Michelle Hartman

Professor Franks

Research Paper- Clinical Physiology

November 20, 2010

The Diagnosis of Transitional Cell Carcinoma- Lilly’s Story:

“Dogs are not our whole life, but they make our lives whole” words once spoken by Roger Caras, truly defines the meaning of Lilly’s life. Lilly, A female, Bernese Mountain Dog, just struck seven years old when she was diagnosed with cancer. The battle, optimistic attitude, and the love my family shared will forever be Lilly’s Story. The story consists of, steps to finding the disease, the tragic disease, transitional cell carcinoma cancer, treatments for the disease. The famous quote stands at truth, A dog is a Man’s best friend.

Lilly was peeing the unusual amount throughout the span of a day. Urinary tract infections are among the most common health problems that veterinarians see on a daily basis. About 14% of all dogs will have a UTI at some point in their lives. 1 This started to cause a concern, so Lilly was brought into an Animal Hospital. Lilly was diagnosed with a Urinary Tract Infection;

The urinary tract in dogs is usually sterile. The presence of microbes in the urinary tract is considered as a urinary tract infection (UTI). UTIs are usually caused by ascendant migration of normal flora organisms from the lower urogenital and intestinal tracts through the urethra into the bladder. The diagnosis is made by urine culture.

Urinary Tract Infection will stain a gram-negative aerobic bacteria, which make up 70% of the cases. Gram-positive bacteria causes most others and fungi and yeast cause about 1%. (Figure 1, below).

Figure 1: Purple Positive (+) Cocci,

Red Negative Rods (-)

The doctor prescribed her to an antibiotic called, Baytril. This type of drug usually last 2 to 3 weeks, depending on the extent of the disease, of course.

Months rolled by and Lilly was still having the “frequent urge to urinate”; the family knew something was not right. Lilly’s simple antibiotic diagnosis was about to change her life. A sonogram showed a mass in urethra. The doctor had diagnosed Lilly, with Transitional Cell Carcinoma. According to the Naturally occurring canine transitional cell carcinoma of the urinary bladder, A relevant model of human invasive bladder cancer, which compared the human bladder to the canine bladder at the University of Purdue, Dr. Knapp states;

“Although the true incidence of canine Transitional Cell Carcinoma (TCC), is not known, TCC is the most common form of urinary tract cancer in the dog and comprises 1.5 to 2% of all canine cancers”

Although bladder cancer in dogs accounts for approximately 1.5% to 2% of all dog cancers, over the past ten years the increasing rate of this type is estimated at over 200%. This process, although draining at times, needed to happen. When reaching a diagnosis, the doctor needs a step-by-step procedure whereby the most common conditions are ruled out one by one until a diagnosis is confirmed. Lilly was weighed in at almost eighty- seven pounds. This was far too thin for a Bernese Mountain Dog.

The urinary tract in dogs includes the kidneys, ureters, urinary bladder, prostate, and urethra. Cancer can occur in any of these sites but the bladder is most commonly affected. Transitional Cell Carcinoma, also known as TCC, is a tumor located in the urinary bladder. This type of cancer receives the name by the urinary bladder being made up of transitional cells, along the lining. They must protect the body from the urine inside the bladder but also must maintain this barrier when the bladder stretches and distends with larger volumes of urine. The most common type of bladder cancer is invasive, TCC, which travels deep into the bladder wall. The ureters, from the kidneys dump their urine into the bladder in the trigone area, which can cause obstruction in the flow of urine.

There are risk factors that can increase the chances of TCC, in the article, Management of transitional cell carcinoma they discuss; The bladder of cancer in canine is a multifactor, just like other malignancies. Risk factors include, obesity, exposure to tick and flea insecticides, exposure to marshes that have been sprayed with mosquito control products, and possible treatment with cyclophosphamide. Obesity results in bladder cancer relatively due to having more body fat which stores and hold concentrated fats.

Treatment options for bladder transitional cell carcinoma are available, just depending on the location of the tumor. According to the Barbara E. Kitchell, DVM, PhD, who wrote the book, The Veterinary Clinics of North America, which described the advances in Medical Oncology, described the treatment options. The suitability for surgery for treatment of TCC depends on the tumor location, inavasiveness, and the client’s long term goals, Surgical options include there different surgeries: partial cystectomy, this is only considered with dogs with localized bladder tumors in areas willing to cut 1 to 2 cm of visible normal tissue: One report was done to eleven dogs with urinary bladder tumors. Survival rates ranged from two to forty-eight months and the 1 year survival rate was 54.5% (6 of 11 dogs)

Permanent cystostomy catheter placement, this procedure is intended to relieve stranguria and to prevent secondary complications associated with urinary outflow: One test was done to seven dogs with possible TCC, six developed stranguria, but the owners were satisfied with the procedure. Also four out of the seven dogs had catheter complications.

Urinary diversion techniques such as total cystectomy with ureterocolonic anastomosis, this procedure is known to be labor-intensive and impractical to handle for owners, though it did receive excellent palliation of urinary symptoms. Owners need to administer long- term antibiotics, dietary modifications for their pet- including low- salt, low protein diets, with sodium bicarbonate supplementation, and available to allow frequent access (every four hours) for urination. Survival rate is known to report up to seven months.

Other medical treatment consist of Bladder reconstruction, Medical therapy or chemotherapy for TCC, which are known as Doxorubicin, Piroxican, Cisplatin, Carboplatin, Mitoxantrone, and radiation therapy, sadly, for this no canine lived past 630 days, which was abnormal, usually results deaths in under a year.

In Lilly’s cancer, the tumor was in the deep neck of the Urethra, making the tumor surgically impossible to remove due to obstructing urination. And finally, once the cancer spread to her lungs, they knew it was time. Prognosis depends on the stage of the tumor, and of course the pet. Once the family had found out it was transitional cell carcinoma, the Doctor did put Lilly on Piroxicam 10 mg, which is a controlled substance for epilepsy patient’s, which controls and helps Urinary Caners, as well as cystectomy with ureterocolonic anastomosis, without the surgery aspect, basically caring for Lilly with a Cancer Diet (that is listed above). The families only option was to show her all the love and support, letting her leave this earth with dignity and strength.

Roger Caras, once said, “Dogs are not our whole life, but they make our lives whole”, which is correct. We all have that “special furry best friend”, who we adore. They make each and everyone of us who we are today. Until one has loved an animal part of the soul remains awakened."

*Lilly's Tribute on PetswithCancer {Endlesslove} Angels*

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