Transitional Cell Carcinoma Resources
This page was created in memory of Nuvak's Serendipity (known as Rennie). Rennie was a wonderful, outgoing, and loving Samoyed-a friend to everyone she met. She was athletic, agile, and totally fearless. She died at age 10 after a year-long fight with transitional cell carcinoma (Bladder Cancer or TCC). We miss her still.
Rennie's Page is intended to be the resource I wish my veterinarian and I had when Rennie was diagnosed. This page is not intended to substitute for consultation with a veterinarian! Please discuss this information with your own vet, and verify its accuracy for yourself.
A Samoyed is one of three Arctic breeds of dog recognized by the American Kennel Club. They were developed to serve as guard dogs, reindeer herders, and sled dogs by the Samoyede people of Siberia. They are medium-size white dogs with black noses, dark eyes, and a double coat.
Samoyed puppies are irresistably cute. Pet store owners know this. Many people purchase a sweet, fluffy puppy with little information about how to properly train it to become a well-mannered adult. Samoyeds are loving, but independent and stubborn by temperment. A well-trained Samoyed is an excellent pet: affectionate, watchful without being aggressive, good with children. An untrained Samoyed will attempt to dominate the household and will destroy shoes, toys, furniture, wallboard, carpet, will turn the yard into moonscape of craters, bark the neighbors' nerves to a frazzle, eat the siding off the house, and become an escape artist.
Untrained Samoyeds are frequently given up to humane societies and rescue organizations by their frustrated owners. Such dogs often make excellent pets in the hands of a person willing to provide consistent discipline and TRAINING.
Back To Contents
Transitional Cell Carcinoma (TCC)?
Advanced, metastatic bladder cancer is a serious disease, currently incurable for more than 80% of patients. It is usually treated with multiple-drug chemotherapy. This sort of intensive chemotherapy has severe side effects but 1 in 7 patients may achieve a remission. Single-agent chemotherapy has a remission rate of less than 1 in 20. Hopefully, research will continue to improve cancer treatments.
Some links about Veterinary Cancer Treatment and Dog Health
Back To Contents
transitional cell carcinoma diagnosed?
A note about terminology. In these studies, complete remission is defined as disappearance of measurable tumor (there may still be cancer cells present). Partial remission is defined as 50% or more reduction in tumor volume without development of new tumors. Stable disease is defined as less than 50% change (increase or decrease) in tumor volume without development of new tumors. Progressive disease (PD) was defined as 50% or more increase in tumor volume or development of new tumors at any time. So "Stable Disease" does not mean that the tumor is not growing; it means the tumor hasn't increased by more than 50% in size over the time studied.
Therapy Piroxicam is a non-steroidal
antiinflammatory drug (NSAID), primarily used to treat human arthritis
under the trade name Feldene (Pfizer). It has been studied in several
species as a chemopreventive or tumor suppressant drug. Dr. Deborah
Knapp of Purdue University School of Veterinary Medicine studied the
antitumor effects of piroxicam in 34 dogs with TCC. 2 dogs achieved
remission and 22 dogs partial remission or stable disease by the
definition of the study. 7 of the 34 dogs lived for more than a year.
These are the best results of any therapy for TCC to date. Anecdotally,
others have not had this degree of success. Piroxicam appears to have
direct antitumor activity. Rather it appears to act indirectly,
by preventing PGE2-mediated immune suppression.
with Cisplatin Cisplatin
chemotherapy of dogs with TCC has been studied by Dr. Wayne Shapiro of
Davis School of Veterinary Medicine and by Dr. Deborah Knapp of Purdue.
There have been no complete remissions of TCC documented in dogs
with Cisplatin chemotherapy, even at levels where considerable
side-effects were observed. Partial remissions have occurred (1 in 6 at
best) and stable disease has been observed for as few as 1 in 4 or as
as half of the dogs treated, with a mean survival time (180 days)
comparable to the piroxicam study.
Therapy is a relatively new
form of cancer treatment. The idea is to administer a nontoxic dye
will make all cells sensitive to light, then target a laser
at the tumor. The good news is that this therapy is available to pet
owners through Dr. Elsa Beck in Detroit, MI. The bad news is that no
controlled studies have been done, so it is very difficult to evaluate
effectiveness. When I spoke to Dr. Beck's associate Dr. Cyman, 15 dogs
with TCC had been treated. Several improved, and lived for a year or
more. Several were also receiving chemotherapy. Several metastesized.
not a technique which has produced complete remission.
Therapy There have been no
reported remissions from radiation therapy. One study of radiation
done during surgery reported that the urinary bladder or ureter scarred
and stiffened when irradiated, and that tumor control was poor. One
told me that radiation therapy definately helped her TCC-afflicted
symptoms, but radiation therapy also made her pet ill.
removal of the bladder There have been
several studies in which dogs had their bladders surgically removed.
it is impossible to explain to a normal, active dog that the little bag
they are wearing must be kept clean and left alone, dogs whose bladders
were completely removed had the ureters surgically attached to the
intestine so that urine flowed into the bowel (ureterocolonic
anastomosis). All of the dogs so treated developed high levels of
nitrogen in the blood (azotemia). This causes nausea/vomiting and
neurologic problems. The dogs lived one to five months. Dogs whose
bladders were only partially removed did better; six of 11 dogs lived
more than a year. The tumor was not completely removed, and after a
appeared to recur in most cases.
There are a variety of natural treatments available to "cure"
cancer. Unfortunately none of their effectiveness has been evaluated
in carefully controlled studies so it is difficult to evaluate whether
and how effective these treatments might be. Commonly suggested
treatments include Essiac and Shark Cartiledge. The effectiveness
of natural treatments is a highly emotional issue for some people
who believe that there is a conspiracy between government and
pharmaceutical companies to stifle recognition of inexpensive herbal
treatments. I don't believe in such conspiracies. My personal
attitude towards herbal remedies is "if it does no harm, is not
invasive, and doesn't prevent other treatments why not try?" The
"does no harm" can be difficult to evaluate. More may not be better
with immune stimulant therapy. Also "natural" does not necessarily
mean "non-toxic". Herbal preparations can be toxic or cause side
effects, just like chemically synthesized drugs.
However, continuous antibiotic treatment should be avoided in order to minimize selecting for antibiotic-resistant bacteria. Urine cultures and antibiotic sensitivity testing must be done. Dr. Deborah Knapp suggested urine cultures at 3 week intervals. I found it helpful to do cultures and limited sensitivity testing every week. I could tell by Rennie's behavior when the antibiotic had stopped working, but her behavior couldn't inform us about the correct antibiotic. It may be necessary to call around and negotiate to find a local lab which can produce results on a reasonable time scale. My vet shipped samples to an out-of-town lab, and it just didn't cut it for turnaround time.
Useful drugs include: Amoxicillin, Primor (sulfa/amethopterin), Clavamox (veterinary Augmentin), Baytril, Naxcel, and Amikacin. Do not simply rely upon alternating drugs. Rennie developed drug resistant bacteria, and a normal two week course of antibiotic therapy was not sufficient to allow resistant bacteria to die out. It took about three weeks from stopping a drug for bacterial resistance to that drug to disappear.
Personal observation: even though we were careful to follow a full course of treatment with each antibiotic and not to treat with multiple antibiotics at the same time, Rennie was living proof that natural selection in a single patient over several months outside a hospital setting is sufficient to eventually produce multiply resistant bacteria. This is very scary stuff. Eventually, the only antibiotics which will work are those administered by injection (Naxcel, Amikacin). Giving subcutaneous injections is not difficult; your vet can teach you. You may need a prescription for syringes in your state. Proper disinfection to kill off any stray bacteria requires care and thought.
Most of the bacteria which cause bladder infections in
a dog with bladder cancer are bacteria normally found in the
and are not dangerous to healthy adults. Still, care should be
taken. Wash the dog's bedding and clean-up rags with bleach, wash
floors and clean urine spots with disinfectant using a mop head you can
launder with bleach. Wear disposable gloves while cleaning up or
cleansing the dog and wash hands thoroughly with disinfectant soap
afterwards. Do not wash hands or place cleaning supplies or dog
supplies in human food preparation areas. The drugs used to treat dogs
and those used to treat people are essentially the same. If there
an infant or an immune-compromised person in your household,
drug-resistant bacteria could be EXTREMELY dangerous to them. You
have to make a difficult decision. Discuss the issue of antibiotic
therapy, disinfection, and drug resistance carefully with your vet and
not let your concerns be dismissed lightly. Your vet may not be
sufficiently familiar with the kinds of bacterial resistance which can
emerge over six to nine months of antibiotic therapy and may need to
consult with an expert at a veterinary teaching hospital. Get good
instructions about how to disinfect effectively. A nurse who does ICU
work is a good source. Get someone to watch you and point out
potential routes of contamination. Do this early, so you have good
habits built up before there's a potential problem. I don't mean to
be alarmist, or anything. None of the people who cared for Rennie had
a bit of a problem. But better safe than sorry.
A dog with a failing appetite can
usually be tempted by canned food
or by liver and garlic and other aromatic goodies. Paradoxically, it
seemed easier to coax Rennie with bland food such as cream cheese or
scrambled egg. A friend who nurses cancer patients told me it is not
uncommon for cancer patients to find that a favorite food with strong
smells or flavors is now "too much". We gave Rennie vitamins and got
calories in her any way we could. Frozen yogurt and cream cheese pack
of calories into a little volume. Cream cheese is also a good way to
administer pills. As long as she would eat it, we gave Rennie plain
unflavored yogurt three times a day. I feel it helped soothe her
and avoid digestive upsets. Dogs who can't tolerate dairy products can
sometimes tolerate yogurt (frozen or fresh) and cream cheese. Cooked
lamb mixed with rice was the food she would eat at the end.
The decision about how to treat a terminally ill pet who is a beloved member of the family is highly emotional and personal. It is my purpose to provide information about available treatments for this invasive form of cancer and to describe the techniques we evolved for keeping our girl as comfortable as possible and for living with an increasingly incontinent housepet. Caring for such a pet requires a large investment of time, effort, money, and emotional energy. We were very fortunate to be in a position to give Rennie these things without seriously shortchanging our families or ourselves. Even so, it was difficult.
When treating a terminally ill pet, one must always consider the pet's comfort and quality of life. A person can consider the risks, and side effects of a course of treatment, weigh these against the potential benefits, and make an informed choice. We have to make these choices for our pets, always keeping in mind that a pet cannot look to the future in the same manner as a person.
Our choice was to treat Rennie only in ways which were relatively uninvasive and which little impact on her quality of life, only for so long as she seemed able to enjoy life. If our situation had been different, I feel that humane euthanasia would have been preferable to exiling her from the family she'd always known or allowing her to live with the pain of improperly treated bladder infections.
Rennie had been accustomed to crates and wire "exercise pens" since puppyhood. For a dog who is accustomed, these are not incarceration but a comfortable, secure "den". To keep her from lying in urine at night and while we were at work, I designed and sewed special "xpen rugs". These consisted of a double layer of polyester pile fabric, sized to cover the entire exercise pen. I was able to buy inexpensive remnants at a local fabric warehouse. I sewed them together with a layer of dacron quilt batting in the center, then machine quilted them and sewed shoelaces to the corners and the center of each side. Rennie's xpen was then set up as follows (from the floor up):
When we were home, we used adult diapers so that Rennie could walk around the house freely. We cut a hole for her tail, shortened the straps, and crossed them over her back. Other people suggested placing a tarp with several absorbant pads for the dog to lie upon, but Rennie was a little too mobile for that suggestion to work well for us. The rare urine spot was sprayed with disinfectant, then sponged with a mixture of 1 teaspoon white vinegar per quart of warm water or 1 teaspoon liquid fabric softener per cup of warm water to remove scent. I like Simple Green cleaner for tile or linoleum and the least expensive commercial foam spot remover to remove spots from carpets, but several people swear by Orange Glo Cleaner [available from Orange Glo Northwest (800)672-6456]. I had some orange-based Flea Dip which was totally useless for killing fleas (I sprayed some on 4 live fleas in a jar and 4 out of 4 were still alive a week later), but it made a great air freshener when diluted according to package directions.
Thank you for visiting Rennie's Page. You are visitor