But there are some things you should know about cancer. First of all, it is not one disease, but rather it is a large family of diseases. Really whenever cells begin to divide in an uncontrolled fashion it is technically cancer. Everything from that gross little warty thing on the top of Buffy's head, right through to the aggressive volleyball sized thing that caused Duke's liver to fail. When these dividing cells don't destroy important tissues or spread through the system we call it benign cancer. When they do, we call it malignant cancer. Fortunately most cancers are benign. To reduce confusion a lot of us try to avoid calling the benign ones cancer at all and will refer to them as tumours or growths, but you should always ask if you are unclear – is it benign or malignant?
The second thing you should know is that even malignant cancer is not a death sentence. In human medicine many cancers are increasingly viewed as chronic diseases that even if they cannot be cured, can be managed well enough to allow a good quality of life for a reasonable length of time. That is our goal in veterinary medicine too, with a strong overriding emphasis on the quality of life aspect. Ultimately it does not matter what label we put on the disease, what matters is what we can do to provide a good quality of life. The cancer label is not helpful – there are many non-cancer diseases that are worse than many cancers. To be sure, there are too many cancers where we have to move rapidly to a euthanasia conversation, but my point is to not view all cancers the same way as there are some that can be easily managed to provide that good quality of life for some time.
I am sometimes asked, “Aren't we just prolonging his life?” If I'm in the right mood and if I know the client well, my answer to that is, “Everytime you take a breath you are prolonging your life!” It's true. The name of the game for every organism is life prolongation, just so long as it is without suffering. An animal doesn't know how long it's supposed to live. It has no thought for tomorrow and no anxiety when I tell their human companion that we can probably only keep it comfortable for another six weeks. Each happy day for an animal during those six weeks is a happy day. It's that simple. We just want to string together as many of those happy days as we can.
The other stumbling block in treating cancer in pets is the word “chemotherapy”. Some people react quite strongly when I suggest that, as if I've now crossed a line into ridiculous territory. But chemotherapy just means drugs to treat cancer, and much like the cancers themselves, there is a huge amount of diversity in these drugs. The most common treatment for a malignant bladder cancer is the same drug we use for arthritis (a non-steroidal antiinflammatory). Used for cancer it is “chemotherapy” (oooh... aaah...). Used for arthritis it is not. Exact same drug, exact same dose. Even aggressive chemotherapy drugs that can have really unpleasant side effects in humans often have far fewer side effects in dogs (cats are a different story). And we have the huge advantage that if one of our patients does become sick on the chemo, we can just stop. At least we tried. The bottom line here is not to dismiss chemotherapy just because of the scary word. It's not for every pet with cancer, but it is for some.
And finally, I am often asked about cause. People will say, “But we feed her the best food.” Or they will ask about the lawn chemicals or the water or the neighbour's treats. The truth is that none of these have any bearing. Cancer in pets (and in people, a few uniquely human high risk beahviours excepted) is mostly due to three things: genetics, age and bad luck. The genetics is obvious as certain cancers are far more common in certain breeds. This doesn't mean that Fido's parents or siblings had to also have it for it to be genetic, it just means that the risk for an individual in that breed is higher, like playing with loaded dice. The age risk should also be obvious. As time goes on your DNA accumulates damage and errors, like an old car or old house, and some of that damage and some of those errors could lead to cancer. But the biggest factor is simply luck. The body of even the tiniest animal is inconceivably complex. When you begin to look at that complexity it is amazing that diseases and disorders such as cancer aren't actually even more common. Be thankful for what works and don't be afraid of what doesn't. Sometimes it's not as bad as you think. Be like your pet and ignore the labels and words and just work to make each day as good as possible and then enjoy that day.
