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Advanced cancer diagnoses lead to more targeted treatments

By Barbara E. Kitchell Jul 21,2021
Dr.Kitchell talks about working with a Pathologist to identify the special markers of cancer to tailor the treatment. This approach is leading to more positive outcomes.
When I was completing my internal medicine residency at the UC Davis School of Veterinary Medicine, they had too many cancer cases to manage. Before I knew it, I found half my case load was oncology—and that turned out to be great. Lots of science goes into cancer care. In these cases, you see clients and their pets often, and there’s a lot of emotion involved, so you really get to know them. It’s so exciting to see pets respond to treatment and get back to enjoying life. Then eventually, we offer end-of-life care. It’s a tough field—and very rewarding.  

As a veterinary cancer specialist today, I’m part of a fast-moving area of medicine, which means a lifetime of learning. I’ve worked in the past in university settings, and it is rewarding to teach veterinary students. But in private practice, every interaction with pet owners is also really a teaching opportunity.

Cancer is so widespread. All the information we share about pets’ cancer care teaches pet owners more about cancer and how cancer treatments work. The next time they hear the word cancer, that pet owner’s mother or child might be beginning cancer care. If we’ve treated their pet, it won’t be the first time they hear the information. That’s an important aspect of the work we do, even as we focus on how to best help that one pet in front of us. 

The critical starting point in any case is reaching an accurate diagnosis. And that’s not necessarily easy. Some cases are particularly complicated or unusual. That’s why it’s important to have a great pathologist as a partner. A pathologist examines tissues and performs lab tests. In a particularly challenging case, the pathologist might suggest special approach, like immunohistochemical stains or molecular pathology. Particularly today, the information they offer opens avenues to therapy that we haven’t had before. If you understand more about how a particular tumor grows and moves through the body, you can identify more effective treatments. 

For example, more detailed information from the pathologist might give us better understanding of how fast the tumor cells are dividing. That helps us select medication that matches the tumor. A fast-moving cancer needs a more aggressive therapy that mirrors the pace that the tumor is growing. A slow growing tumor doesn’t need that and choosing a more aggressive therapy won’t help us that much. 

In another case, a pathologist might identify special markers for melanoma. Melanoma can look like anything. Having a diagnosis that includes special markers helps us identify the right treatment for that particular patient. 
Dr. Kitchell examing a dog with a vet tech
Here’s an example: The best approach for treating a T-cell lymphoma is different from the best approach from a B-cell lymphoma. We used to say, “B is bad, but T is terrible.” B cells are like a munitions factory—they’re easier to bomb. T cells are more like hand-to-hand combat soldiers. And they look the same. 

Traditionally, we’d say that with about one year of therapy, about 30 percent of pets with B-cell lymphoma would live 2 years—and with T-cell lymphoma, they’d live six months. Now that we can tailor the therapy to the T cell, we’re seeing pets with T-cell lymphomas live 15 months to 2 years. That’s a remarkable advance in just a few years.  Because the pathologist can tell us which lymphoma we’re managing, we can do better. We’re not stuck with a one-size-fits-all therapy. 

We had an Australian Shepherd come in for treatment that was a perfect example.  
Bear had hypercalcemia. This elevation of blood calcium can make patients very sick and cause kidney failure. On top of that she has a genetic mutation that heightens her sensitivity to certain types of drugs, which means she could easily suffer more from the side effects of cancer treatments. If we hadn’t known, we might have given her drugs that made her very sick and didn’t help her cancer that much. But advanced pathology helped us manage her quality of life and provide effective treatment. In the past, we would have expected her to live 6 months. But right now, she’s two years from her diagnosis. Those phenomenal cases keep you buoyed up when you face the others, that don’t do as well as you might hope.

Everything we do is dependent on a good solid diagnosis at the beginning. That helps us pick the right treatment choice—and it’s the pathologist that gets you there. 

Breadth of expertise and access to so many specialties and subspecialties is one of the things that make it so rewarding to work in the VCA network. Because we have opportunities to bring together veterinary cancer specialists who focus in different areas—medical, surgical, radiation, and research—we get multiple points of view and different experiences. And when you get oncologists, pathologists, clinical pathologists, and radiologists all bringing their expertise to bear on a case, it’s quite a remarkable thing. 

I love working for VCA. It’s a wonderful organization and it is a privilege to work here and help give pets and their people the care they need. 


Barbara E. Kitchell, DVM, PhD, DACVIM (Internal Medicine, Oncology), served two terms as president of the Veterinary Cancer Society and has written more than 100 scientific publications, abstracts, proceedings, book chapters and handbooks in her field of veterinary and comparative oncology. In 2013, Dr. Kitchell left her post as a full professor and Director of the Center for Comparative Oncology at Michigan State University to join VCA Veterinary Care Animal Hospital and Referral Center in Albuquerque, NM. At home, the busy doctor is mom to 5 wonderful young people and manages a menagerie that includes five dogs, five cats, a box turtle, a tarantula, and more multi-legged companions. She lives in the mountains of New Mexico, right on the border of the national forest—and she says her Great Pyrenees keep the bears off the deck. 
 
Barbara E. Kitchell
Barbara E. Kitchell
DVM, PhD, DACVIM (Internal Medicine, Oncology)
VCA Veterinary Care Animal Hospital and Referral Center
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Everything we do is dependent on a good solid diagnosis at the beginning. That helps us pick the right treatment choice—and it’s the pathologist that gets you there.
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