In my last blog post on lymphoma, I shared that I would personally treat my dog with a multi-agent chemotherapy protocol if she was diagnosed with lymphoma. You will learn a lot about diagnostics and treatment options once you meet an oncologist, so in this blog post, I will share some of the things you need to know before you get to the oncologist –the things I wish you knew before you actually see me.
If lymphoma is suspected, make an appointment a.s.a.p, like tomorrow or in the following days. Do not wait, especially if your dog is not feeling well. Symptoms are typically non-specific and include decreased appetite, decreased energy, weight loss, vomiting, diarrhea, increased urination, and increased drinking.
For most other cancers, it is not as urgent that you get into see the specialist – a week or two is typically fine (You may want to see the oncologist with your dog sooner, but from a medical standpoint, it is not as critical to get there in the coming days).
But lymphoma is different, because it is one of the more rapidly moving systemic cancers. Without treatment, the median survival time is one month from the time of diagnosis. So get to the oncologist quickly. I personally will double-book myself in order to get a patient in the following day if lymphoma is suspected.
Do not start prednisone, a steroid, before you see the oncologist. While prednisone is often used for its anti-inflammatory effects, it also has anti-cancer properties and can kill lymphoma cells. So dogs treated with steroids will respond and often feel better. This sounds great, right?
Unfortunately, prednisone started first can interfere with chemotherapy and can trigger a mechanism called Multi Drug Resistance. In fact, pre-treatment prednisone has been demonstrated to be a strong negative predictor for dogs with lymphoma.
In addition, steroids will start to kill the cancer cells making any diagnostics performed after the steroids less accurate. This can also be a problem if the aspirates were not confirmatory for a diagnosis, and/or if aspirates or biopsies need to be repeated. If prednisone has been started, getting an accurate diagnosis may be challenging and cause a delay in treatment.
Be prepared to do diagnostics and start treatment the day of your first oncology consultation. With other cancers, I typically tell guardians to think about the options over the weekend, and we can often safely wait a few days to do staging diagnostics, like chest X-rays and abdominal ultrasound, and to start treatment. In fact, if surgery was performed, I will typically wait 10 to 14 days post-operatively to start chemotherapy. In non-lymphoma dogs, there is more time to make decisions.
But due to the rapidly progressive nature of lymphoma, I encourage Guardians to make a decision during the consultation appointment. I mention this because if you are not expecting to start treatment right away, you may feel pressured and rushed. Even though you may not have all the information until the appointment, I think it helps to know you should be ready to decide about treatment at the appointment or within a day or two.
You will learn a lot more about lymphoma from your specialist, but these are things I want you to know before you get there. And don’t forget that there is an entire, lengthy chapter on lymphoma, in the Dog Cancer Survival Guide.