Little Book of Cancer - Fitzpatrick Referrals

The Little Book on Cancer

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Contents

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Preface

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What is cancer?

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What types of cancer are there?

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What types of cancer treatments exist?

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What can I do to help my pet?

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What would you do if it was your pet?

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Fitzpatrick Referrals team and facilities

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Commonly asked questions

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Contact details, useful links and information

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Preface

Welcome to our Little Book on Cancer. It was written to try and help you through a difficult time, to answer any questions you have and empower you to make the right choice for you and your pet. What we hope to show you is that cancer is not a death sentence – in fact far from it. Some animals may have their cancers cured, but if this is not possible many pets can live a happy and comfortable life by managing their symptoms.

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What is cancer?

What types of cancer are there?

The body is made up of tiny building blocks called cells. These make up all of the body tissues including the skin, intestines, lungs and bone. Most cells have a life-span and over time the old cells die and are replaced by younger ones that divide. In animals, many things can cause this process to become abnormal, including sun damage, second-hand smoke, some herbicides and also genetic faults. When this process fails abnormal cells are created, these become independent from their surroundings (they ignore normal body signals to slow down or die) and also become immortal (divide forever and never die). When this uncontrolled cell division occurs millions of times, a small cluster of abnormal cells is formed that keep growing into a mass, lump or tumour. Some tumours will not spread (benign) and some might spread or metastasise (malignant or cancer).

There are many types of cells within the body and there are an equal number of cancer types, but they can be broadly divided into three groups: 1 The first are tumours of the skeleton and connective tissues of the body such as bone, cartilage, muscle and tendon. These tend to have “sarcoma” at the end of the condition term. 2 The second are tumours of organs such as liver, lung, intestine, mouth or skin. These tend to have “carcinoma” at the end of the condition term. 3 The third group are called ‘liquid tumours’ or ‘round cell tumours’ and these can travel all over the body in blood and lymph vessels. Examples include mast cell tumours, melanoma, histiocytic disease and lymphoma.

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Osteosarcoma This is cancer of the bone and can occur all over the skeleton although the most common site is the distal radius or just above the wrist. Treatment focuses on treating bone pain through a variety of techniques, and possibly using anti-cancer drugs (chemotherapy) to try and slow down the tumour spreading. Sometimes the limb is removed (amputation) and many dogs do very well and lead full lives on three legs. Limb-sparing surgery is an alternative to amputation. The bone containing the tumour is removed and either the defect can be replaced with a metal spacer anchored inside the skeleton (endoprosthesis) or an implant can be used that allows an artificial external foot to be fitted (exoprosthesis). This might be an appropriate choice for giant dogs or smaller dogs with pre-existing orthopaedic and neurological conditions. Our orthopaedic and oncology surgeons work closely together to make sure that the best decision is made in every case.

Soft tissue sarcoma These are soft masses growing beneath the skin that can feel like fatty lumps. They can have little fingers of cancer spreading out into local tissues and so when they are removed at surgery, a margin of healthy tissue needs to be taken around the mass to make sure all of the cancer extensions are removed. In the more aggressive cases, chemotherapy might be used after surgery. Lymphoma This is a tumour of the lymph nodes and/or the blood and might appear as swollen lymph glands in the neck, armpit, groin or behind the knee. Patients will be tired, lose weight and sometimes drink much more than normal. Treatment for lymphoma is normally chemotherapy which can cause the enlarged lymph nodes to rapidly shrink to normal and the pet can regain a good quality of life. In most cases, cats and dogs can live with lymphoma for many months or even years.

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Melanoma This is a pigmented black tumour that might appear in the mouth, the toes and the skin. Melanoma can often bleed and be uncomfortable and so surgery helps to improve quality of life. After the mass is removed, immunotherapy is often used to try and slow down cancer spread. This is a special vaccine that uses the body’s own immune system to target and kill cancer cells. Squamous Cell Carcinoma This is a common tumour in cats that can appear in the mouth, on the nose and the ears. It is normally treated in the first instance with surgery to remove the mass and some of the surrounding tissue. Sometimes radiation therapy and chemotherapy are also useful in these patients.

Mast cell tumour This is the most common malignant skin tumour in dogs. These are manifested in many different ways and can appear anywhere, making it very important to identify them quickly and get them checked by your family vet. These tumours often need surgery to be removed. The more aggressive mast cell tumours might also require chemotherapy to slow down or stop spread. Sometimes patients with mast cell tumours are given chemotherapy before surgery to shrink the mass in order to aid a successful outcome. Occasionally radiation therapy is used in addition to surgery to treat a scar or difficult mass.

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What types of cancer treatments exist?

Chemotherapy Drugs are given either by mouth, into the bloodstream and occasionally directly in body cavities or the tumour itself. Our medical oncology team will go through the process step-by-step before starting to make sure this path is right for you, your pet, and your family. Chemotherapy in pets is very different to chemotherapy in people – we use the same drugs but at lower doses to keep their life as normal as possible. We want them to be bright, active, happy, and energetic, with vigorous appetites and enthusiasm for life. We use anti-sickness drugs and carefully monitor their doses to make sure they live life to the full. Our chemotherapy goal is for your pet to look so well that none of your family or friends would even know they were receiving chemotherapy.

Depending on what cancer your pet has will determine what options for treatment are available. You will not be pressurised into any decision – the goal should only be to explain what options exist and to work with you and your family vet, to decide which path is best. Any decision you make will be supported and the team will work hard to make sure your pet is as comfortable as possible, for as long as possible. The main types of treatment are: Surgery Surgery alone cures more tumours than any other treatment or combination of treatments. We use the same anaesthetic drugs, surgical equipment, instruments, and suture materials as in human theatres to make the procedures as safe and successful as possible. We often use CT scans of your pet’s tumour to help plan surgery to increase the chance of getting all the tumour, first time. Our surgeons have years of experience of cancer surgery and perform some of the most advanced cancer surgeries in Europe. We also design and manufacture custom-made patient-specific implants in our own facility that are not available anywhere else in the world.

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Radiation therapy Although radiation facilities are not yet on site at Fitzpatrick Referrals, they soon will be, and our specialists have worked with radiation patients and protocols for years and have published widely in veterinary journals on the use of radiation therapy in cancer patients. We discuss when and if radiation therapy would be an appropriate part of your pet’s treatment, and if chosen we arrange a referral to one of the radiation facilities in the South-East. We are very experienced in managing radiation side-effects, working with irradiated tissues and managing complex cancer plans.

Immunotherapy This is using the body’s own immune system to fight cancer cells. Immunotherapy is often referred to as a cancer ‘vaccine’. To date, only melanoma has a licensed vaccine that can be given to animals and has been used for many years in advanced melanoma cases. Often the cancer vaccine is combined with surgery to remove the bulk of the tumour that might be causing many of the clinical signs, with the vaccine being given to target the microscopic cells travelling in the body. At Fitzpatrick Referrals we continue our active involvement in research efforts world-wide in this and other arenas of cancer therapy to bring the most advanced and very best treatments to our animal friends as soon as possible.

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What can I do to help my pet?

If your pet has any treatments it is imperative that you listen and follow through with the aftercare advice that the oncology team give to you. This is all in your pet’s best interest to get them on the road to recovery.

Cancer is a scary word, and at first it is totally natural to be upset and anxious. What you have to remember is that your pet does not understand the word cancer, but they understand you. One of the most important things you can do to help your pet is to stay as positive and upbeat as possible – our animal family know when we are sad. As you normally would, it is key to make sure your pet eats and drinks well, as well as making sure they get plenty of rest. Keep to their routine as many pets find change stressful.

If at any time you have any questions, you can contact us day or night on +44 ( 0)1483 668100 .

If someone cannot answer your question straight away we will respond as soon as possible.

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We get asked this question a lot, and you would think it would get easier to answer with time and experience. Pets are family and to many of us they are like furry children. No-one would expect you to give an opinion on how someone should treat their child with cancer, and we find the question equally difficult. Many factors come into the decision – the type of tumour, it’s growth rate, the tumour location, if it has spread, how far you live from the cancer centre, your personal experience with cancer, your financial situation and your pet’s character to name just a few. What we promise however is that we will carefully explain the pros and cons of various options and patiently work with you to find the one that feels right. We do not judge, we do not criticise and we do not coerce. We are on the same team. What would you do if it was your pet?

Fitzpatrick Referrals team and facilities

We have tried to ensure that we have covered all aspects of care, from state-of-the-art technology down to the update photos of inpatients. We have done our best to make sure we have everything your pet could possibly need under one roof. With advanced equipment such as CT, ultrasound, keyhole surgery, fluoroscopy and, in the near future, a radiation unit. Each and every member of our team have as much compassion for you and your animal friend as they do scientific knowledge and the wherewithal to help you manage cancer. We are here to help and to hold a hand or a paw in your time of need. This is our vocation and our mission. As it says on the door of our hospital, ‘ This hospital is dedicated to hope and healing for animals everywhere and to the people that love them ’.

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My pet has just been diagnosed with cancer, can my other pets catch it? No. Cancer is caused by cells in the body mutating (refer to ‘What is cancer?’ page 4) and is therefore created within the body, and cannot be passed on, even in blood or saliva. Commonly asked questions If my pet stays, how long will he/she stay here? This can vary case by case. If your pet has surgery they will stay for as long as your specialist thinks is in their best interest. We always want your pet to be home with you as soon as we feel it is appropriate. Just like us, our animal friends like to be at home as quickly as possible.

We have a full-time medical oncology specialist who works closely with the specialist oncology surgeons, alongside a team of highly trained oncology nurses and residents. You can rest assured that your animal friend is surrounded by all the care they need, including a veterinary surgeon, nurse and support staff on the premises 24 hours a day, 365 days a year. We have also thought about your personal needs. We know how hard this time can be for you and your family. The front of house team are specifically there to look after you, whether you need someone to hold your hand or just to listen, you are equally as important in this process as your pet. We aim to be there every step of the way for both your pet’s journey and yours.

For our full list of facilities or more information about our team please go to www.fitzpatrickreferrals.co.uk

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Can I visit my pet when they are at the hospital? Pets love their family as much as you love them and if you visit they may think they are going home with you! For that reason, in general, we try to minimise visiting whilst your pet is with us. We find that they settle better this way but you can be assured that they will be getting plenty of cuddles from our team. We are of course more than happy to send you photos!

Can I bring my pet’s own food if they have to stay? We already stock many types of food at the hospital so do ask our nursing team what is available. Many patients after surgery are fed special bland easily- digestible foods as their intestines might not be ready to cope with their home diets. We regularly cook for our patients to tempt them to eat when they are not feeling 100% – warm fish and chicken are particular favourites! We apologise but we do not feed or keep raw diets in the hospital. Although this might be what patients are fed at home, when patients are sick and have poorer immune systems, we only feed them cooked food.

If my pet stays, can I bring their belongings with them for comfort?

In order to prevent the introduction of foreign bacteria we regretfully ask you not to bring your pet’s personal belongings. Many of our patients are sick with low immune systems and so may not be able to fight off new infections.

After surgery do I have to keep my pet’s head collar/cone on?

Absolutely yes! It really is in their best interests. By taking the head collar/cone off it is likely your pet will lick their wound site or stitches, which can lead to infection. Keeping the collar/cone on allows the wound to heal as quickly as possible so they can return to a normal life or start the next part of their cancer treatment without delay.

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Contact details

Fitzpatrick Referrals Oncology and Soft Tissue Ltd 70 Priestley Road, Surrey Research Park, Guildford Surrey GU2 7AJ, UK +44 (0)1483 668100 www.fitzpatrickreferrals.co.uk guildford@fitzpatrickreferrals.co.uk Registration No. 8627448 World-Class Veterinary Medicine, Hope and Healing Useful links and information It can be a difficult time when your pet has cancer and coping is not easy. You can obtain additional information from: Veterinary Society of Surgical Oncology www.vsso.org When it is time to say goodbye to a pet for any reason, Blue Cross are there to help you through this painful time with a confidential and free service. Blue Cross www.bluecross.org.uk/pet-bereavement-support +44 (0)800 096 6606 pbssmail@bluecross.org.uk

This Little Blue Book is the first in a series produced by Fitzpatrick Referrals

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