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Total Cancer Management in Small Animals

Susan G Wynn, DVM

Cancer: Remove the Cause

•  Multiple cases of cancer in one house are not uncommon, and a toxic insult can sometimes be identified. Potential problems include pesticide and herbicide use and perhaps (although this is controversial) exposure to electromagnetic fields from nearby power lines.

The first, earth-jarring moments after hearing that a loved pet has cancer are not a good time to make decisions, but most pet owners respond, in time, by having myriad questions about cancer treatment options. Managing cancer well depends on so many things—the cancer type, the general health of the animal, the environment, and the ability of the owner to follow through. If you are looking for 'complementary' approaches to cancer treatment, it is important to consider all of these things.

First question: is chemotherapy or radiation appropriate? Most people balk at the idea of either, drawing upon mental pictures of wasted, bald, human cancer patients in constant pain. Fortunately, we do not need to subject our pets to heroic measures, and you are free to make the decision one way or another (not as easy to do for a human patient). It is important to note, however, that dogs and cats seem to tolerate these treatments much better than people do. In addition, there are certain cancer types that are very responsive to these conventional, if drastic treatments. Surgical removal of certain types of tumors may well be the only way to stop these cancers in their tracks, for instance. Many holistic veterinarians believe that cancer is a severe and acutely threatening disease, and that the response must be proportional. Others believe that using exclusively natural treatments may rebalance this symptom of 'chronic disease', or will allow the patient to live a better life—at least the remainder of it. No controlled trials comparing the two approaches have ever been done.

In my experience, animals with cancers that are very responsive to chemotherapy live longer, happier lives when given the benefit of both worlds. One such cancer type is lymphoma or lymphosarcoma. Other types, such as primary lung carcinomas or melanomas, will have a variable or poor response to chemotherapy—in cases like these, it is probably fair to disregard any recommendation to pursue chemotherapy or radiation. For tumors that are potentially completely removed with surgery, this option will give a pet a running start, and allow it to better deal with potential 'seed' tumors elsewhere in the body.

Where do you get the most reliable information regarding the use of chemotherapy, surgery or radiation for your cancer case? The best, most up-to-date and reliable information will come from a board certified internist, especially one with an interest in oncology. These specialists may be found in private practice in big cities or at the veterinary schools.

Second question: Can’t natural treatments alone cure cancer? In a word—no. Remember that these are gentle treatments, but cancer is not a gentle disease. What natural treatments can do is improve the animal’s general state of health and give it a better chance to fight the disease. Some of the approaches used include therapeutic nutrition, herbal immune stimulation, and possibly herbs that face cancer head on.

Basic Diet

The supposed “Cancer Fighting Diet” and its various incarnations have been popularized recently. The principles behind this diet are simple: lower carbohydrates, raise fats, and use good quality protein. Researchers theorize that tumor cells utilize carbohydrates (found in sugar, grains, starchy vegetables and the like) more readily than energy from other sources such as fat. This diet is not yet available commercially, but it is easy to cook one for your pet. The diet described below is purposefully vague and designed only to get you thinking—the diet is not balanced for long term health maintenance and should be constructed only under the supervision of your veterinarian.

In general, a good quality protein source such as poultry, fish, or cottage cheese should comprise anywhere from 30–70% of the total diet volume. Another excellent protein source is soybean, so tofu may be substituted for meat on occasion. The remainder should be a mixture of vegetables, which should be provided in variety. Animals tend to like the sweet taste of carrots, corn and green beans, but an effort should be made to provide vegetables with fewer sweet carbohydrates and more of the suspected cancer fighting indole-3-carbinols and other phytochemicals (such as broccoli, cabbage, brussels sprouts, cauliflower, bok choy, kale, radishes, tomatoes, red peppers, carrots, etc). Many owners like to feed pets fruits, but you should remember that the sweet taste comes from simple carbohydrates, so fruits should be somewhat limited.

Most pet owners find that their animals do well with no starches added to the diet, but if your pet seems to lose energy, consult a veterinarian and find a low percentage to add to the diet. Carbohydrates come from grains like wheat, oats, barley, rice and corn. These can be added in the form of cooked oatmeal, barley, pasta, brown rice, potatoes, quinoa, etc.

The easiest way to ensure that the pet is getting the balance required is to blend all of the above ingredients in a food processor, so that a picky dog or cat doesn't throw out a vegetable that he or she dislikes! Many people make a large batch of food, then freeze meal size portions so that it is fresh when thawed and fed to the pet. Animals eating home-prepared diets should always receive a multivitamin-mineral supplement, as well as bone meal—be sure to consult your veterinarian for help with these additives.

Nutraceuticals, hormones, herbs and other supplements

There are quite a few considerations that go into designing a supplement program for a cancer patient. Will the supplement interfere with chemotherapy? Is immunestimulation potentially harmful, as is the possibility with lymphoma? Has the patient lost his or her appetite due to the illness? Below is a brief listing of supplements that may be helpful as adjuncts to cancer treatment. Again, no doses are provided because every animal (besides ranging tremendously in size and species requirements) should receive an individual evaluation.

Supplements to consider:
Look for the *—these are considered essential supplements

*Fish oil or other omega-3 fatty acid sources: fish oil appears to reduce metastasis and enhance immune function, as well as having anti-inflammatory effects.

*Vitamin A: Vitamin A and beta-carotene enhance immune function and may prevent some forms of cancer. Be careful though—a large study suggested that beta-carotene accelerated development of lung cancer in smokers. This might be important if your pet lives with a smoker.

*Vitamin C: like Vitamins A and E, adequate vitamin C levels may be associated with lower cancer risk, supplementation may enhance effects of conventional therapies and reduce toxicity, and the antioxidant function may reduce inflammation.

*Vitamin E: Epidemiologic evidence suggests that vitamin E prevents cancer, though this hasn’t been confirmed in vitro. Vitamin E does enhance immunity, and may ameliorate the adverse effects of chemotherapy.

*Selenium: strongly associated with a decreased risk of cancer; supplementation may reduce adverse effects of chemotherapy.

Coenzyme Q10: may reduce toxicity of the chemotherapeutic drug adriamycin; also, immune enhancing and antioxidant.

*Arginine: shown to enhance immune function in experimental cancer studies

Pycnogenol: powerful antioxidant, especially from grape seed extract.Melatonin: suggested to suppress several cancer types, but not all.

Glandulars: extracts of thymus gland, for instance, may contain cytokines helpful in managing cancer.

Herbal supplements with suggested or confirmed anti-cancer effects (note: some of these herbs may be quite toxic—even more so than some chemotherapy drugs in the correct dosage—so use under the direction of a trained veterinarian only):
Green tea
Turmeric
Soybeans
Garlic
Pau d’arco
Carnivora (venus fly trap)
Coptis
Oregon Grape
Mistletoe
Chaparral
Immunestimulants
Reishi (ganoderma)
Maitake
Ashwaganda
Ginseng
Astragalus
Echinacea

Homeopathic treatment of cancer

There are veterinarians who specialize in homeopathic treatment, and those who have a special interest in homeopathic treatment of cancer. Any pet owner inclined towards homeopathic management should consult a homeopathic veterinarian. A brief listing of some homeopathics often used in cancer treatment should convince you that prescription is best left to the specialist:
Arsenicum Album, Arsenicum Iodatum (Ars-i), Asterias (Aster), Cadmium sulphide (Cadm-s), Calcarea carbonica (Calc or Calc carb), Carbo Animalis (Carb an), Carbo, Carcinosin (Carc), Conium maculatum (Conium), Graphites, Hydrastis (Hydr), Mercurius corrosivus (Merc cor, Nitric acid (Nit ac), Phosphorus (Phos), Phytolacca (Phyt), Silicea (Sil), Sulphur, Thuja, cell salts and tumor nosodes, and constitutional remedies suited to the patient at that time. This list is by no means all inclusive. Potency is critical, and many practitioners recommend low (X) or LM potencies.

Homeopathic treatment of cancer has not been well evaluated experimentally.
Special Treatments

There are a number of unconventional treatments in use by cancer patients—most of them have no support, or even analysis, in the medical literature. Anecdotal claims, however, suggest that Essiac tea, Antineoplaston therapy (probably not available for pets), Hoxsey, and Gerson therapies should be investigated. Immunoaugmentative therapy is being used by one American veterinarian; it may be effective in a limited number of cases, but the evidence is still coming in.

Shark cartilage is being investigated for its possible role in preventing tumor growth; it is important to note that the particular constituent suspected of having anti-tumor properties is not found in commercially available varieties of shark cartilage. It is also important to know that sharks can get cancer!

Ozone is not used widely in veterinary medicine; the technique usually involves rectal insufflation or bubbling ozone through the patient’s blood and re-administering it. While the clinical data is conflicting, experimental evidence seems to suggest that ozone may exert cellular effects consistent with its reputation as a helpful adjunct in the treatment of a variety of chronic diseases. Although evidence that ozone may be valuable in the treatment of viral disease, cancer, and circulatory disorders is intriguing, it is important to realize that ozone is a toxin, and should be used only under the supervision of a doctor experienced in this technique.

Don't Distract Your Pet When He's Working

Science is only beginning to understand the role the immune system plays in the development in chronic disease—the system of checks and balances among the different 'squadrons of warriors' are far from understood, and the delicate balance of power sometimes breaks down during the course of chronic problems, such as cancer, allergies, autoimmune and degenerative diseases.

Cancer patients may have depressed immune function, meaning that invaders can set up shop in the body and have a party, because the immune ‘sentries’ have no power to stop them. This immunesuppression can be caused by chronic drug use—especially steroids. It can also be caused by chemotherapy. Lastly, the existence of a chronic problem itself may, under certain circumstances, exhaust immune function. It stands to reason, then, that cancer patients may be more susceptible to infectious diseases. However, many will have long term immunity from earlier vaccines, and, truthfully, the chances of a cancer patient contracting distemper or panleukopenia are vanishingly small.

So vaccines may be unecessary in cancer patients, but there is another consideration. We are doing a great deal to support immune function in these dogs and cats, the better to have them attack errant cancer cells. Do we really want to complicate matters for an already stressed immune system by giving these patients viral vaccine antigens to deal with on top of their cancer?

In our practice, cancer patients are almost never vaccinated with routine distemper/parvo or feline panleukopenia vaccines (and certainly never with the optional vaccines such as lyme disease, feline leukemia, FIP, etc). We run antibody titers yearly (see Vaccination Decisions for more information) for distemper and parvo in dogs, and triennial titers for panleukopenia for cats . If the pet is due for rabies vaccination, this is more complicated. Rabies titers are available from Kansas State University and Auburn University; however, not all states will accept titer results in lieu of vaccination. You must check with your state veterinarian to be sure.

Along the same lines, we don't want to force dogs, in particular, to deal with another potentially deadly disease while they fight cancer. In general, heartworm prevention—either daily or monthly—is recommended according to the normal schedule. If your cat is a candidate for heartworm prevention, please discuss this with your veterinarian.

Go Forth and Fight the Good Fight

Your pet needs you to be an education warrior—find out everything you can, contact all the experts, and make the most informed decision possible. Once you find a balanced blend of supportive, tonic, natural therapies and decide the extent to which you will use conventional treatments, sit back and get ready for the ride. Fighting cancer does not end with eternal life, but what does? Most people are gratified when they have numerous options and a balanced team to help them through the process.

Bibliography

- Basic diet and cancer
- Ogilvie GK, Walters L, Salman MD, Fettman MJ, Johnston SD, Hegstad RL (1997 ). Alterations in carbohydrate metabolism in dogs with nonhematopoietic malignancies. Am J Vet Res 58(3):277-281
- Ogilvie GK, Vail DM, Wheeler SL, Fettman MJ, Salman MD, Johnston SD, Hegstad RL (1992). Effects of chemotherapy and remission on carbohydrate metabolism in dogs with lymphoma. Cancer 69(1):233-238
- Vail DM, Ogilvie GK, Fettman MJ, Wheeler SL (1990). Exacerbation of hyperlactatemia by infusion of lactated Ringer's solution in dogs with lymphoma. J Vet Intern Med 4(5):228-232
- Ogilvie GK, Vail DM. Nutrition and cancer (1990). Recent developments.Vet Clin North Am Small Anim Pract 20(4):969-985
- Vail DM, Ogilvie GK, Wheeler SL, Fettman MJ, Johnston SD, Hegstad RL (1990). Alterations in carbohydrate metabolism in canine lymphoma. J Vet Intern Med 4(1):8-11
- Fish Oil
- Paulsen JE, Elvsaas IK, Steffensen IL, Alexander J (1997). A fish oil derived concentrate enriched in eicosapentaenoic and docosahexaenoic acid as ethyl ester suppresses the formation and growth of intestinal polyps in the Min mouse. Carcinogenesis 18(10):1905-1910
- Colombo DT, Tran LK, Speck JJ, Reitz RC (1997). Comparison of hexadecylphosphocholine with fish oil as an antitumor agent. J Lipid Mediat Cell Signal 17(1):47-63
- Schut HA, Wang CL, Twining LM, Earle KM (1997). Formation and persistence of DNA adducts of 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) in CDF1 mice fed a high omega-3 fatty acid diet. Mutat Res 378(1-2):23-30
- Takahashi M, Fukutake M, Isoi T, Fukuda K, Sato H, Yazawa K, Sugimura T, Wakabayashi K (1997). Suppression of azoxymethane-induced rat colon carcinoma development by a fish oil component, docosahexaenoic acid (DHA). Carcinogenesis 18(7):1337-1342
- Vitamins A, C, & E
- Gey KF (1998). Vitamins E plus C and interacting conutrients required for optimal health. A critical and constructive review of epidemiology and supplementation data regarding cardiovascular disease and cancer. Biofactors 7(1-2):113-174
- Gogos CA, Ginopoulos P, Salsa B, Apostolidou E, Zoumbos NC, Kalfarentzos F (1998). Dietary omega-3 polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely ill patients with generalized malignancy: a randomized control trial. Cancer 82(2):395-402
- Franceschi S (1997). Micronutrients and breast cancer. Eur J Cancer Prev 6(6):535-539
- Moriguchi, S, Maekawa, K. Okamura, M., Oonishi, K. Kishino, Y (1995). Vitamin E prevents the decrease of cellular immune function with aging in spontaneously hypertensive rats. Nutrition Research 15(3): 401-414
- Wang, Y.J., Huang, DS, Wood S, Watson RR (1995). Modulation of immune function and cytokine production by various levels of vitamin E supplementation during murine AIDS. Immunopharmacology 29(3):225-233
- Yano T, Obata Y, Yano Y, Otani S, Ichikawa T (1994). Vitamin E acts as a useful chemopreventive agent to reduce spontaneous lung tumorigenesis in mice. Cancer Letters 87(2):205-210
- Flagg EW, Coates RJ, Greenburg RS (1995). Epidemiologic studies of antioxidants and cancer in humans. J. Am. Coll Nutr 14(5):419-427
- Albanes D, Heinonen OP, Huttunen JK, Taylor PR, Virtamo J, Edwards BK, Haapakoski J, Rautalahti M, Hartman AM, Palmgren J, Greenwald P (1995). Effects of alpha-tocopherol and beta-carotene supplements on cancer incidence in the alpha-tocopherol beta-carotene cancer prevention study. Am J Clin Nutr 62(suppl):1427S-1430S
- Block, G (1991). Epidemiologic evidence regarding vitamin C and cancer. Am J Clin Nutr 54:1310S-14S
- Shimpo K, et al (1991). Ascorbic acid and adriamycin toxicity. Am J Clin Nutr 54: 1298S-1301S
- Ripoll EAP et al (1986). Vitamin E enhances the chemotherapeutic effects of adriamycin on human prostatic carcinoma cells in vitro. J Urol 136:529-31
- Selenium
- Sundstrom H (1989). Supplementation with selenium, vitamin E and their combination in gynaecological cancer during cytoxicity chemotherapy. Carcinogenisis 10:273-78
- Clark LC, Combs GF, Turnbull BW, et al. Effects of Selenium Supplementation for Cancer Prevention in Patients with Carcinoma of the Skin: a randomizedcontrolled trial. JAMA 276(24):1957-1963
- Garlic
- Nagourney, RA 1998. Garlic: Medicinal food or nutritious medicine? Journal of Medicinal Food 1(1): 13-28
- Dangerous Exposures
- Reif JS, Lower KS, Ogilvie GK (1995). Residential exposure to magnetic fields and risk of canine lymphoma. Am J Epidemiol 141(4):352-359
- Reif JS, Dunn K, Ogilvie GK, Harris CK (1992). Passive smoking and canine lung cancer risk. Am J Epidemiol 135(3):234-239
- Homeopathy
- Maliekal, TP (1997). Antineoplastic effects of 4 homoeopathic medicines. British Homeopathic Journal 86:90-91.
- Bourgeois JC (1984). Protection du capital veineux chez les perfusées au long cours dans le cancer du sein. Essai clinique en double aveugle: Arnica contre placébo [Dissertation]. Bobigny: Université Paris Nord
- Chowdhuri H (1983). Cellular changes during control of cancer by Sicafek; a combination of biochemic salts. British Homoeopathic Journal 72:169-176
- Hadjicostas C, Diamantidis S (1995). Comparative clinical study of parallel allopathic and homeopathic treatment to allopathic treatment in cancer of the large intestine. Researches of MIHRA Athens, Athens.
- Wynn S G. 1998 Animal Studies of Homeopathy. JAVMA 212(5):719-724
- Ozone
- Wynn SG (1996). A Brief Review of Ozone Therapy for Medical Practice. J. AHVMA
- Washuttl, J., R. Viebahn, and I. Steiner, The influence of ozone on tumor tissue in comparison with healthy tissue (in vitro). Ozone Science and Engineering 12: 65-72.
- Sweet, F., M. Kao, and S. Lee (1980). Ozone Selectively Inhibits Growth of Human Cancer Cells. Science, 209: 931-933.
- Paulesu, L., E. Luzzi, and V. Bocci (1991). Studies on the biological effects of ozone: induction of tumor necrosis factor on human leucocytes. Lymphokine and Cytokine Research 10(5).