Talking to Clients about Cancer

Chapter 69

Talking to Clients about Cancer

Cancer is being treated more and more frequently in the primary care setting. Furthermore, the primary care veterinarian often makes a diagnosis of cancer and performs initial client education. Critically important life-or-death decisions regarding euthanasia, treatment, pursuit of referral, and so on may be made based on information from the primary veterinarian. There is a stigma attached to a cancer diagnosis, and owners of pets with cancer may anthropomorphize and equate cancer treatment in animals with experiences they may have had. Being able to address these concerns succinctly and dispel some of the myths that owners may have is a critical component of cancer management in the primary care setting, whether the pet is to be treated in the primary care clinic or referred elsewhere. The following questions and answers between a pet owner and a veterinary caregiver illustrate some ways to discuss these issues with clients.

Did Something in the Environment Play a Role in My Pet’s Cancer? Was I Feeding the Wrong Food?

Some weak associations have been proposed between certain types of cancer and environmental influences. These include an association between herbicide or insecticide exposure and transitional cell carcinoma risk in Scottish terriers, exposure to environmental tobacco smoke and gastrointestinal lymphoma risk in cats, and exposure to the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) and lymphoma risk in dogs. In the vast majority of cases, no such association can be made, and most of the studies reporting environmental associations with cancer have been small and their results have not been verified independently. Thus for the most part there are no confirmed strong associations between environmental or dietary factors and cancer risk in animals.

Do We Have to Do That for This Lump Now? Can’t We Just Wait and See What Happens?

Owners may use such a phrase regarding initial diagnostic testing (“Let’s wait and see if it grows”), additional surgery or other treatments to prevent local recurrence after incomplete excision (“Let’s wait and see if it grows back”), or therapy to delay or prevent metastasis (“Let’s wait and see if it spreads”). All of these statements may require discussion with owners to promote early and appropriate diagnostic testing and therapy.

Let’s wait and see if it grows: In general, delay in reaching a diagnosis serves only to increase the difficulty of surgery and, potentially, the likelihood of metastasis. The lump that has been found may very well be nothing, but if it is a malignancy, the time to find that out is sooner rather than later.

Let’s wait and see if it grows back: Locally recurrent tumors are associated statistically with a worse prognosis in certain diseases and suspected of carrying a worse prognosis in others. For this reason, the time to pursue aggressive local therapy is the very first time the tumor occurs.

Let’s wait and see if it spreads: In general, treatment of gross metastatic disease is palliative at best. Asking drugs to treat bulky metastatic disease is asking a lot, but asking those same drugs to have an effect against microscopic tumor cells in the lung or lymph node may be much more reasonable.

Doesn’t Performing Fine-Needle Aspiration or Biopsy Irritate the Tumor and Increase the Risk of Spread?

Fine-needle aspiration or biopsy does not make the tumor more likely to spread. Getting from the primary tumor into the bloodstream is only one of many steps in the “metastatic decathlon.” Exceptions to this rule are the following: (1) Some mast cell tumors may become inflamed following fine-needle aspiration because of degranulation and histamine release, although this in no way hastens metastasis. This is rarely serious and can be treated or prevented by administering a histamine H1 blocker. (2) Transabdominal needle aspiration or needle-core biopsy of splenic and bladder masses is contraindicated because of the risk of local dissemination in the abdomen or seeding of the biopsy tract.

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Jul 18, 2016 | Posted by in PHARMACOLOGY, TOXICOLOGY & THERAPEUTICS | Comments Off on Talking to Clients about Cancer

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