How I Diagnose and Treat Canine Lymphoma
Coffee Morning webinar presented by Sarah Mason
Have you got half an hour to spare and an interest in oncology? If so, this coffee morning webinar is for you and anybody else wanting to know about this increasingly specialist area. Sarah has amazing academic credentials. She started with a BSc in molecular biology and a PhD in cell cycle regulation at Glasgow University. Post-doctoral studies in Harvard University medical school followed before she returned to Liverpool Veterinary School, graduating MRCVS in 2007. Her feet have not touched the ground since with an important two years in small animal practice, a Cert AVP in small animal medicine and an ECVIM (oncology). She now heads up the Cambridge Veterinary School’s medical oncology service. With an interest in education she has followed up the previous qualifications with a postgraduate certificate in education. With all that academic and practical experience, you would expect something special and Sarah delivers with her overview of canine lymphoma.
Multicentric lymphoma is the most common presentation in canine lymphoma. In the approach the all-important history is emphasised followed by a thorough physical examination. The differential diagnosis is listed:
- Other metastatic neoplasia
- Infectious diseases such as Ehrlichia
- Generalised dermatopathy
- Systemic disease (e.g. infectious or immune mediated)
The technique of fine needle aspiration, preferably of a pre-scapular or popliteal lymph node (using a 23G needle) is described and some illustrations of cytological and histopathological positive slides are shown. There is some useful information on histopathological classification followed by a consensus statement from the WHO on the classification of the lymphoma type.
Back in the clinic a discussion with the client before embarking on further investigation is essential. Important points here are:
- Likely prognosis for assumed diagnosis (high grade versus indolent)
- With or without treatment
- Commitment to treatment –time budget, time commitment, health and safety issues (children in household, disposal of contaminated urine, faeces for example)
- Value of staging-minimal, partial or full
There is a useful chart depicting WHO stages for canine multicentric lymphoma and then the minimum database for clinical staging is outlined followed by the more extensive staging protocols.
The first line treatment options are as follows:
- CHOP based regimes
- COP/LOP based regimes
- Palliative: oral regime
- No treatment
- Quality of life monitoring/appropriately timed euthanasia
The general principles of treatment are discussed here rather than an in-depth discussion of drugs doses. There is a slide on health and safety for staff reminding colleagues of their obligations when using cytotoxic drugs. Two case studies follow summarising the general concepts in practice.
Sarah summarises her webinar:
- Canine lymphoma is treatable
- Quality of life is the most important treatment outcome
- Outcome varies widely depending on individual response, treatment protocol employed and type of disease
- Much larger, well-designed, prospective, homogenous, multicentre studies are required to assess the treatment outcomes of dogs with nodal lymphoma.
As with all the coffee morning webinars I have watched to date there is a considerable amount of information in half an hour. It is half an hour well spent. For those contemplating introducing this treatment and for those already employing it the essential features and checklists are described very clearly.
Webinar link: https://www.thewebinarvet.com/webinar/i-diagnose-treat-canine-lymphoma/