can no longer detect cancer in the patient.

A steroid hormone made in the adrenal cortex that can also be created synthetically and given as a treatment. They are often used as anti-inflammatories and as part of treatment for certain kinds of cancer, such as lymphoma.

A radiographic study that provides detailed pictures of organs inside the body.

A drug used to treat many types of cancer. Doxorubicin comes from the bacterium Streptomyces peucetius and damages DNA. It is a type of anthracycline antitumor antibiotic.

A lab technique used to evaluate the number of cells in a sample, the percentage of living cells, and specific cell characteristics. It can be used to more accurately diagnose a tumor using tumor markers.

Pathologists evaluate biopsy samples to determine tumor grade. They look under the microscope at stained cells from a tumor and evaluate specific features that help determine how quickly a tumor may grow or spread. Factors that affect determination of grade vary from cancer to cancer. In general, well differentiated tumors that look like the tissue from which the cells arose tends to behave less aggressively. Tumor grade should not be confused with stage.

An alternative approach to treatment based on the belief that using natural substances in very small amounts can restore health. According to the beliefs of homeopathy, for a remedy to be effective it must cause the same symptoms in a healthy individual as those being treated in a patient.

The study of diseased cells and tissues using a microscope.

A technique used to identify specific molecules in different kinds of tissue. The tissue is treated with antibodies that bind the specific molecule. These are made visible under a microscope by using a color reaction, a radioisotope, colloidal gold, or a fluorescent dye. Immunohistochemistry is used to help diagnose diseases, such as cancer, and to detect the presence of microorganisms. It is also used in basic research to understand how cells grow and differentiate (become more specialized).

Treatment to boost or restore the immune system’s ability to fight cancer.

Enlarged or swollen lymph glands.

Malignancy is from the Latin roots mal- = "bad" and -genus = "born". Malignant tumors behave aggressively and tend to be locally invasive and spread (metastasize) to distant sites. They are the “bad characters” of the cancer world. They tend to have a more rapid course and require more intense treatment. Malignancy can be presumed if diagnostics show definitive evidence of metastatic spread; however, the diagnosis of malignancy is usually achieved by evaluation of a biopsy or cytology sample from the mass in question. Pathologists look at these samples for cancerous cells that have invaded into normal tissue structures. They also look for how similar or different (anaplastic) the cancer cells look compared to the normal tissue structure from whence they arose. Sometimes, they are so bizarre the tissue of origin is hard to determine. They also look for mitotic figures, cells that are in the process of active division and replication. In general, the more mitotic figures and the less the cancer cells look like normal tissue cells, the more likely that the tumor will behave aggressively.

The time from either diagnosis or start-of-treatment (usual for chemotherapy studies) at which ½ of the patients diagnosed with a given disease are expected to still be alive. This is one type of average. Medians are used more often in cancer medicine because they provide a more accurate reflection of outcome. In real life, we are more accustomed to using means. Here’s an example of the difference. There are 11 patients treated with x. 10 of those patients live 1 year. The 11th patient lives 10 years. The expected median survival for this population of patients is 1 year. The mean survival is 1.8 years, almost double the median. Since 10/11 patients survived only one year, the median is clearly a more accurate indication of what a patient might expect if treated with x, though more prolonged survival is obviously possible.

Metastasis is spread of tumor from a primary site to a secondary site in the body. This term is used most often for solid tumors such as sarcomas and carcinomas. One of the most common sites of metastatic spread is the lungs. Cats and dogs don’t smoke and therefore have a lower risk of primary lung tumors; therefore, most lung tumors in veterinary patients are usually metastatic spread from a primary site. Another common location for metastatic spread is the liver. Lymph nodes are another common site. The pattern of metastatic spread may be different depending on the tumor type. In general, metastastic disease at diagnosis warrants a worse prognosis and outcome for most cancer patients. One exception is lymphoma. Lymphoma is a systemic disease, and we usually expect lymphoma patients to present with multiple lymph nodes, the liver, and the spleen affected.

Continuous or frequent treatment with low doses of anticancer drugs, often given with other methods of therapy.

A dietary supplement believed to have health benefits.

Relief of the symptoms of cancer. Palliative care is given to improve quality of life by treating the symptoms of cancer. It does not necessarily treat the cancer itself.

Treatment with drugs activated when exposed to light. The activated drugs can kill tumor cells and cause necrosis and death of a tumor.

The length of time usually from start of treatment in which a disease does not get worse.

The use of high-energy radiation to kill cancer cells. The radiation source is usually a machine (external-beam radiation) that delivers radiation to the patient’s tumor. Radioactive materials may also be placed in the body near the cancer site. Radiation is used to provide local control of a tumor. It is most effective for tumors highly sensitive to it, or in addition to a surgery that has reduced the tumor burden to microscopic.

Reduction or disappearance of signs of cancer. In partial remission, some but not all signs have disappeared. In complete remission, all signs disappear. The hope with a complete remission is that all cancer has in fact gone, but this is often not the case. With only a few million cells left in the body, cancer is difficult if not impossible to detect. Thus, cure is something that is proven with time, and most patients after successful treatment are declared to be in a complete remission, not cured.

A cancer of the muscle, bone, fat, cartilage, blood vessels, or other connective or supportive tissue. These are more common in veterinary patients than in human ones.

Cancer stage is determined by diagnostics performed to determine the extent of a tumor’s spread in the body. Staging is different depending on tumor type and expected behavior but is generally predicated on tumor size and location, lymph node involvement, spread of cancer to other organs, invasiveness, and number of tumors. The importance of staging varies among tumors. With canine lymphoma, for instance, little difference exists in terms of outcome for a stage 3 versus stage 4 tumor, and patients rarely present with a stage 1 or 2 tumor. For oral melanoma, there are vast differences in expected outcome and survival based on stage.

The body is made of many types of cells. These cells divide, grow, and die in an orderly process to maintain homeostasis or balance within the body. When cells continue to grow beyond what is needed, a tumor forms. This can be a benign growth (proliferation, hyperplasia) or malignant (cancerous). Cancer is by nature disordered. Cells grow haphazardly, and the “check and balance” system normally used to control the process and allow the cells to naturally die is in disarray. Cells in malignant tumors (cancer) are abnormal and divide without order. They invade normal tissues and destroy them. These cells also sometimes “shed” from the main tumor and are released into the blood supply and lymphatic systems that spread through the body. Tumor cells can be carried to distant sites, such as the lungs or liver. There they can potentially lodge and form new colonies of cells and grow into masses in other tissues.

A class of drugs that interfere with cell signaling and therefore theoretically prevent tumor growth. Masitinib and Palladia are two examples of these kinds of drugs.

This is also called a radiograph. An x-ray is a type of radiation that can pass through the body and make grey scale pictures of internal organs that can help us diagnose disease. Technically, the radiograph is the film upon which the x-rays have made a picture. Radiographs can be useful for determining increased size of organs and the presence of masses. They can show changes in organ structure as well. They are limited in that they cannot diagnose tumors and that organs that are superimposed upon each other cannot be evaluated effectively.