Should I use chemotherapy on my dog with transitional cell carcinoma (TCC) of the urinary bladder?

     This is a very good question and I will confess that as little as a few years ago I  was not a big fan of chemotherapy in dogs.  Likewise, though I discussed this option with families faced with having to treat TCC in their dogs, many would not consider the chemotherapy either because of personal experiences with chemotherapy or because their pets were doing so well following our Ultrasound Guided Endoscopic Laser Ablation (UGELAB) procedure that they did not feel any need to pursue chemotherapy.   Since the prognosis for a patient with TCC was so poor, in the beginning  of our developement of the UGEALB procedure,  we were happy to “knock the tumor for a loop” using the laser and to buy a little extra time without “heavy-duty” medicines.  Traditional surgery provides a median survival time of about 80-129 days for TCC patients.  UGELAB was providing a median survival time of approximately 380 days even when faced with obstructive tumors in the urethra that were considered inoperable before UGELAB.  We were delighted with these results and with repeated laser treatments some dogs were now living years instead of months. 

      Then  “the hammer fell”.   Dogs that had lived much longer than expected as a result of our laser procedure where now  dying not because of the  obstructive nature of transitional cell carcinoma but rather because we had kept them alive long enough to die of metastasis and/or extension into the body cavity around the bladder.    It became obvious that the only way to overcome this frustration was to consider chemotherapy.  Statistically, the longest median survival  time  studied was a combination of mitoxantrone and piroxicam.   Still considering quality of life for  my patients as a primary concern, I consulted with several board certified veterinary oncologists to learn about their experiences with this combination of drugs and what we might expect for our TCC patients.  Surprisingly, the oncologists I spoke with had all had good experiences in administering these drugs in combination without significant side effects.   We had already been using piroxicam for years with minimal side effects, most of which could be handled by adjusting doses or providing protective stomach preparations along with the piroxicam.   Faced with the certainty that our wonderful successes with endoscopic diode laser surgery would eventually be terminated by the development of metastasis,  it seems like a “no brainer”  to give the mitoxantrone and see how we made out.  We had nothing to lose and everything to gain. 

     The first few patients we treated with mitoxantrone could not have gone smoother.   The side effects were minimal and certainly justified considering that we were fighting a cancer that will eventually kill.    Two of our TCC  patients “parents”   reported that their furry kids actually  felt better for a few days after the chemo than they had felt before the treatment.   Difficult to explain,  but no complaints here.  I do not mean to imply that this chemotherapy regimen will not have any side effects.  Some dogs are a little quite for a few days or have a poor appetite.  One of our patients has continued to have a poor appetite long-term and he ( Charlie) insists on having his Mom cook for him but to me, if due to the chemo, this is a small price to pay for a longer and happy life.  Almost all dogs  will develop a very low white blood cell count at 10-14 days and this most be monitored so that the treatment can be adjusted as needed.  We have had no “horror stories” in this regard and every dog has had their blood counts return to normal.  While I am a VERY positive person and attack TCC with a “will win” attitude  we need to recognize that serious side effects are possible  including death.  Faced with the certainty of dying from TCC  my personal belief, given our experiences,  is that proceeding with chemotherapy after  palliative laser therapy (UGELAB) is simply the right thing to do in most cases.

   During initial consultations with clients trying to learn more about treating transitional cell carcinoma in dogs using diode laser through a cystoscope,  I always try to emphasize point out that I am a very positive person, unwilling to simply “roll over” for this bladder cancer.  We have had some wonderful results and a few heart aches, but overall we have met with what I consider to be tremendous successes.  Recognizing that my positive attitude might influence my perception  of what it is like to undergo the UGELAB treatment, I also feel it is important to understand the process from the perspective of the moms and dads and furry kids who have experienced the UGELAB procedure and , in some cases, the mitoxantrone/piroxicam treatment.  This TCC BLOG is a wonderful venue for an appropriate exchange of experiences at Ridgewood Veterinary Hospital.  I encourage those families to contribute to this blog and to help me create a realistic environment wherein others facing this deadly canine bladder cancer can decide on a treatment plan best suited to them and their pets.   Please join our conversation so we can all help,  when appropriate,   to create a longer, healthier, happy life  for these wonderful furry family members.   If you have  joined us in the battle against TCC at Ridgewood Veterinary Hospital please share your story with us.  If you elected to treat with mitoxantrone, what was this like for you and your dog?   If you are struggling to decide on an appropriate treatment for you dog, please post your questions.  Want to stay in touch with the conversation as it progresses?   Sign up for an RSS subscription at www. RidgewoodVet.com under the TCC BLOG link.      

     Let’s help each other  learn more about how to “just do the right thing” for our kids!!!

 Dean J. Cerf, D.V.M.

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