Having a Heart to Heart Talk with Yourself About Your Pet’s Cancer Diagnosis

Cure Pet Cancer

November is National Pet Cancer Awareness Month. One in every four dogs and one in every five cats will develop cancer in their lifetime and @amcny is doing its part to raise pet cancer awareness by tweeting to #CurePetCancer to raise awareness.

Since cancer diagnoses are common in pets, many of my readers will face the difficult task of choosing cancer treatment decisions for their pet. Here is a list of questions you should ask yourself as you work through that decision-making process.

What kind of cancer specialist does my pet need?
Veterinary cancer specialists are not all the same. At AMC, we have three different types of cancer experts for pets: those that focus on administering chemotherapy, some who specialize in delivering radiation therapy, and the third type have special training in surgical oncology. We all know the basics of cancer treatment principals, but have different strengths within that core information. Your pet may need a consultation with one of us or all of us, depending on the type of cancer that has been diagnosed. The answer to this question lies in the biopsy because the type of tumor your pet has dictates the treatment options.

What kind of treatment is the oncologist recommending and is it right for my pet?
There are three main treatments for cancer: surgery, radiation and chemotherapy. Not every treatment is appropriate for every type of cancer and based on the biopsy, an oncologist will discuss what options are available to your pet and the expected outcome for each treatment option. Chemotherapy and radiation therapy require multiple treatments over several weeks to months. Surgery typically requires only a few visits to the hospital and has the highest chance of curing certain cancers. Cancer is most common in older pets and the grey muzzle set is also most likely to have other medical conditions which have to be taken into consideration in making the decision to pursue cancer treatment.

Do I have the resources to undertake the recommended treatment?
This question isn’t just about money, although cancer treatment can be costly. Another consideration when making the decision to treat your pet’s cancer is your time. Sometimes a trip to the surgical oncologist is all that is needed and other times 20+ trips are required for a course of chemotherapy. Be sure you understand what is required for the recommended treatment protocol. Your emotional resources count too. Maybe you are also caring for a seriously ill human family member and cancer treatment for the pet is more than you can handle. Or maybe it is the other way around and you can’t bear to lose two family members at once.

What is the prognosis for my pet with and without treatment?
This is a loaded question. The question is fair, but pet families who choose not to treat their pet’s cancer don’t often consult with an oncologist. That means oncologists, like me, don’t always have a good handle on the prognosis without treating many types of cancer.

If you have decided to make an appointment for a consultation with a veterinary cancer specialist, read about fancy cancer words that we try to keep out of our conversation with you, but sometimes accidentally slip into a conversation about treating your pet. Being prepared for a visit with a specialist will help to make sure all your questions are answered.

Strange Cancers from the Animal World

melinda at AMC

Being a veterinary oncologist by training, an article about cancer always catches my attention. I wanted to share some strange cancer news from the animal world for this week’s blog post.

Contagious Cancer in Dogs
I have a very special patient right now, Melinda, a recipient of a grant from AMC to the Rescue, the Animal Medical Center’s fund to support specialty care for animals in need of a forever home. Melinda has a strange cancer called transmissible venereal tumor. This tumor is contagious and typically spreads between dogs during mating. Even though this tumor can look ugly, it is usually curable with several rounds of chemotherapy, and Melinda is responding well to treatment. Analysis of the cells in transmissible venereal tumor finds fewer chromosomes than in normal dog cells. The chromosomes in the tumor are shaped differently than normal dog chromosomes. Transmissible venereal tumor was first reported in 1876, but genetic analysis tells us the tumor is thousands of years old.

Cancer Immunotherapy for Tasmanian Devils
Beginning in the 1990’s, wildlife biologists identified a new type of cancer in Tasmanian devils. Like the transmissible venereal tumor of the dog, the devil facial tumor has chromosomal abnormalities and is spread when a male devils fight over a potential mate. The tumors are fatal and in certain areas of Tasmania, nearly 90% of devils were lost to this disease. But in March 2018, an encouraging report was published in Nature. Scientists at the University of Tasmania created an antitumor vaccine from devil facial tumor cells which were modified to make them induce an immune response against a tumor already present on the face of a Tasmanian devil. In three of five devils treated with the vaccine, the tumors regressed. This is the first step to helping eradicate this tumor from wild devils and also saving this rare and endangered species.

No Cancer in Elephants
Studying cancer in animals helps researchers understand cancer in humans. For example, bone cancer or osteosarcoma occurs more commonly in dogs than in children and for years, the dog has served as a model for developing new osteosarcoma treatments. Elephants are a species less likely to get cancer than other animals, like humans and dogs. By studying the DNA of elephants, scientists have found clues to why these majestic creatures are resistant to cancer. One reason is elephants have multiple copies of a gene TF53. The gene codes for a protein p53 which helps to remove mutant cells before they become cancerous.

In a second study, scientists found elephant’s cells repair damage quickly and that keep cells from going rogue and becoming malignant. Understanding the unique resistance of elephants to cancer may lead to methods of cancer prevention in creatures more susceptible to cancer.

Cancer is a frightening and devastating disease in everyone, including pets, wildlife and humans. But by studying the biology of cancer in multiple species, we can make progress in understanding and treating this dreaded disease.

The Difference Between Diagnostic Radiology, Radiation Therapy and Interventional Radiology

radiation therapy

At first glance, these three disciplines within veterinary medicine seem pretty much the same, but at the Animal Medical Center, diagnostic radiology, radiation therapy, and interventional radiology represent three different groups of veterinarians with three very different sets of background and training. What ties these three disparate groups together is their use of radiation to diagnose and treat disease.

Diagnostic Radiology
These days you are more likely to find a Department of Diagnostic Imaging in a hospital than a Radiology Department. Radiology is an older term, used when x-rays were the only testing modality using radiation available in medicine. Today, AMC’s Diagnostic Imaging Service uses not only traditional x-rays but also ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) in the diagnostic evaluation of patients. AMC’s Diagnostic Imaging Service also has a fluoroscopy unit, which is like a video x-ray. This machine allows us to watch bodily functions like blood flow or swallowing in real time. To see an example of fluoroscopy, read about Molly the Ganaraskan. Every veterinarian at AMC depends on our diagnostic imaging team for their expertise in imaging sick pets and helping us to make an accurate diagnosis.

Radiation Therapy
A very accurate description, AMC’s Radiation Oncology Service uses radiation to treat tumors. Specifically, we have a linear accelerator (linac), a giant machine that creates various types of radiation depending on patient needs. Our state-of-the-art linac can make electrons for superficial treatments, produce high energy pinpoint beams for stereotactic radiosurgery, and stereotactic body radiation therapy. Diagnostic Imaging’s CT scanner interfaces with Radiation Oncology’s 3-D computer planning system. The interface allows the linac’s multileaf collimator to sculpt the radiation beam to precisely target the tumor being treated. The veterinarians working in radiation therapy have training in both the physics of radiation as well as the management of cancer.

Interventional Radiology
Specialists in interventional radiology use minimally invasive techniques to make image-guided diagnoses and also deploy high tech treatments for a variety of diseases. Using a range of techniques which rely on the use of images generated by diagnostic radiology equipment such as fluoroscopy, ultrasound, CT scan, or MRI imaging, the interventional radiologist precisely targets various organs with treatments such as stents, occluders and medications. Watch a video where AMC’s interventional radiology team uses fluoroscopy to close off abnormal blood vessels in the liver. The veterinarians in our Interventional Radiology Service have diverse backgrounds in surgery, internal medicine plus specialized training to use minimally invasive equipment.

Linked together by their use of radiation as a diagnostic and therapeutic tool, diagnostic radiology, radiation therapy and interventional radiology are just a few of the highly trained specialists at AMC working to make sick pets healthy again.

Melanoma Monday for Dogs

melanoma monday

May is a busy month, cancer-wise. May has been designated as Skin Cancer Awareness Month and, more specifically, the first Monday in May is Melanoma Monday. Skin cancer is much less common in pets than in people, in part because most pets avoid tanning booths and prefer not to sunbathe. But dogs do develop malignant melanomas in their oral cavity or on their toes. In these locations, melanoma can be as deadly in dogs as it is in humans. The good news about canine melanoma is that treatment options are available to veterinary cancer specialists and these options can be tailored to your dog’s specific needs. The decision in favor or against various treatment options for melanoma depend on the location of the tumor, the extent of the tumor throughout the body and, based on a biopsy, how likely the tumor is to spread.

Surgical removal of a melanoma serves a dual purpose – diagnosis and treatment. Removal of the melanoma is an important first step in treating the cancer. For melanoma of the toe, surgery can easily remove the toe and the tumor, resection of melanoma in the oral cavity is less simple. In the process of removing the melanoma, tissue from the tumor is submitted for a biopsy to confirm the diagnosis. Surgery may also be used to sample lymph nodes in the region of the tumor to help determine how far the tumor has spread. The extent of the tumor dictates ongoing treatment needs.

Radiation Therapy
If an oral melanoma cannot be removed, radiation therapy has proven effective in shrinking these tumors. Radiation can also be implemented post operatively if tumor cells are discovered in the lymph node biopsy or if the oral biopsy shows a melanoma has been incompletely removed. Treatment of melanoma of the toe with radiation is uncommon, but not unheard of, since surgery is usually successful at removing the tumor.

Melanoma is the first veterinary cancer to have a specific immunotherapeutic agent developed for treatment of the disease. Most of us associate a vaccine with protection against disease, but the canine melanoma vaccine alerts the dog’s immune system to the presence of melanoma and starts an immune reaction against the melanoma cells. In clinical research, this vaccine has been shown to lengthen survival time in dogs with melanoma when the vaccine is administered after surgery or radiation therapy is performed to control the primary tumor. Immunotherapy agents have also been developed for human patients with melanoma.

Chemotherapy is probably the least commonly prescribed cancer treatment for dogs with melanoma. Veterinary oncologists have studied a few drugs in this disease, but no drug consistently shrinks these tumors and prolongs survival. Drugs most commonly considered for the treatment of melanoma in the dog include platinum-based drugs such as carboplatin, doxorubicin, lomustine and dacarbazine.

While it may be comforting to know, treatment options are available if your dog develops a melanoma. Identifying the tumor and quickly instituting therapy is still critical for long-term control of the tumor. Bad breath, oral bleeding, and toe swelling can all be signs of a melanoma in your dog. If you identify one of these signs, make an immediate trip to your veterinarian.

Splenectomy in Dogs

A Facebook post on the Animal Medical Center’s wall congratulating Dutch for being the first dog to complete a clinical trial protocol for hemangiosarcoma at AMC generated this question: “Since Dutch had his spleen removed, does he need special vaccinations going forward?” Below is my rather long answer.

The Spleen
The spleen is a soft, spongy, dark red organ that dangles off the stomach, connected by a thin veil of tissue and blood vessels. This organ is a component of the immune system and in some ways is just a very fancy lymph node. Like lymph nodes, the spleen is responsible for clearing infectious organisms from the body and it also participates in recycling senescent blood cells.

Definition: Splenectomy
Because the spleen floats somewhat freely in the abdomen, attached to the stomach by thin tissue and blood vessels, splenectomy is not an intricate surgery. Through an abdominal incision, the surgeon clamps off blood vessels, ligates (sutures, staples or clips them securely closed), severs the ligated vessels and tissue, removes the spleen from the abdomen, and submits it to the lab for biopsy. Finally, the abdominal wall is closed with sutures or staples.

Need for Splenectomy
Dutch, the dog in the Facebook post, had his spleen removed because of a common, canine splenic tumor, hemangiosarcoma. Other tumors, such as mast cell tumors, lymphoma or sarcoma, are also frequent indications for splenectomy. Blunt force trauma, a fall from a height, or an automobile accident, can result in splenic rupture and lead to a splenectomy. Twisting of the stomach, also known as gastric torsion or bloat, can tear the blood vessels connecting the spleen to the stomach, and without an intact blood supply, the spleen must be removed. Because the spleen plays a role in removing aged blood cells, a malfunction of the spleen may increase blood cell destruction. To control blood disorders like immune-mediated thrombocytopenia (ITP) or some forms of hemolytic anemia, splenectomy can be part of the treatment protocol for some blood disorders.

Complications of Splenectomy
In dogs, complications of splenectomy include the typical post-operative ones like incision infections and poor healing. Depending on the underlying cause for splenectomy, blood transfusions and repair of fractures may be necessary. In dogs undergoing splenectomy for tumors, abnormal heart rhythms frequently occur and veterinarians monitor for arrhythmias in the ICU for a day or so following splenectomy. Once discharged from the hospital following splenectomy, dogs can resume normal activity once the incision is well healed.

The Facebook Question
While the indications for splenectomy sound a bit scary, the surgery itself seems straightforward in the dog. So why did AMC’s Facebook friend ask their question? Human patients undergoing splenectomy have many more long term sequelae than our canine patients. Splenectomized humans receive antibiotics prior to dental procedures, vaccinations to protect them against pneumonia and meningitis, and exercise a great deal of caution if they develop a fever. This blog often talks about One Health, the concept acknowledging the links between the health of animals, people and the environment, but in the case of splenectomy, the dog the dog stands alone.

Feline Lymphoma

feline lymphomaNovember is National Pet Cancer Awareness Month. Last spring I wrote about canine lymphoma, so in honor of Cancer Awareness Month, I thought I would do the same for feline lymphoma.

What is Lymphoma?
Lymphoma is cancer of the immune system. The immune system is distributed throughout the body to protect against infections. Lymphoma in cats most commonly affects the gastrointestinal tract, although since the immune system is distributed throughout the body, lymphoma can be seen in any organ in the body including the eyes, in front of the heart, and in the kidneys, liver or spleen. Unlike canine lymphoma, feline lymphoma rarely occurs in the lymph nodes.

In cats (and also humans) it is not a single disease, but is probably more than 20 different diseases; each of the 20 or so forms of lymphoma behaves somewhat differently and the prognosis varies between types. The most common form of lymphoma we see in cat intestines is called small cell lymphoma. We also see an intestinal variant called large cell lymphoma. The photomicrograph on the right shows a rare form of feline lymphoma called large granular lymphoma. The name comes from the granules seen in some of the cancerous lymphocytes.

How is Lymphoma Treated?
Three major types of treatments underlie all cancer therapy: surgery, radiation therapy and chemotherapy. Since lymphoma is widespread throughout the body at the time of diagnosis, surgery is not generally used for treatment as removal of all the lymph tissue in the body is impossible, but sometimes a solitary mass of lymphoma may be removed from the intestine if the mass is causing problems for the cat. Surgery may also be recommended to obtain a biopsy for diagnosis. Radiation therapy can be used in select cases of feline lymphoma, especially if chemotherapy stops working. However, chemotherapy remains the mainstay of feline lymphoma treatment.

Multiple Lymphoma Protocols
In my office file drawers, I have a big fat folder of articles describing various chemotherapy protocols for the treatment of lymphoma. Many of them are simply a riff on a theme. In my opinion, there are three basic options for chemotherapy of feline lymphoma:

  1. Steroids, glucocorticoids, cortisone, and prednisone are all names for the same type of drug. In lymphoma, steroids kill the cancer cells but are not “traditional” chemotherapy agents.
  2. Treatment with a single chemotherapy drug. This is most commonly used in intestinal small cell lymphoma. Steroids and chlorambucil can keep a cat with small cell lymphoma in remission for months.
  3. Using multiple chemotherapy drugs known to be effective against lymphoma and combining them into a rotational schedule which minimizes toxicity and maximizes efficacy.

How Long Will My Cat with Lymphoma Live?
Like with dogs, the answer is: it depends. Cats treated for small cell intestinal lymphoma often live 2-3 years and some can even discontinue chemotherapy. More aggressive forms of lymphoma like large cell lymphoma may only survive months despite multi-agent chemotherapy. A board certified veterinary oncologist can give you the most accurate prognosis for your cat.

Helpful Hints About Lymphoma

  • Feline lymphoma is an internal disease. Cat owners will notice weight loss, poor appetite and possibly vomiting/diarrhea which are common clinical signs of multiple cat illnesses like inflammatory bowel disease, pancreatitis and diabetes. A full medical evaluation is required to make a lymphoma diagnosis.
  • Because cat lymphoma typically occurs in the intestines, biopsies are frequently used to diagnose lymphoma in cats. Often high tech testing like flow cytometry or DNA analysis are required to confirm a lymphoma diagnosis in a cat.
  • In a survey of cat owners who chose to treat their cat’s lymphoma, 85% were completely satisfied with their decision.

Veterinary Nursing In Action @AMC: National Veterinary Technician Week 2016

animal medical center dentistryThe theme of this year’s National Veterinary Technician Week is “Veterinary Nursing In Action.” The theme speaks to the role of veterinary technicians or nurses in the veterinary profession. During their training, credentialed veterinary technicians must show proficiency in the care of all species; those with feathers, fur, scales, and skin. Technicians are the backbone of the Animal Medical Center; without them,we would be unable to provide high-quality compassionate care.

What kind of action do veterinary technicians see?
Veterinary technicians see lots of action since they are involved in every facet of veterinary healthcare. They can be found in examination rooms, operating rooms and patient wards. View veterinary technicians in action at the Animal Medical Center.

How do veterinary technicians work with veterinary surgeons?
The operating room is a wonderful example of how our technicians impact patient care. Black Jack the cat describes his surgical procedure and how AMC technicians were active in his care as he moved to the operating room, recovery suite and finally to his spot in ICU. Just like nurses in a human hospital, our veterinary technicians made sure Black Jack was as comfortable as possible during his stay.

Where else do technicians work at the AMC? In the cancer clinic.
Like surgeons, oncologists depend on veterinary technicians for their patient management skills. Technicians administer both chemotherapy and radiation therapy treatments. They provide pet families education on topics like giving medications or using a feeding tube. This slide show highlights the actions veterinary technicians use when working with cancer patients.

Is a career as a veterinary technician for me?
A licensed veterinary technician is capable of offering nursing care to all species and that’s a pretty AWESOME career! Opportunities abound for veterinary technicians to take action as part of the healthcare team. While many work in neighborhood veterinary clinics, they may also work in industry, the military, universities, research facilities, zoos, aquariums, and in any facility housing animals. Are you interested in the backstory about life as a veterinary technician? Learn about some of the challenges these dedicated professionals face and learn if this career might be for you.

Radiation Therapy Machines: Machines and Methods

radiation therapyMay is Pet Cancer Awareness Month. Since the goal of Pet Cancer Awareness Month is to educate pet owners about cancer, I am going to devote this week’s blog to clearing up some of the confusion over the various forms of radiation therapy. Radiation therapy machines treat cancer by delivering high energy radiation to a tumor, killing the tumor cells. There are several types of prescriptions for the dose of radiation delivered to a tumor.

Radiation Oncologists and Their Machines
A number of different machines are available to administer radiation:

  • The Animal Medical Center uses a Varian Clinac® linear accelerator (linac) to deliver radiation therapy to tumors. Our linac has a multi-leaf collimator (MLC) which moves while the radiation beam is on, sculpting the beam around the tumor, protecting normal structures from radiation. Here is a MLC in action. Radiation using a MLC is called image modulated radiation therapy (IMRT). We also can utilize a 3-dimensional computerized treatment planner. The AMC’s linac can also be used to deliver stereotactic treatments. I will expand on stereotactic treatment below.
  • The Cyberknife® is a linac merged with a robotic arm, which allows the machine to dance around the patient. The radiation beam turns on and off, zapping the tumor from multiple angles. Treatment from multiple angles creates a treatment field conforming to the shape of the tumor.
  • A Tomotherapy machine is a cross between a linac and a CT scan. Tomotherapy creates an image of the tumor immediately prior to treatment and uses the image to direct treatment. Both imaging and treatment occur using the same machine.
  • The Gamma Knife® treats brain tumors. And although the word knife suggests this machine does surgery, it does not. It precisely delivers a high dose of radiation to a very focal area in the brain while avoiding normal brain tissue.

Radiation Therapy Prescriptions
Radiation can be prescribed in a number of different fashions. The standard for many years has been administration of multiple small doses of radiation with the goal of eradicating the tumor. This course of treatment is often referred to as “definitive” or “hyperfractionated” therapy. Oncologists commonly recommend this type of treatment to follow when a surgical procedure has not removed every last tumor cell. The opposite of hyper is hypo and oncologists often use a few large doses of radiation to treat tumors that cannot be removed by surgery. Oral melanoma is a good example of a tumor treated this way.

The most advanced dosing schemes for radiation therapy are Stereotactic Radiation Therapy (SRT), which includes both Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT). Stereotactic treatments use high doses of radiation given over one to three treatments. On-board imaging equipment allows precise delivery of the radiation dose in stereotactic treatments. Stereotactic radiosurgery, like the Gamma Knife, is not a form of surgery. It is typically administered in a single dose and is reserved for treatment of brain tumors. Stereotactic radiosurgery was the first type of stereotactic radiation therapy. Stereotactic Body Radiation Therapy, as the name implies, is administered outside the brain. The AMC’s Clinac is able to deliver both SRS and SBRT.

The “Best” Type of Radiation Therapy
No one radiation therapy machine or prescription is “best.” The type appropriate to treat your pet’s tumor will be determined by the biopsy results, surgical resectability of the tumor, and size and location of the tumor. The AMC has a board certified radiation oncologist who can help you make the best decision possible to manage your pet’s cancer with radiation.

Canine Lymphoma: A Quick Snapshot

Today, like many days I spend in AMC’s Cancer Institute I saw a dog patient diagnosed just a few days ago with lymphoma. What appears below is a summary of my conversation with the dog’s family about lymphoma and the options for treatment of their beloved companion.

What is Lymphoma?
Lymphoma is cancer of the lymph nodes or other lymphoid tissue such as the spleen or tonsil. In dogs (and also humans) it is not a single disease, but is probably more than 20 different diseases; each of the 20 or so forms of lymphoma behaves somewhat differently and the prognosis varies between types. In dogs with lymphoma, we most commonly see enlarged lymph nodes on the outside of the body and using x-rays or ultrasound, see enlarged internal lymph nodes as well. When viewed using a microscope, the cells in a normal lymph node are composed of a variety of different sized cells called lymphocytes. Lymphocytes in enlarged lymph nodes (shown in the photomicrograph) typically appear much larger in diameter than the cells normally inhabiting the lymph nodes. Lymphocytes in lymphoma demonstrate less variation in their size than in a normal lymph node. If special testing is performed, the lymphocytes can be identified as either B or T cells. This differentiation is an important predictor of outcome.

How is Lymphoma Treated?
Three major types of treatments underlie all cancer therapy: surgery, radiation therapy and chemotherapy. Since lymphoma is widespread throughout the body at the time of diagnosis, surgery is not generally used for treatment as removal of all the lymph tissue in the body is impossible. Surgery may be recommended to obtain a biopsy for diagnosis. Radiation therapy can be used in select cases of canine lymphoma, but chemotherapy forms the mainstay of canine lymphoma treatment.

Multiple Lymphoma Protocols
In my office file drawers, I have a big fat folder of articles describing various chemotherapy protocols for the treatment of lymphoma. Many of them are simply a riff on a theme. In my opinion, there are three basic options for treatment of canine lymphoma:

  1. Steroids, glucocorticoids, cortisone, and prednisone are all names for the same type of drug.  In lymphoma, steroids kill the cancer cells but are not ”traditional” chemotherapy agents.
  2. Treatment with a single chemotherapy drug, most commonly doxorubicin (Adriamycin®), although others can be used.
  3. Using multiple chemotherapy drugs known to be effective against lymphoma and combining them into a rotational schedule which minimizes toxicity and maximizes efficacy.

How Long Will My Dog With Lymphoma Live?
The quick answer to this question is, ‘it depends,’ and I realize that answer is in no way helpful. The contingencies listed below are general rules, but cannot be used to predict how an individual dog will respond to treatment. First, dogs treated with chemotherapy live longer than untreated dogs. The most common form of lymphoma seen in dogs progresses rapidly and if untreated, the average survival time is about two months. With treatment, these dogs often survive a year or more. Some lymphomas are considered indolent or slowly progressive. Dogs with this form of lymphoma may survive years without any treatment; however, indolent lymphoma is quite rare. Dogs showing clinical signs related to their lymphoma have a shorter survival than dogs who still are feeling well. Dogs diagnosed with T cell lymphoma do not respond to chemotherapy for as long a time as dogs with B cell lymphoma.

Helpful Hints About Lymphoma

  • Lymph nodes enlarged due to lymphoma are most commonly painless swellings under the chin, in front of the shoulders, behind the knees.
  • A quick needle aspirate can be used to diagnose lymphoma, but occasionally a biopsy is recommended to provide additional information about the specific type of lymphoma.
  • In a survey of dog owners who chose to treat their dog’s lymphoma with multiagent chemotherapy, 92% had no regrets about their decision and 68% felt their dog’s quality of life was the same as before treatment with chemotherapy.

Photo: A microscopic view of lymphoma cells in a lymph node. Photo courtesy of Dr. Jamie Haddad, IDEXX Laboratories