Better prognosticating for dogs with mammary tumors
Mammary tumors in dogs are the equivalent of breast cancers in people, and, as in the human disease, the canine tumors can manifest in a variety of ways. Some are diagnosed early, others late, and they can be either slow growing or aggressive.
Yet current prognostic tools, which provide information about the tumor stage -- how large or dispersed it is -- and grade -- how likely it is to grow quickly -- don't always give veterinarians or owners clear picture of how a tumor is going to progress, and what treatments might be most appropriate.
A new "bio-scoring" system, devised by a team led by Karin Sorenmo, a veterinary oncologist at Penn's School of Veterinary Medicine, equips clinicians with a more reliable prognosticating method. The researchers shared their work in the journal Veterinary and Comparative Oncology.
"Mammary gland carcinomas are the most common tumors in intact dogs around the world," says Sorenmo. "Yet we still haven't made great progress in deciding which dogs are fine with just surgical treatment, which dogs might require chemotherapy, and which dogs might benefit from hormonal treatment. In testing this new approach, we found it helps identify the dogs that develop metastasis better than other methods. I'm very excited about it."
To develop and assess this new scoring method, Sorenmo relied on a unique dataset that emerged from Penn Vet's Shelter Canine Mammary Tumor Program. This initiative, spearheaded by Sorenmo, enables shelter dogs to receive treatment for their mammary tumors, then finds foster or permanent homes for each animal.
The current work took data from 96 dogs treated through the program, as well as an additional 31 dogs treated in a similar fashion at the Norwegian University of Life Sciences. The records they used including the pets' disease stage, grade, treatments received, and outcome -- specifically, the time to metastasis, or spread of their disease within the body.
The "golden rule" for determining treatment currently, Sorenmo says, is to look at tumor stage, from stage I when the tumor is localized and small, up to stage IV when it has spread to distant organs.
Dogs can have advanced stage disease but, if their tumor has a low grade -- that is, it is not fast-growing -- they may have a better outcome than a dog with a lower stage but a more advanced grade. In addition, a tumor's histology, or the molecular markers that characterize the cancer cells, can further influence its behavior and the eventual outcome of treatment.
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Some interesting findings arose from the statistical analysis. "We found that if you had a grade 1 tumor, no matter how large it gets, the vast majority of the time it doesn't cause any trouble," she says.
Since a good number of the dogs in the study had experienced long delays in receiving care due to being abandoned or in shelters, and thus had larger tumors than one would expect to see in the pet populations, the researchers were able to detect this size-independent effect.
"It's the same thing with lymph node involvement," says Sorenmo. "Everyone thinks that is a sign that the cancer has already started to move, but again we found that with a grade 1 tumor it doesn't matter. Those dogs didn't develop distant metastasis."
Using the overall bio-score, the researchers were able to differentiate dogs at lower risk of developing metastasis from those at a higher risk. If a pet has a higher bio-score, Sorenmo says, then a veterinarian or an owner may want to consider more aggressive treatment options, including chemotherapy. Dogs with a lower bio-score, on the other hand, may do just as well with surgical intervention alone.
The healing power of fish skin for a dog named Stella
When Stella first entered the emergency department at the Michigan State University Veterinary Medical Center on a Wednesday night, Feb. 13, 2019, she had second- and third-degree burns across 10% of her body.
Stella, a 1-year-old female Rottweiler, had miraculously escaped a house fire in Lansing, Michigan, while her owners were away. Although lucky, she didn't escape burns across her head, nose, ears, hind end and sides of her body. She also developed ulcers and scarring in both eyes due to fire exposure.
For two weeks, she fought for her life.
"Stella's will to live was amazing; she never quit fighting," said Rose Wahl, one of the licensed veterinary technicians who was there when Stella arrived. "Her resilience and strength have astounded everyone who has worked with her."
The immediate threat for Stella upon arrival was the trauma and thermal injuries to her trachea and lungs. So, she was put on intravenous, or IV, fluids and pure oxygen to help her breath. Once stabilized, the MSU soft tissue surgery team went to work, while ophthalmologists cared for her eye injuries.
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"We had to get creative with her burns because of the significant trauma to Stella's lungs," said Brea Sandness, a veterinarian and surgical resident at MSU.
That's when the surgical team turned to a less traditional method -- using Icelandic, descaled cod fish skins donated by Kerecis, a company developing fish-skin products for use in burn and other medical procedures in humans and animals.
Because of the makeup of the tissue and high omega-3 fatty acids in the cod skin, these grafts have anti-inflammatory and antibiotic properties, important for healing and tissue regeneration. They don't require heavy sedation, either.
"We were able to place them on her with minimal sedation, which not only allowed us to heal her without additional stress to her lungs, but improved the way her burns healed," Sandness said.
The descaling of the cod skins is what differentiates them from other fish grafts, such as tilapia. While scaled tilapia grafts, which gained national attention during the California wildfires earlier this year, are effective, they act more as an organic covering while the skin underneath heals itself.
According to Sandness, descaled grafts have been shown to stimulate the production of cells and become functional, living tissue. In Stella's case, these grafts, which can be changed as often as the burn requires, were absorbed by her body as new tissue grew into the graft.
Today, Stella is back to being a relatively active pup. But even though her burns are healing well, she still struggles with respiratory issues that will likely need close monitoring and care throughout her life.
"Stella is one of the bravest and strongest patients I've ever encountered," Wahl said. "Not only did she show incredible endurance and resilience, she has maintained a sweet and kind attitude throughout this whole ordeal."
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