Memorial for Marco, The Beagle Who Valiantly Battled Bladder Cancer

This article originally appeared on Dr. Mahaney’s The Daily Vet column on PetMD as Memorial for Marco, The Beagle Who Valiantly Battled Bladder Cancer Recently, one of my patients who persevered through life-threatening illness with grace and determination passed away. Marco was a Beagle of nearly 17 years (yes, that’s seventeen years) who ultimately succumbed to a long battle with cancer. I got to know Marco and her devoted human caretaker through my work at Veterinary Cancer Group where she was undergoing treatment for Transitional Cell Carcinoma (TCC). Marco’s owner’s memorial is included at the end of this article, but I want to first take the opportunity to discuss TCC in dogs. What is TCC in Dogs? TCC is a malignant cancer of urinary bladder cells (I use the term urinary bladder instead of just saying “bladder,” as there’s also the gall bladder in the canine body). Malignant means the cancer is very aggressive and likely to spread to other body tissues. The bladder and other urinary tract structures (kidneys, ureters, urethra, prostate, and vagina) are lined by transitional epithelial cells which can become cancerous when their DNA is damaged and start rapidly dividing to form tumors. According to Canine Bladder Cancer by Deborah W. Knapp, DVM, Dipl. ACVIM: "Within the urinary system, the bladder is the location most frequently affected with cancer. Compared to cancer in other locations in the body, bladder cancer is unusual, comprising approximately 2% of all cancers in the dog. With more than 70 million pet dogs in the United States, however, even unusual cancers like bladder cancer, are problems for thousands of dogs and their families." What Are the Clinical Signs of TCC in Dogs? As mentioned by Dr. Knapp, TCC causes significant problems for any patient affected by the disease. The ability to normally urinate is always mildly to severely compromised (with severity worsening as the disease progresses), which ultimately leads to the need to make quality of life decisions for our pets that often lead to humane euthanasia. Clinical signs of TCC include: Stranguria — straining to urinate Pollakiuriap — frequent urination in typically small amounts Hematuria — blood in urine, which can be clots or generalized orange to red tinge Dysuria — difficulty urinating, which sounds similar to Stranguria but doesn’t necessarily involve straining Urinary Incontinence — dribbling of urine from the penis (male) or vulva (female), and/or voiding large volumes of urine in a seemingly unconscious manner, etc. Others — exercise intolerance, difficulty moving, decreased appetite, tenesmus (straining to defecate), water consumption changes, increased licking of the penis or vulva, etc. Any of the above clinical signs are also consistent with urinary tract infection, crystals, stones, or other ailments. Therefore, it’s important that any urinary tract signs exhibited by your pets are brought to the attention of your veterinarian and appropriate diagnostic tests (urinalysis, urine culture, abdominal ultrasound, X-rays, etc.) are performed. Why Do Dogs Get TCC? Although it’s not completely known why pets get TCC, there are some theories. There can be a genetic component (see below in the Breeds and Sexes explanation) and environmental factors. According to Dr. Knapp, “Environmental factors identified as risk factors in early studies have included pesticides and insecticides such as ‘old generation’ flea dips. The greatest cause of TCC in humans is smoking. Further study is needed to determine the extent to which second hand smoke could contribute to TCC in dogs.” The ‘old generation’ flea dips to which Dr. Knapp is referring include organophosphates and carbamate, which are no longer commonly used for pest control on or in our pets now that safer and more effective products exist. A Purdue University College of Veterinary Medicine study “found an association between risk of transitional cell carcinoma of the urinary bladder in Scottish terriers and the dogs' exposure to chemicals found in lawn treatments.” Research veterinarian Lawrence T. Glickman states, “we found that the occurrence of bladder cancer was between four and seven times higher in the group exposed to herbicides.” Additionally, "the level of risk corresponded directly with exposure to these chemicals: The greater the exposure, the higher the risk." Knapp chimes in by stating that “these findings indicate that Scottish Terriers, as well as other dogs of high-risk breeds for TCC, should be restricted from lawns treated with herbicides and pesticides.” Plus, “Scottish Terriers have an 18-20 fold higher risk of TCC than other dogs. Shetland Sheepdogs, Beagles, West Highland White Terriers, and Wire Hair Fox Terriers are 3 to 5 times more likely to develop TCC than other dogs.Dogs in related breeds may also have a higher risk of TCC, but this has not been studied yet.” Females are more commonly affected by TCC than males. Marco was a female (spayed), pure-breed Beagle and the first female patient I’ve treated with this disorder. I’ve also had two male patients who ultimately succumbed to the disease. Coincidentally, both of the males happened to be Welsh Terriers, which is the same breed as my dog Cardiff (who’s overcome his own battle with T-Cell Lymphoma). Are There Treatments for TCC in Dogs? A variety of treatments are available for TCC, but the appropriate single or combination treatment depends on the individual patient and the severity of the disease. Options include: Surgery — to cut TCC tumors from the bladder and other associated structures Chemotherapy — oral or injectable chemotherapy may be used Radiation — multiple types of radiation treatments exist to temporarily shrink tumors or potentially provide complete resolution Urethral stent placement — to help maintain the outflow of urine from the bladder through the urethra Anti-Inflammatory Drugs — NSAIDs (non-steroidal anti-inflammatory drugs) like Piroxicam interfere with the inflammatory process and can promote a sense of comfort in affected patients. Acupuncture — I’ve used acupuncture to reduce muscle spasming associate with TCC and to promote improved energetic flow throughout the body and a general sense of comfort in my patients. Herbal Treatments — Pet-appropriate tablets, capsules, powders, and teapills (“BB” like format) can help have a blood-moving, anti-inflammatory, anti-cancer, and immune system-supporting effect. I primarily use Dr. Jie’s Jing Tang Herbal, Inc. products. Other — As veterinary oncologists are always developing new means by which cancer can be treated, there are clinical trials that are currently underway in private practices and veterinary teaching hospitals in the U.S. and abroad. Marco had a variety of treatments which significantly extended her good quality of life for many months beyond her initial diagnosis. 17 years is a remarkably long life for any dog, especially a pure-breed like a Beagle. Marco is and will continue to be missed by her human family and those that cared for her. Although she’s no longer walking this earth on her four feet, she’ll never be forgotten. Here’s the memorial as written by Marco’s owner: Marco, I didn't expect that the time would come so soon. I had many more things that I wanted to share with you. I still regret that you had to leave us a week before your 17th birthday. You have given us so much joy and happiness over the many years. You always liked listening to my mom's favorite classical music. Now I feel empty without you... but I have to think that you don't need to suffer from the pain anymore. Please remember that I am always with you, as promised, Marco.