Oncology cases are inevitable in clinical practice, therefore some degree of expertise in the diagnosis and treatment of cancer is expected by clients and is an essential component of a comprehensive primary care veterinary practice.
Because oncology patients are frequently of an advanced age, their owners are often highly bonded to them and emotionally distraught after receiving a cancer diagnosis.
Referral of an oncology patient is a multifactorial process that considers the patient’s quality of life and the pet owner’s preferences, emotional attachment to the animal, and the adequacy of his or her physical and financial resources to properly care for the animal.
The primary care clinician, specialist, and pet owner must work together as a unified healthcare team and have a shared understanding of the options, procedures, and expectations of referral treatment.
Once the possibility of a neoplastic process is suspected, determination of the tumor type serves as the basis for all subsequent steps in patient management.
A biopsy is the basic tool that allows removal and examination of cells from the body to determine the presence, cause, or extent of a disease process.
Fine-needle sampling, which may or may not involve aspiration, can be performed safely for the majority of external tumors, without sedation or anesthesia.
With training and experience, the general practitioner can often determine the presence and type of neoplasia in the office. Submission to a clinical pathologist for diagnostic confirmation is usually indicated prior to therapy.
Diagnostic staging is a mainstay of oncology case management. Staging is the process of determining the extent of local disease and the presence or absence of regional or distant metastasis.
Chemotherapy is now a commonly used treatment modality in veterinary cancer medicine.
Adjunctive therapies have long been used as a means of improving the quality of life in veterinary cancer patients and are now an accepted component of oncology case management.
The nutritional status of all oncology patients should be routinely assessed beginning at diagnosis and throughout treatment.
Recognition and alleviation of pain in oncology patients is essential for maintaining quality of life. In simple terms, radiation therapy utilizes ionizing radiation to kill cancer cells.
Palliative radiation is playing a larger role in veterinary oncology as owners increasingly seek to improve quality of life, decrease pain, and minimize hospitalization of their pets rather than achieve a cure.
As a general rule, if a primary tumor can be completely excised with acceptable morbidity, surgery is the best choice of treatment. The first attempt at surgical excision always offers the best opportunity to completely remove the tumor.
All excised tumors should be submitted for histopathologic examination and margin analysis. The importance of attention to appropriate safety precautions in handling hazardous drug (HD) preparations in the hospital setting cannot be overemphasized. The veterinarian is legally and ethically obligated to educate staff regarding safe handling of chemotherapeutic drugs.
Errors in dose calculations are responsible for a large portion of mistakes made in chemotherapy. Chemotherapeutic agents have a narrow therapeutic index and can lead to significant or fatal toxicity if overdosed.
Multiple studies in human oncology confirm that effective communication skills are a critical source of satisfactory case outcome for both the patient and clinician.
It is important to enlist the skills and resources of the entire healthcare team when caring for an oncology patient.
Because oncology cases may conclude with the death or euthanasia of the patient, a satisfying outcome for all is highly dependent on good communication between the practitioner and the client.