When your dog is first diagnosed with cancer, a lot of questions usually come up before you can even make a decision about treatment options. And, once treatment has started, you will continually find that you have new questions and concerns about how to best help your dog manage any side effects of treatment and to help them maintain their quality of life for as long as possible.
We've put together a few of the most commonly asked questions from pet owners about cancer treatments and how to manage the inevitable side effects of treatments. And, while every dog is different, and you should ALWAYS consult your veterinarian if you have concerns about your dog's progress, hopefully the information you find here will at least give you some guidance and a place to start so you know what questions to even ask at your next vet appointment.
General Treatment FAQ's
How do I know which treatment option is right for my dog?
When you find out that your dog has cancer, one of the first decisions you will need to make is whether or not to treat the cancer, and then deciding which treatment method to use. In most cases, surgery, chemotherapy or radiation will be recommended, depending on your dog’s type of cancer. Often, a combination of these approaches will offer your dog the best chance of cure or long remission. How you decide to treat your dog’s cancer is ultimately a very personal decision, and one which needs to be based on your dog’s type of cancer, their age, their personality, the treatment protocol that would be used, your individual philosophies, and unfortunately, the time and money that it would take to pursue treatment.
For example, if your dog is 14 years old and has a very aggressive form of cancer, it may be more loving to choose dietary changes or holistic supplements to manage your dog’s symptoms and make them comfortable than to pursue surgery or chemotherapy. Or, you may realize that taking your dog in for radiation therapy two days a week for several weeks would be more damaging to their spirit than any potential benefit it may bring. Educate yourself about the potential benefits of any treatment, be honest about what you are willing to commit to, and most importantly, ask yourself if this is really in the best interest of your dog, knowing her better than anyone else in the world.
This is an area where there are absolutely no right or wrong decisions. Listen to your heart, evaluate your specific situation, and go from there.
Why has my dog lost weight since being diagnosed with cancer?
Two types of weight loss are common in cancer pups — anorexia and cachexia.
Anorexia can occur when your dog loses interest in food, generally because they don’t feel well, or are nauseous. In these cases, it’s important to find something that your dog is willing to eat, which can sometimes take a little coaxing and creativity. If tempting your dog with some of her favorite foods is not enough to do the trick, you may want to consider providing something that is very bland, such as baby food. If that is still too much for your dog to handle, try giving her a frozen meal. Frozen food doesn’t have the same odor and flavor as unfrozen food does, so it can be easier to tolerate than regular food if your dog is feeling nauseous. Frozen Hill’s n/d canned food is a great choice, or even frozen fish, such as smelt, can be a good meal. Ultimately, if your dog becomes fussy about eating though to the point that they are consistently losing weight, it’s more important to get them to eat than to stay on a strict diet.
Cancer cachexia is a different type of weight loss, and the reason that cancer is often called a “wasting disease”. Cachexia occurs when the body is taking in enough calories, but it’s not able to absorb nutrients properly and so the dog becomes weak as it begins losing fat and muscle mass. If your dog starts to lose weight because of cachexia, you may want to try adding digestive enzymes to their food, such as Prozyme. These enzymes will help your dog’s body to absorb the nutrients in their food more easily, helping them to maintain or gain weight more easily.
Whether the cause is anorexia, cachexia or a combination of both, it’s important to monitor your dog’s weight regularly and to notify your vet if your dog starts to lose weight on a consistent basis.
What does remission mean?
Remission is one of the best words you can hear from your vet after a diagnosis - it's a sign that the treatment plan you are using is working and can offer a great deal of hope and optimism. But, Remission does NOT mean that the cancer is gone. It simply means that all clinical signs of the cancer are gone. For example, in the case of lymphoma, your dog has achieved complete remission when the vet can no longer find any enlarged lymph nodes in their body.
While some dogs stay in remission permanently (and are ultimately considered cured), many cancers will come out of remission at some point. When that happens, the vet may recommend repeating the treatment plan used initially to induce another remission. That may mean another surgery or another round of chemotherapy using the same or different drugs, in order to get the cancer back under control.
Things to keep in mind about chemotherapy:
In most cases, you can stop treatment even after it’s started if it is not working or you change your mind.Chemotherapy is expensive, but you pay for each treatment, not in one lump sum, and some veterinarians offer payment programs to further reduce the financial hardship. If you have pet insurance, that will also reimburse you for some of the costs of treatment.Dogs receive a much lower dose of chemotherapy drugs, so they tolerate it much better than humans and often have few side effects.Earlier treatment often results in better outcomes.While chemotherapy is often a very effective form of treatment, it is not the ONLY treatment. Be sure to find out about all treatment options for your dog.
What are the most common chemotherapy drugs used and their side effects?
Below is a description of some of the most common chemotherapy drugs used and their typical side effects, as described in the Textbook of Veterinary Internal Medicine (2005).
Prednisone Side Effects:
Although Prednisone is not officially a chemotherapy drug, and is frequently used to treat a variety of conditions, it is commonly used as part of a chemotherapy protocol, which is why it is included here.
Increased thirst - drinking large amounts of water
Increased need to urinate (from drinking so much water!)
Significantly increased appetite
Can cause some mild behavior changes
More prone to overheating/exertion during exercise
In some cases in which pet guardians could not afford the cost of chemotherapy, Prednisone has been used alone to treat Lymphoma. Although it is generally a short-term fix, it can buy some extra time with your pup if no other options exist.
Elspar (L-asparaginase) Side Effects:
Can cause an allergic reaction. As a result, Diphenhydramine (Benedryl) is usually given to the dog before this drug is administered. Any reaction to this drug would normally occur within 15-20 minutes of administration.
Vincristine Side Effects:
Side effects can include:
Loss of Appetite
Low white blood cell count (WBC)
Tissue damage at injection site
If this drug leaks outside the vein, it will begin to kill skin tissue.
Cytoxan (Cyclophosphamide) Side Effects:
Low white blood cell count (usually occurs 5-7 days after administration)Can be toxic to the bladder and cause bloody urine or chronic cystitis, so often lasix or a diuretic is given along with this drug to ensure that your dog expels this drug from their bladder regularly.
Adriamycin (doxorubicin) Side Effects: This drug has a cumulative effect on the heart. If your dog receives too much of this drug over the course of treatment, they could develop heart problem. As a result, only so much of this drug can be given to your dog in their lifetime. The vet should monitor your dog’s heart throughout treatment to ensure that it is not causing any problems, and if your dog has any existing heart conditions, you may want to consider an alternate drug, such as Mitoxantrone. In some cases, you may want to consider having an x-ray or ultrasound done prior to each Adriamycin treatment to confirm that there is no heart damage present. Using a CoQ10 supplement may help reduce the cardiotoxicity of this drug.
Nausea or Vomiting
Diarrhea (usually occurs 2-5 days after administration)
Loss of appetite
Will my dog lose their hair from chemotherapy?
In people, hair grows continually throughout their lives and since chemotherapy drugs usually target rapidly dividing cells, hair loss is common in people undergoing chemo. But in most dogs, the bulk of their fur is not continually growing, so the vast majority of breeds are not affected significantly by this side effect. Exceptions to this are the few breeds that do have continual hair growth such as Poodles and Old English Sheepdogs. So, while you may notice some thinning of your dog's coat, loss of whiskers, and possibly a change in the texture of your dog's coat, it is unlikely that they will lose much, if any, of their fur.
What do I do if my dog has diarrhea after a treatment?
One of the most helpful drugs to keep on hand is Metronidazole (Flagyl). This drug can be very helpful if your dog experiences severe diarrhea during treatment (which is not that uncommon), and is given in pill form. A daily dose of Spasfon can also be very helpful in preventing stomach upset, and many pet owners choose to incorporate this into their daily routine.
For those who prefer a natural solution, giving your dog a tablespoon or so of canned pumpkin (100% pumpkin, NOT pie filling), can help mild cases of diarrhea.
If your dog does experience severe diarrhea, make sure they continue to drink enough fluids (you may want to put some chicken broth in their water to get them to drink more or give them some Adiaril to keep them hydrated), and consider giving them a blander, easier-to-digest diet for a couple of days, such as baby food or rice and boiled chicken.
Having occasional loose stool a few days after a chemotherapy treatment is not at all uncommon and should not be cause for immediate concern. As with most side effects, keep an eye on it, try some of the suggestions discussed above, and hopefully the problem will resolve itself within a couple of days. If it doesn't, call your vet.
What’s a rescue protocol?
A rescue protocol is just a name for using a different combination of chemotherapy drugs when and if your dog stops responding to the first protocol (treatment plan) used. Since cancer cells tend to adapt and become resistant to certain drugs after a while, a new combination of drugs can often help your dog get back into remission. An example of a commonly used rescue drug for treating lymphoma is CCNU or lomustine.
Rescue protocols can often be effective in inducing another remission although second or third remissions are generally not as long-lasting as the first remission.
How much will chemotherapy cost?
Cost will vary according to the size of your dog (the bigger the dog, the more drugs that need to be administered), the type of cancer they have, the number of extra tests that need to be conducted and your particular vet’s fee schedule. But, generally speaking, you should be prepared to spend several thousand euros in the course of your dog’s treatment, especially if you go through chemotherapy. But, as you pay per appointment, not in a lump sum, this amount is spread out over several months. Also, if you have pet insurance, they will likely reimburse you for some of the costs of treatment.
Keep in mind thought that chemotherapy is just another name for "drug therapy" and there are many different cancer drugs. If cost is a major factor for your family, discuss with your vet whether or not there is an alternative drug or drug combination that may be less expensive yet still effective. Although alternative drug treatment protocols may not be "optimal", they can still offer your dog good quality of life for longer than if you choose to do nothing.
For example, if your dog has lymphoma and a full multi-drug chemotherapy protocol is not possible, ask about using an oral chemotherapy drug such as CCNU, which can be less expensive and require fewer vet visits. Or, perhaps you can only afford to treat your dog using Prednisone along with dietary changes and/or holistic supplements. The results of using different drugs may not be as good as using the "recommended" protocol, but they might allow you to help you and your dog enjoy some extra time together without compromising quality of life. So, don't be afraid to ask for alternatives and choose the path that is best for your dog and your whole family.
Why do I need to monitor my dog’s temperature during chemo treatment?
You should consider investing in an in-the-ear pet thermometer (unless you’re proficient at taking a rectal temperature), as it’s important to monitor your dog for fever throughout treatment. Because chemotherapy drugs often affect the bone marrow and reduce the body’s ability to produce new blood cells, including the white blood cells responsible for fighting infection, it’s very important to identify and treat any infections that might occur as early as possible, as this is potentially the most serious side effect of chemotherapy. A fever is an indication that your dog could have an infection of some kind. Your dog’s white blood cell count will generally be at its lowest 5-7 days after treatment, and this is when they are most susceptible to developing an infection. If your dog develops a temperature, call your vet immediately. This is an emergency!
Lymphoma FAQ's Should I have my dog’s lymphoma staged and typed?
When your dog is diagnosed with lymphoma, your vet may recommend other tests to stage the disease and identify if other organs have been affected. Also, a process called Immunotyping can determine if your dog has B-cell or T-cell lymphoma. The purpose for these tests is to predict outcomes. Sometimes this can be helpful, as dogs with T-cell type lymphoma often do not respond well to chemotherapy and have a reduced chance of going into and sustaining remission. The tests can also indicate if your dog has any other pre-existing problems that would make it more difficult for them to tolerate chemotherapy.
However, it’s important to consider your dog’s well-being when deciding whether or not to perform these tests, which can be very stressful and usually will require the use of anesthesia. Also, these tests are expensive. One thing to keep in mind is that if a dog with lymphoma is going to respond to chemotherapy and go into remission, it will generally happen within the first 2-3 treatments (there are always exceptions to the rule, however!). And, the prognosis does not change substantially if they have multicentric lymphoma or organ involvement at the time of starting treatment, or not. So, you may want to consider going ahead with chemotherapy treatments and then see what happens rather than putting your dog through multiple tests and ending up with the same treatment protocol.
The bottom line is to ask questions. For each test your vet suggests, find out what is involved, what information will be gained and whether or not that information will impact treatment. If treatment would be the same no matter what, then it is probably not necessary.
Is there a standard chemotherapy protocol for lymphoma?
For lymphoma, one of the most common forms of canine cancer, the chemotherapy treatment protocol most often used is the Wisconsin-Madison protocol. The Madison protocol uses the drugs Prednisone, Elspar (L-asparaginase), Vincristine, Cytoxan (cyclophosphamide), and Adriamycin (doxorubicin) during treatments that occur over a period of 26 weeks. Prednisone is taken orally at home, at first in high doses on a daily basis, and will gradually be reduced. The rest of the drugs are given at the clinic, with a different drug being administered during each visit.
You should note that although there is a “standard” for how this and other protocols should be administered, the oncologist can adjust the protocol to meet your dog’s individual needs. If your dog does not tolerate a specific drug well or exhibits more severe side effects, modifications can be made to the drugs used, dosage and schedule of treatment.
How soon will I see results from treatment if my dog has lymphoma?
For lymphoma, it is common to begin seeing results very soon after the first chemotherapy appointment.