Caller Denise asks if transitional cell carcinoma is really a death sentence and what she can expect after her dog Sadie’s diagnosis.
Transitional cell carcinoma (TCC) is the most common bladder cancer in dogs. While there is no cure, Dr. Nancy Reese does consider this cancer to be treatable and you can dramatically improve your dog’s comfort and quality of life with medications.
TCC can also be diagnosed with a special urine test, which is much easier to do and less stressful for your dog than a surgical biopsy (not to mention less expensive!).
As the cancer progresses, it can become uncomfortable and may even obstruct the bladder and prevent the dog from urinating. About 50% of cases will eventually spread to other parts of the body as well. But treatment will usually keep your dog comfortable for 6 months to a year.
Listen in to learn where this cancer can occur, how it is diagnosed, and options for treatment.
Links Mentioned in Today’s Show:
CADET® BRAF and CADET® BRAF-PLUS Urine Tests for Bladder Cancer
Chemotherapy for Dogs Demystified | Dr. Sue Ettinger Deep Dive Podcast Episode
Metronomic Chemotherapy for Dogs with Cancer Article by Oncologist Dr. Susan Ettinger
About Today’s Guest, Dr. Nancy Reese:
Dr. Nancy Reese is a small animal veterinarian with over 30 years of clinical experience taking care of cats and dogs and other critters in the Sierra Nevada foothills. She is also a perpetual student and researcher, as evidenced by her many degrees. In addition to her Doctor of Veterinary Medicine from the University of California, Davis, she earned a Masters in Preventive Veterinary Medicine at UC Davis and then a Ph.D. in Epidemiology at UC Davis. If you string all her letters out after her name it looks like this: Nancy Reese, DVM, MPVM, PhD. In her spare time, she volunteers to help evacuate and shelter animals caught up in disasters, and she’s currently training to help in human search and rescue efforts. Dr. Reese lives in a log cabin with her husband, her 13-year-old golden retriever, and her two 13-year-old cats. Her hobbies include boosting the quality of life and longevity for all animals in her care, hiking, travelling, and cross-country skiing. Oh, and lots of dog walking. degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University.
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[00:00:00] >> James Jacobson: Today’s show is brought to you by the bestselling book, The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. It’s available everywhere books are sold in both paperback and digital editions and on the publisher’s website at DogCancerBook.com. Use coupon code PODCAST on that website to get 10% off The Dog Cancer Survival Guide today.
[00:00:30] >> Dr. Nancy Reese: I have to say it’s something that most veterinary oncologists would at least call a treatable, not a curable cancer, but a treatable, meaning symptoms can be improved and the, and the survival with different treatments can be six months to a year. Biggest thing with treatment is that it improves quality of life. And I think that’s what most of us really care about. I mean, I’d love to say we have a cure, but if we can’t have a cure then improving quality of life is certainly a very reasonable goal.
[00:01:00] >> Announcer: Welcome to Dog Cancer Anwers, where we help you help your dog with cancer. Here’s your host, James Jacobson.
[00:01:09] >> James Jacobson: Hello, friend, and welcome to Dog Cancer Anwers. Today we are answering a call that we received on our Listener Line from a dog who has been diagnosed with bladder cancer. I’m sure that we can all sympathize with this dog lover’s fears, and joining us to discuss transitional cell carcinoma and whether it is a death sentence or what you can do, is our medical editor, Dr. Nancy Reese. Dr. Nancy, thanks so much for being with us today.
[00:01:40] >> Dr. Nancy Reese: Thanks for having me back. Happy to be here, and hopefully give some helpful information if I can.
[00:01:46] >> James Jacobson: We got a caller who is named Denise and she’s calling about her dog Sadie.
[00:01:51] >> Denise Redding: Hi, my name is Denise Redding calling in reference to my 11-year-old white Lab. Her name is Sadie. She has been diagnosed with TCC. Uh, the tumor appears to be at the trigone end, the plumbing end of the bladder. And she’d been in and out of vets for many years, being treated for UTIs, obviously none of which, uh, worked. So now that we found another vet, all of a sudden it’s a death sentence.
She is urinating uncontrollably, little bit better now. I don’t know the symptoms of when it ends, how it ends. We’re not going to put her through surgery. And I wanted to know if you guys had any comments, your vet had any comments there at the cancer center. I sure would like to see what anybody else is going through and how it progresses to the end as uh, I don’t want to keep her alive just for me, I want it to be for her.
Thank you very much and have a great day.
[00:02:54] >> James Jacobson: So, Dr. Nancy, any thoughts on Sadie?
[00:02:58] >> Dr. Nancy Reese: Yeah, it’s always hard to get well any kind of cancer diagnosis, but particularly if ever those words, the death sentence is used that, that makes it a pretty scary type of situation to face. First thing make sure, it probably has been done, but to make sure that it truly is a transitional cell carcinoma. There are the possibilities of having other types of tumor that could affect the bladder, and those might have different treatment outcomes, but it sounds like, given the trigone area, that’s the most common type of, of tumor they will get that area.
[00:03:32] >> James Jacobson: Well, let’s get into the trigone. I like how she calls it the plumbing end of the dog.
What does that actually mean for, for those of us who are not into plumbing, or know that much about veterinary medicine?
[00:03:41] >> Dr. Nancy Reese: Yeah, call your plumber and find out. The trigone is an area of the bladder and it basically is where the ureters, which are the tubes that go from the kidneys to the bladder – there’s one on each side, cause there’s a kidney on each side – and where those ureters join the bladder, and that’s how urine gets made in the kidneys and then transported down to the bladder. The trigone is a little sort of triangular shaped area where those two tubes come into the neck of the bladder, or the narrowing end of the bladder, and then it joins the urethra, which is the tube that goes from the bladder to the outside. So that trigone area is where two tubes come out and one tube leaves.
And so anything that’s in that area, it starts to block the flow of urine. Either blocks it up towards the kidneys or blocks it from going out the, uh, exitory end.
[00:04:34] >> James Jacobson: Got it. Ok. That makes sense.
[00:04:35] >> Dr. Nancy Reese: So it is the most common spot for-
[00:04:38] >> James Jacobson: That’s what I was going to say, that if you’re going to get cancer in the area that would be in that trigone area.
[00:04:42] >> Dr. Nancy Reese: Yeah. Unfortunately it’s the most common spot for some reason they get the TCCs. It can actually occur anywhere within the bladder or in any one of those tubes coming or going from the bladder. So you could have, occasionally, a transitional cell carcinoma that would be more surgically removable because it doesn’t necessarily have to affect that trigone area. But it’s a reasonable choice not to consider surgery because it’s the one spot where surgery ends up frequently not working well in that area because it’s too vital structurally to have those tubes and things, you just can’t remove it without causing irreversible damage to the rest of the urinary tract system.
[00:05:23] >> James Jacobson: Okay.
[00:05:23] >> Dr. Nancy Reese: So surgery is certainly not the best choice for this type of tumor anyhow.
[00:05:27] >> James Jacobson: So how does this progress, what are your thoughts on what they can do? You know, the dog is incontinent now.
[00:05:33] >> Dr. Nancy Reese: Yeah. And then that does make it hard when you’re already dealing with an incontinence issue. But it is, I mean, I have to say it’s something that most veterinary oncologists would at least call a treatable, not a curable cancer, but a treatable, meaning symptoms can be improved. And the survival with different treatments can be six months to a year.
And in an 11 year old Lab, that might be a good length of time to get out of an animal. Biggest thing with treatment is that it improves quality of life. And I think that’s what most of us really care about. I mean, I’d love to say we have a cure, but if we can’t have a cure, then improving quality of life is certainly a very reasonable goal.
I don’t know if the dog is currently taking any medications, but there are several options. And even the most simple one is using a non-steroid anti-inflammatory drug. And they found that those drugs, things like, in the common veterinary use we have Rimadyl and Meloxicam and Deramaxx. But somewhere along the way, people found that treating pain, it actually had an effect on the size of some of these tumors, particularly the transitional cell carcinomas. So the original one, that used was a human non-steroid anti-inflammatory drug called Piroxicam, and that actually did seem to have some shrinking ability in the tumor, or at least slowing down the rate of growth.
And now that they’ve found the other ones like Deramaxx seems to work probably equally as well and may have a wider margin of safety. But that’s a great thing to be doing because you’re helping with pain and you might also be reducing the tumor size or at least slowing the growth down. So I’m always in favor of using a non-steroid like that when the animal has the TCC, because they – forget if we talked about it, but want to make sure that it is a TCC, ’cause I mentioned there’s other types of tumors that can affect the bladder, and there is a nice, newer, non-invasive test where the owner just has to collect – it, it’s a good amount of urine, but, um, they, they collect urine and it can be a couple of days samples to send into a lab that can confirm that it’s the TCC and not some other type of tumor.
So it’s again, it’s a nice, easy test that at least confirms it’s a TCC before thinking about, you know, other types of treatment. So that’s, I’d certainly recommend that being done if it hasn’t just to make sure that another treatment wouldn’t be more appropriate.
[00:08:01] >> James Jacobson: So confirm that it is actually a-
[00:08:02] >> Dr. Nancy Reese: Yes. I think that’s always a good step.
That’s a great first step. It sounds like they probably had to do some imaging because they know where this tumor is located. So most likely that’s already been done, but a biopsy or the CADET BRAF test, that is the urine test, that would be a good thing to send out.
[00:08:21] >> James Jacobson: And the CADET urine test is it just as simple as that, it’s just really just taking a urine sample and sending it to a lab?
[00:08:27] >> Dr. Nancy Reese: Yeah. So the like I said it takes about 40 ccs of urine and it has to be transported in a special container, but the veterinarian will give the owner that and then they can collect the urine over a couple of days. And that, that detects a gene mutation that’s associated with the transitional cell carcinoma.
So it’s, it virtually has no false positives. You can occasionally get an animal that has a TCC that comes up negative, but that’s, it’s pretty uncommon. So it’s a great, easy, non-invasive test and I’m all in favor of non-invasive.
[00:08:59] >> James Jacobson: Yeah, well, yeah. I mean, if you’re just trying to get the dog to pee. Although 40 ccs is a bit of urine. Right?
[00:09:05] >> Dr. Nancy Reese: Right. Right. So then you can do it over a couple of days and combine the samples.
[00:09:08] >> James Jacobson: So if it isn’t transitional cell carcinoma, and obviously you can’t see, what are some other things that it could be?
[00:09:15] >> Dr. Nancy Reese: There’s different types of muscle tumors that can affect there, so the, the bladder wall is, is made of some muscle tissue and things so you can have those, or you could have some other type of tumor that has spread to the bladder. So like I said, a biopsy is another option to find out specifically if it is a TCC versus something else, or the urine tests, like I said, because it just might be, another type of tumor would have a completely different chemotherapy that might be more effective.
[00:09:44] >> James Jacobson: Is it your experience that a lot, I mean, and we don’t know in the case of Sadie here, but is it your experience that veterinarians will think, well, I see it on the imaging, it probably is a TCC, and just go with that, or are most people going to do things like that urine test and additional labs to make sure?
[00:10:03] >> Dr. Nancy Reese: I think, and until the urine test came out, I’d say a lot of times it was presumed that it’s a TCC based on the imaging and the findings. You know, that’s never the best thing to do because we really like to know it is definitive or not. But honestly, in, in practice, you see a tumor on the imaging in that area, you’re going to bet that it’s a TCC. And the thought of doing a biopsy – because this is one of those tumors where, it’s still, it’s getting more controversial now because they used to say that you do not want to stick a needle into one of these to get a sample of it, because it might seed the tumor as you’re pulling the needle out.
So dogs – that always sounds horrible anyhow – but dogs take the needle into the bladder very well. It’s not that uncomfortable, they do fine. But there were some early studies that said that it might seed the tumor as you’re pulling that needle out. Some people say that may not be happening as much, but I still would probably not risk taking a needle sample like that.
So that means you’d be doing like a surgical biopsy, which again, we try to avoid. There’s other ones where you can do a certain type of catheterization where you might collect some of those cancer cells too, but that’s not the most comfortable thing. Easier, the urine test is just vastly easier.
[00:11:20] >> James Jacobson: Wow. I’m going to take a quick break, but when we come back, I want to kind of pursue that death sentence thing that we started talking about at the top of the show. We’ll be right back.
So Dr. Nancy, one of the things that the caller was saying is that she wonders if this is a death sentence, and I’m not sure, obviously if the veterinarian said that, or if this is just something she’s picked up, but you had some thoughts about that.
[00:11:44] >> Dr. Nancy Reese: Yeah. Like I said, I really hate those words. But, you know, I mean, we unfortunately do have to face that reality that a lot of cancers progress to where that, that does in one way or another end up ending the animal’s life, whether it’s from discomfort or the effects of the actual cancer.
So it is something that invariably will progress. So we don’t have any kind of cure, so it is something that will progressively get worse over time. It’s a matter of how much time that we can get out of that with different treatments and things. I think after it’s been diagnosed, probably 50% of those animals will get metastases, so it can spread to the lungs or can spread to other organs or sometimes even bone.
And those might be the debilitating effects that end up resulting in needing to have euthanasia. Other way that it can cause quote, "a death sentence" or at least cause enough concern over the animal’s quality of life is the physical discomfort of having this, this mass in there or blocking that urine flow. Either it can back up into the kidneys and cause kidney problems, or they’re unable to urinate and their bladder just keeps getting bigger and bigger and more uncomfortable. There is a surgical, kind of palliative thing where they can actually put a little tube to keep one of those urinary tubes open so that the animal could still urinate.
So there’s ways to get around the mass and sort of redirect the plumbing in a way. But again, that’s, that’s a pretty big thing that not a lot of people are gonna necessarily opt for.
[00:13:16] >> James Jacobson: Probably not on an 11 year old Lab.
[00:13:19] >> Dr. Nancy Reese: Right, right.
[00:13:20] >> James Jacobson: Right. Well okay, but there are a lot of options as we’ve discussed to me to make sure that it is transitional cell carcinoma.
[00:13:27] >> Dr. Nancy Reese: Right.
[00:13:27] >> James Jacobson: Use that urine test. And then if you don’t do surgery, which it sounds like it’s not the best option, then the NSAIDS can be really helpful.
[00:13:35] >> Dr. Nancy Reese: Absolutely. So the NSAIDS, either by themselves, which I’ve done for people that just want kind of comfort care, but you can also, there are some chemotherapies that – again, not curative – but they can shrink or at least stabilize the tumor and, you know, there’s some of the drugs that probably this been mentioned on this show once or twice, given all the wide variety of cancers you guys talk about, but Cisplatin or Carboplatin or Mitoxantrone, all of those are some options for chemotherapy. And they’re, they’re not intensive in terms of not super frequent, not a lot of hospitalization and things.
So those are good either with or without the non-steroid.
[00:14:14] >> James Jacobson: Awesome.
Well, Dr. Nancy, thank you so much, I think this has been real helpful and, uh, thanks for being with us today. And thank you, listener. If you are like Denise and have a question about dog cancer, well, then give us a call on our Listener Line. That phone number is (808) 868-3200.
That’s (808) 868-3200. You can find all the links and resources mentioned in today’s show in the notes at DogCancerAnswers.com. For even more information on transitional cell carcinoma and other cancers, visit the website DogCancer.com to read our full compliment of articles. And if your dog has been diagnosed with cancer and you need someone to talk to, join our support group on Facebook. And you can find that at DogCancerSupport.com. I’m James Jacobson, and from all of us here at Dog Podcast Network, I want to wish you and your dog, a very warm, Aloha.
[00:15:25] >> Announcer: Thank you for listening to Dog Cancer Anwers. If you’d like to connect, please visit our website at DogCancerAnswers.com or call our Listener Line at (808) 868-3200. And here’s a friendly reminder that you probably already know: this podcast is provided for informational and educational purposes only.
It’s not meant to take the place of the advice you receive from your dog’s veterinarian. Only veterinarians who examine your dog can give you veterinary advice or diagnose your dog’s medical condition. Your reliance on the information you hear on this podcast is solely at your own risk. If your dog has a specific health problem, contact your veterinarian.
Also, please keep in mind that veterinary information can change rapidly. Therefore, some information may be out of date. Dog Cancer Answers is a presentation of Maui Media in association with Dog Podcast Network.