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ACCC Surgeons Answer Common Questions in Webinar

Fourth Annual “How to Navigate the Cancer Diagnosis” Kicked Off in June

ACCC’s Tammi Ruddle, DVM, Board-Certified in Surgery, and Robin Holtsinger, DVM, Board-Certified in Surgery, presented The Five Most Commonly Asked Questions of Our Surgical Team at the June webinar held for referring veterinarians across Florida. Merck Animal Health once again is the sponsor of the series. A full recording of their talk is available here.

In summary, they led a lively and candid discussion about challenges faced by surgeons solely dedicated to the care of cancer in pets. Below are a few of the key points they reviewed:

Clear and transparent communication at the outset, they stressed, is critical to managing a pet owner’s expectations.  “We need to be honest about all of the possible outcomes, both good and bad,” said Dr. Ruddle. “Clients can get upset if they don’t know what can happen. We have to be clear about what can go wrong. The result is a healthier and more trusting relationship.”

Masses on extremities can be especially challenging, they explained, but the doctors try to look for ways to avoid amputation. That goal is carefully balanced with the desire to help prevent recurrence. With cancerous tumors removing tissue around the area (or margins) is critical for eliminating as much of the cancer as possible. However, when the tumor is located in places with less skin or significant muscle mass, like the bottom of a paw or between a digit, amputation may be necessary.

When a cancer diagnosis is definitive and treatments such as radiation or chemotherapy are scheduled post-surgery, the surgeon has a little more latitude in the tumor removal. Yet, extra caution is taken to ensure a faster wound recovery so treatment can begin sooner.

“When I know radiation is scheduled,” explained Dr. Ruddle, “I don’t take as wide of margins and make sure the area is closed securely.” 

A diagnosis by a cytologist is highly recommended by surgeons, although staging is not always necessary until a pathology report is prepared on the tumor after it is removed. The exception to this guideline is when the tumor looks “angry,” which may indicate a higher-grade tumor.  

For active mast cell tumors, prior to surgery, the surgeons recommend the following medications:  diphenhydramine to decrease histamine; Famotidine as an H1 receptor antagonist; and Corticosteroids, which reduce inflammation.

Although these medications do not affect the grade of the tumor, in many cases they help calm the tumor down and ease the surgical process. “Recently, we’ve seen a lot of non-steroidal medications used,” said Dr. Holtsinger, “but their use can delay surgery”.  Traditionally, some veterinarians were worried that using steroids would have negative consequences, but we find that isn’t the case today.

Other issues reviewed during the webinar included the increase in cases of anal sac adenocarcinomas and the steps being taken to help avoid incontinence in dogs, the challenges surrounding lymph node removal, and the latest findings in clinical trials of the cancer treatment, Stelfonta.

The next webinar is scheduled for July 16 with ACCC’s Jarred Lyons, DVM, Board-Certified in Radiation Oncology, who will present “Bone Tumors: Surgery Is Not Feasible or Desired, So What’s Next? Register here.