Veterinary Oncology: The AAHA Updates Its Guidelines on Cancer Management in Dogs and Cats

Diagnosing and treating cancerous tumors in pets is an essential part of veterinary medicine. The American Animal Hospital Association’s (AAHA) new oncology guidelines enable veterinarians to stay up to date on the latest knowledge and developments in the field, ensuring that animals with cancer receive optimal treatment and the best possible quality of life. These updated best practices, published in the latest issue of the Journal of the AAHA*, are also available on the association’s website: . The 2016 AAHA guidelines list, in tabular form, the cancers commonly seen in dogs and cats. They compile information on tumor types, primary sites, patterns of growth, recommended tests and examinations, treatment options, prognosis, and known poor prognostic factors. Designed as concise reference tools, these tables cannot fully capture the variety of behaviors exhibited by the listed tumors. Rather, they are intended to serve as a basis for active dialogue with the animal owner—particularly when developing a treatment plan—as well as to guide clinical decision-making, without prejudging the specific course of a particular cancerous lesion in a given animal. In the same vein, the clinical case highlighted (management of osteosarcoma in a nine-year-old dog) serves as an example, not a diagnostic decision tree. The discussion following the case study focuses on the rationale behind each step of the clinical decision-making process, including the appropriate treatment plan, and extends to important considerations such as end of life care. Each practitioner can evaluate and treat this clinical case independently using the tables provided. Because affected animals are often elderly, their owners are very attached to them and emotionally distraught upon receiving a cancer diagnosis. In this context, the client plays a vital role in how their pet’s illness will be managed. For the veterinarian and their team, cases of canine or feline cancer are among the most sensitive to treat. But in this field more than any other, demonstrating their expertise can greatly strengthen the bonds they share with their clients, based on an effective protocol and the maintenance of an informed dialogue. The underlying idea is that all staff members—both clinical and administrative—can have a positive influence on the outcome of an oncology case . A unified team, speaking with one voice to address the expectations of animal owners whose animals have cancer, will build a long-term relationship with these clients, based on communication and empathy. In particular, this support will guide decisions when death or euthanasia must be considered, or when the balance between the animal’s quality of life and life expectancy is at risk. Because every case in oncology is medically unique and multifactorial, these guidelines recommend a sequential approach tailored to each animal with cancer, taking several factors into account: the tumor diagnosis, its classification, treatment modalities, the safety of the animal and the healthcare staff during chemotherapy, the possibility of referring the case to a clinic specializing in oncology, and active and empathetic support for animal owners. Determining the tumor type through histological examination of a biopsy specimen is the first step in all subsequent stages of cancer management. The choice of treatment modalities depends on the tumor type, histological grade, and stage, and may include surgery, radiation therapy, chemotherapy, immunotherapy, and certain supportive care measures such as nutritional support and pain management. The guidelines also address the strict safety measures that must be followed when handling agents and administering chemotherapy—now commonly used in veterinary oncology—to prevent accidental exposure of the animal, the healthcare team, the owner, and the environment.   * Barb Biller et al.: 2016 AAHA Oncology Guidelines for Dogs and Cats, JAAHA, https://www.aaha.org/graphics/original/professional/resources/guidelines/2016_aaha_oncology_guidelines_for_dogs_and_cats.pdf