Anal sac carcinoma – chemotherapy?

Re: Anal sac carcinoma – chemotherapy?

Evelyn Barbour-Hill — Tue, 21 Apr 2015 14:56:18 GMT

[quote user="robloxley"]I'd be keen to be sure it is not operable: (n=1, but) we have a dog we referred for primary/met removal and postop chemo that is doing well and disease free 4+yrs down the line[/quote]

Fair comment, but I'm a **** good surgeon and when I say I think it's inoperable, or at any rate the benefit achieved by surgery would be insufficient to justify it, my words were well chosen. No offence, though.

The primary is about 4 cm diameter (it's not truly circular of course) plus some side bulges which make it 5 to 6cm in some directions, maybe more; and quite tightly bound to rectum in one area. Grossly palpable 2cm mass dorsal to rectum intrapelvic. Mass c. 6cm long by 2.5 cm diameter caudal abdomen. Who knows what further small masses might be found on laparotomy.

Of course it would be physically possible to "remove" "everything", but that's not the sole factor in deciding what is operable.

I don't think anyone can assess whether a cancer is operable without looking at it.

Many thanks for the Palladia information. That's something I can discuss with the clients, anyway.

Re: Anal sac carcinoma – chemotherapy?

Tim Charlesworth — Tue, 21 Apr 2015 13:50:02 GMT

[quote user="robloxley"]

[quote user="Evelyn Barbour-Hill"]I think it's inoperable, or at any rate the benefit achieved by surgery would be insufficient to justify it[/quote]

I'd be keen to be sure it is not operable: (n=1, but) we have a dog we referred for primary/met removal and postop chemo that is doing well and disease free 4+yrs down the line

[/quote]

+1 - how big is the tumour?

Re: Anal sac carcinoma – chemotherapy?

Rob Loxley — Tue, 21 Apr 2015 13:45:02 GMT

[quote user="Evelyn Barbour-Hill"]I think it's inoperable, or at any rate the benefit achieved by surgery would be insufficient to justify it[/quote]

I'd be keen to be sure it is not operable: (n=1, but) we have a dog we referred for primary/met removal and postop chemo that is doing well and disease free 4+yrs down the line

Re: Anal sac carcinoma – chemotherapy?

Martin Atkinson — Tue, 21 Apr 2015 09:58:37 GMT

[quote user="Gerry Polton"]Palladia has really only been shown to be effective (anecdotally) in cases with substantial disease burdens.

In the patient with a significant burden of disease that can be removed surgically, I advise post-op chemo; I favour carboplatin but mitoxantrone is cheaper and may be just as good but is less well-validated.

[/quote]Thanks for the explanation, it now makes sense (sort of)!

Re: Anal sac carcinoma – chemotherapy?

Gerry Polton — Tue, 21 Apr 2015 09:35:54 GMT

You heard it here first:

I use Palladia at the label dose!!!

It does work and it does work well. I am in a minority. Most oncologists recommend reduced doses from the outset but I say that the work done to prove its efficacy and tolerability was done at the licensed dose so that is the dose I use. There is a license-defined strategy for dose reduction in cases of adverse effects; this is what I use if there is a problem.

Simples!

Gerry

Re: Anal sac carcinoma – chemotherapy?

Gerry Polton — Tue, 21 Apr 2015 09:33:25 GMT

Hi Martin

Palladia has really only been shown to be effective (anecdotally) in cases with substantial disease burdens. I am investigating what its application is in the post-op case with minimal residual disease but one must consider that just because something works in one context doesn't mean it will in another. For example, imagine that if we did nothing they died of their cancer in six months, if we gave Palladia they might die of the complications of the drug in four months. (These figures are for illustration only). In the patient with a significant burden of disease that can be removed surgically, I advise post-op chemo; I favour carboplatin but mitoxantrone is cheaper and may be just as good but is less well-validated.

Gerry

Re: Anal sac carcinoma – chemotherapy?

Glenn Hodgson — Tue, 21 Apr 2015 09:26:25 GMT

"Palladia is not for the faint-hearted" here here.

Our patient has been admitted for 3 short periods during her treatment. Primarily for UTI related issues. Ab's, Supportive care and no palladia for a while and she settled.

And lets not blame the steroids too much. My itchy westies don't have the same issues. We have allmost titraited the palladia to effect, primarily useing patient demenour/uti frequency. Now she is on her ideal dose she doesn't visit us for non-routine checks....

I'd be tempted to start with a lower dose next time. We started on 3mg/kg. She is happy on 2mg/kg. What dose do you use Gerry.

Re: Anal sac carcinoma – chemotherapy?

Martin Atkinson — Tue, 21 Apr 2015 09:26:15 GMT

[quote user="Gerry Polton"]I'm with Glen. Palladia and stool softeners. [/quote]Interesting Gerry. Your colleague Francesca suggested carboplatin for the case I referred to her, albeit the anal gland and a secondary sub-lumbar node mass had been surgically removed, and mitoxantrone had been mentioned as well. Any reason for difference of approach?

Re: Anal sac carcinoma – chemotherapy?

Gerry Polton — Tue, 21 Apr 2015 08:14:26 GMT

I'm with Glen. Palladia and stool softeners. Palladia is not for the faint-hearted. Patients will develop problems which appear minor at first but can quickly become major or even life-threatening. But if well-managed these cases can enjoy a remarkably good quality of life for a remarkably long time. The secret to success if staying in very close contact with the client and stopping treatment temporarily at the faintest whiff of a treatment-induced adverse event.

Gerry

Re: Anal sac carcinoma – chemotherapy?

Anthony Dennison — Mon, 20 Apr 2015 19:08:13 GMT

Currently on the oncology unit of my medicine certAVP - unfortunately it's one of the subjects I struggle to fully wrap my head around. Metronomic chemotherapy with cyclophosphamide and certain coxibs has been shown to work in a range of tumours with various effects.

A small study in Italy

Or, TKI's in combination with metronomic cyclophosphamide can be well tolerated, like in this study

Hope that helps. There is a possibility I'm well off the mark here, like I said, oncology makes my brain hurt.

Re: Anal sac carcinoma – chemotherapy?

Martin Atkinson — Mon, 20 Apr 2015 18:51:47 GMT

I sent one to Gerry's practice at NDSR so we need to wait for him. They recommended Carboplatin but the owners couldn't afford it after the insurance ran out after surgery. She lived for 3 months before the mets went to her spine. Lovely clients and the nicest and unluckiest dog I've ever treated - why does it always happen to them?

Re: Anal sac carcinoma – chemotherapy?

Glenn Hodgson — Mon, 20 Apr 2015 18:44:27 GMT

I have a spaniel that had 4cm l.nodes on diagnosis. Surgery was declined. Treated with pred and palladia and stool softeners. That was 9 months ago and still going strong.. Will use again.

And there ends the anecdote

Re: Anal sac carcinoma – chemotherapy?

Hannah Wynne Richards — Mon, 20 Apr 2015 18:31:51 GMT

Mephalan I'll check up on dosage rates and get back to you.

Wynne