Canine and feline geriatric oncology honoring the human animal bond 2nd Edition by Laurie Kaplan,Alice Villalobos 9781119290445 1119290449

Chapter 1: Molecular Biology of Cancer and Aging

What Is Cancer? How Does It Start?

Tumor Suppressor Genes, Apoptosis, and Genomics

Cancer and Aging

One Medicine and Cancer Awareness

Epigenetics, Environmental Influences, Toxins, and Risk Factors

Immuno-Oncology or Onco-Immunology

Retroviral and Infectious Disease in Cancer

Endocrine Influences in Tumorigenesis

Feline Injection Site Sarcoma (FISS)

How Cancer Kills

Mechanisms of Metastasis

Angiogenesis

Why Are There So Many Kinds of Cancer?

Diagnostic Molecular Technology

What Are Sarcomas, Carcinomas, and Adenocarcinomas?

Blood Cancer

Carcinomas and Adenocarcinomas in Dogs and Cats

What Can Be Done to Halt Cancer in Pets?

Much Is Left Unsaid and Unaddressed

Ageism

Physiologic and Chronologic Aging Variability

Incidence

Preventable Tumors in Geriatric Pets

Summary

References

Suggested Reading

Chapter 2: Caring for Geriatric Cancer Patients: The Concept of Pawspice and What Is Needed Aside from Medical Care

Age Brings More Complexity and Susceptibility

The Bond Grows Stronger with Age

Individualize Client Character

Sensitivity Self-Assessment

Defining the Human–Animal Bond

Conversing with Clients

Dealing with Inappropriate Depression and Grief

Dealing with Anticipatory Grief

Disenfranchised Grief

Inappropriate Optimism: Keep Reality Buttons in Place

Expect Shock and Dread

Consider Extenuating Circumstances

Pawspice Care Philosophy

Summary

References

Suggested Reading

Part Two

Chapter 3: The Warning Signs of Cancer in Geriatric Pets

Principles and Practice in Geriatric Oncology

Warning Signs of Cancer in Dogs and Cats

Commonly Overlooked Prodromal Warning Signs of Cancer

Oral Cancers are Discovered Late

Warning Signs of Skin Cancer in Cats

Cutaneous Lymphoma: Often Misdiagnosed as Dermatitis

Mast Cell Tumors (MCT)

Rapidly Growing Masses in the Skin

Warning Signs of Mammary Cancer in Dogs

Breast Tumors in Cats: Malignant Mammary Carcinoma

Cancer of the Nasal Passages

Warning Signs of Abdominal Masses

Warning Signs of GI Lymphoma in Cats

Warning Signs of Hepatic Tumors

Warning Signs of Splenic Tumors

Chronic Hematuria Heralds Bladder or Prostate Cancer

Warning Signs of Colon Tumors

Warning Signs of Anal Sac Carcinoma

Dealing with Geriatric Caregivers with Geriatric Pets

Acute Warning Signs

Collapse or Seizures: May Be a Ruptured Abdominal Mass or Brain Tumor

Dyspnea: May Indicate Thoracic Masses or Effusions

Pathological Fracture: May Be Osteosarcoma

Acute Pain or Paresis: May Be from Spinal Cord Tumors

Behavior Changes: May Be from Brain Tumors

Paraneoplastic Syndromes

Anorexia and Hepatic Lipidosis

Thoughts on Feline Anorexia

Cats with Oral Cancer Require Feeding Tubes

Sarcopenia versus Cancer Cachexia, an Insidious PNS

How Cancer Causes Anemia

Hypercalcemia of Malignancy (HM)

Warning Signs of Hypercalcemia of Malignancy (HM)

Workup and Treatment of Hypercalcemia of Malignancy (HM)

Pain Is a Warning Sign and a Paraneoplastic Syndrome

Client Education

References

Suggested Reading

Chapter 4: Basic Types of Cancer and Their Biological Behavior

Introduction

Carcinomas

Sarcomas

Blood (Hematopoietic) Cancer

CNS Tumors

Miscellaneous Tumors and Tumors of Unknown Origin

Approaching Cancer According to Location

Summary

References

Suggested Reading

Chapter 5: Generating the Diagnosis and Prognosis of Cancer in Geriatric Pets

Principles and Perspective for Diagnosis in Geriatric Cancer Patients

Diagnostic Tools and Techniques Used for Diagnosis and Staging Cancer

Fine Needle Aspiration Cytology: A Very Handy but Underutilized Tool

Large Aspiration Needle Chop for Firm Tumors

Characteristics of Cancer in Cytology

Punch and Tru-cut Core Biopsy Needle Techniques

Incisional versus Excisional Surgical Biopsy for Diagnosis

Histopathology Terms: Adequate versus Complete Margins

Intraoperative Cytology

A Word About Unhelpful Diagnostic Abdominal Surgery

Point-of-Service Panels and Cytology of Fresh Blood Smears

Clinical Pathology and the Geriatric Cancer Patient

Imaging Detectable Tumors

Imaging Tumors with Radiography

Imaging Tumors with Ultrasound

Screening Senior and Geriatric Patients with Imaging

Imaging Tumors with CT, MRI, and PET

Positron Emission Tomography

Hybrid Imaging Technology

Nuclear Imaging with Radioisotopes

Bone Scans and Function Scans

Screening Strategy for Active Surveillance

Staging Cancer

Canine Lymphoma Staging System

Phenotyping Lymphoma and Leukemia for Prognosis and Treatment

Tumor Markers for Diagnosis of Cancer and Targeted Therapy

Gene Microarray Results Can Guide Therapeutic Options

Complimentary or Alternative Methods Used in the Diagnosis of Cancer

Summary

References

Part Three

Chapter 6: Treating Cancer in Geriatric Pets

Principles and Philosophic Perspective for Treating Geriatric Cancer Patients

Overview of the Four Musketeers of Cancer Therapy

Unhelpful Surgery

Neoadjuvant and Perioperative Therapy

Novel Approaches

Multimodality, Combinatorial Therapy

What is Integrative Therapy?

The Role of Surgery in Cancer Management and “When Is It Too Much Surgery”

Special Considerations for Surgery

A General Rule of Thumb for Oncologic Surgery

A Letter to Every Surgeon (Please Read Before Recommending Surgery)

Reconstructive Surgery

Summary: The Role of Surgery in Cancer Management

Chemotherapy in the Management of Geriatric Cancer

Handling Chemotherapy Drugs Safely

Classification of Chemotherapy Drugs

Terminology for Applied Chemotherapy

Combination Chemotherapy in Geriatric Pets

Neoadjuvant Chemotherapy

Directed Chemotherapy

Intralesional Chemotherapy

Locoregional Tumor Treatments with Interventional Radiology

Chemotherapy with Rapamycin May Provide Antiaging Benefits

Protocols for Various Tumor Types

Precautions with Specific Chemotherapy Agents

The Treatment Calendar

Summary: Chemotherapy in the Management of Geriatric Cancer

Adverse Effects of Cancer Therapy in Geriatric Pets

Adverse Events Related to Chemotherapy

Treatment for Chemotherapy Toxicity

Summary: Adverse Events of Cancer Therapy in Geriatric Pets

The Role of Radiation Therapy in Cancer Management

Uses of Radiation Therapy

Adverse Events Related to Radiation Therapy

Treatment of Radiation Adverse Events

Multimodality–Multidisciplinary–Combinatorial Therapy

Cancer Drug Resistance and Genomics

Immunotherapy, Cancer Vaccines, and Gene Therapy

Vaccines for Cancer Therapy and Gene Therapy

Suicide Genes

Antiangiogenic Gene Therapy

Clinical Trials in Gene Therapy

Monoclonal Antibodies

Checkpoint Inhibitors, Programed Cell Death Ligands, and Adverse Events

Summary: Immunotherapy, Cancer Vaccines, and Gene Therapy

Antiangiogenesis Therapy with Metronomic Chemotherapy

Chemoprevention and Immunonutrition for Cancer Patients

Confusion and Controversy about Chemoprevention and Immunonutrition

Pets at Risk

Immunonutrition Suggestions

Nutritional Support for Older Cancer Patients

Can Diet Affect Geriatric Cancer Patients?

Summary: Chemoprevention and Immunonutrition for Cancer Patients

Integrative and Alternative Medicine

Accept Clients as Partners in Integrative Decision Making

Herb–Drug Interactions

Summary: Integrative and Alternative Medicine

Electrochemotherapy (ECT)/Electroporation (EP)

Basic Principles

Mechanism of Action

Electrochemotherapy Technique

Equipment, Devices, and Machines

Electrochemotherapy Protocol

Advantages

ECT/EP Approach

Indications

Limitations

Metronomic Chemotherapy in Dogs

Key Points

Introduction

Conventional Chemotherapy versus Metronomic Chemotherapy

Metronomic Chemotherapy

Inflammation and Cancer

NSAIDs in Cancer Treatment

Commonly Used Protocols

Side effects

Clinical Case

Conclusions

References

Suggested Reading

Radiation Oncology

Medical and Surgical Oncology

Herb–Drug Interactions

Electrochemotherapy (ECT)/Electroporation (EP)

Metronomic Chemotherapy in Dogs

Chapter 7: Pain Control for the Geriatric Cancer Patient

Treating Pain Is Good Medicine

Pain Pathways

Cancer-Induced Pain

Nervousness Plus Anxiety Equals Emotional Pain: Go Fear Free!

Short-Acting Immobilization for Chemotherapy

Confronting the Brutality of Pain

Pain Scales and Scoring Charts

Agonist Opioids

NSAIDs for Cancer Pain

Steroids

Psychoactive Pharmaceuticals in Multimodal Therapy for Quality of Life

Integrate Complementary and Alternative Therapy

Fear Free Patient Visits

Multimodality Pain Management

Cats and NSAIDs

Pre-emptive Analgesia for Surgery and Painful Procedures

Using Local Analgesics

Epidurals and Local Pain Control

Perioperative Pain Control

Compounding Pharmacies

Pain Control for Pawspice Care

Adverse Drug Reactions and Interactions in Pain Control

Summary

Cannabis Commentary

References

Suggested Reading

Cannabis Resources

Chapter 8: Decision Making with Advanced and Recurrent Cancer in the Geriatric Patient

Linking Gene Expression to Decision Making for Personalized Cancer Care

The Need for Family Practice Skills

Ethics, Economics, and Empathy Issues

An Inherent Conflict of Interest

How Far Is Too Far?

Patriarchal Practitioners

Framework for Decision Making

Recurrence Bodes an Upset Lifestyle

Aesculapian Authority

Rethinking Advanced Stage Cancer, Recurrence, and Age

Dilemmas During Decision Making

The Veterinarian’s Role in Decision Making

Expect Recurrence and Look for It

Physical Performance Assessment

Frailty, Sarcopenia, Aging, and Cachexia

Dealing with Anemia and Chronic DIC

Other Geriatric Syndromes

Diagnosing Recurrent Cancer

Using Technology for Monitoring Recurrent Cancer

Advanced Stage and Relapsing Lymphoma

Resistant Lymphoma

A Few Words on MOPP Rescue

LoLuC-P: A Low-Cost Protocol for Lymphoma Maintenance

Options Beyond Chemotherapy for Cancer Recurrence

Metronomic Chemotherapy

Recurrent Soft Tissue Sarcoma (STS)

Recurrent Mast Cell Tumors

Options for Clients Who Decline Multiple Surgeries for Recurrent Cancers

Recurrent Hemangiosarcoma

Recurrent, Metastatic Osteosarcoma

Pulmonary Metastatectomy

Recurrent OSA Lesions in the Axial Skeleton

Advanced and Recurrent Mammary Cancer in Dogs

Advanced Stage or Recurrent Mammary Cancer in Cats

Anal Sac Carcinomas, Recurrence, and Metastasis

Residual or Recurrent Nasal Cancer

Multiple Primary Malignancies

The Role of Integrative Medicine in Advanced Stage and Recurrent Cancer

Nutrigenomics, Immunonutrition, and Chemoprevention

Summary

References

Suggested Reading

Chapter 9: When and How to Decide That a Geriatric Cancer Patient Is Terminal

Clarification of Terminology for Terminal

Criteria for Terminal Decision Making

Initial Presentation of a Terminal Case

Hemoabdomen

Osteosarcoma

Advising Deeply Bonded Clients in the End Phase

Attend to the Carer’s Needs

When Do You Use the Word “Terminal”?

The Tumor Is Inoperable, or Is It? Can Stereotactic Radiosurgery Help?

The Long Problem List and Polypharmacy

Healer or Executioner

Chemotherapy for Advanced Stage Geriatric Patients

Palliative Radiation Therapy and SRS for Terminal Patients

Electroporation/Electrochemotherapy for Selected Terminal Patients

Client Consent Forms

The Future is Bright

Summary

References

Chapter 10: Palliative Care: End of Life “Pawspice” Care

What is Aggressive Palliation for Cancer?

Informed Consent and Informed Refusal

Aggressive Palliation and High-Risk Procedures

Pawspice Care for Geriatric Cancer Patients

Reevaluation of Attachment

Home Care 101 for the Pawspice Patient

Pet Aversion to the Caregiver

Willingness: The Essential Ingredient on Both Sides of the Exam Table

The Evolution of Pawspice Philosophy

Education of Home Carers

Assessing Quality of Life Using the “HHHHHMM” (H5M2) QoL Scale

Understanding the HHHHHMM Quality of Life Scale

Help Clients Use the QoL Scale

Satisfaction: An Important Ingredient of Pawspice Care

Pawspice Programs Are Metastasizing

Practical Ideas for Treating Some Specific Disease Conditions

Severe Refractive Vomiting

Severe Pain

Managing Soft and Loose Stools

Immunonutrition and Chemoprevention as Palliative Care

Provide Emotional Support for Carers of Pawspice Pets

Tips for Pawspice/Hospice Patients in Decline

Summary

References

Suggested Reading

Chapter 11: Euthanasia for the Geriatric Cancer Patient

A Philosophy and Principles

Emergency-Related Euthanasia

Cecilia’s Case (Self-Doubt Follows Even Good Decisions)

Planning for Death

Euthanasia Always a Two-Step Process at the Hospital

Do Not Betray the Human–Animal Bond Before Euthanasia!

Suggest a Wake

Compassion and After-Life Services

Dealing with the Pet’s Body for High-Need Clients

Home Euthanasia and Hospice: A Movement in Response to a Need

Compassion Fatigue and Ethics Fatigue

Compassion versus Cure without Care

Posteuthanasia Follow-Up

Sending an After-Life Gift

Sir Walter Scott on the Human–Animal Bond

References

Suggested Reading

Chapter 12: The Veterinary Professional/Client Relationship: Supporting Your Clients – Supporting Yourselves

Background of the End of Life Care/Pet Loss Study

Supporting Your Clients Through the End of Life Care Experience

Information

Resources

Choices

Support

Pet Loss: Supporting Your Clients – Supporting Your Practice

Red Flag Signs

Suicidal Ideation

The Importance of Follow-up

Pet Loss and the Impact on Veterinary Professionals

Compassion Fatigue and Self-Care

Causes and Symptoms of Compassion Fatigue

Compassion Fatigue and the Veterinary Practice

A Self-Care Plan – Managing the Effects of Compassion Fatigue

Creating a Compassionate Practice for Clients and Veterinary Professionals©

References

Chapter 13: Professional Support: The Well-Being of the Veterinarian and the Team

Prioritizing Quality of Life

Filling Our Well-Being Balloons

The Brown Gauze Moment

Mindfulness