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Oliver originally presented to his primary veterinarian, Dr. Ellen Dryer at Seven Hills Pet Clinic, for urinating with increased frequency, and having accidents in the house. Dr. Dryer diagnose a urinary tract infection and starting him on antibiotics. When his signs did not improve an ultrasound was used to evaluate his bladder - a possible mass or blood clot was noted to be present inside it. Examination of another urine sample did not identify any further bacteria but did find large numbers of abnormal epithelial cells. These findings raised concern for a bladder tumor and Oliver was referred to Care Center Cincinnati's Integrated Oncology Service for further evaluation.
At Care Center, an abdominal ultrasound confirmed a large mass arising from the internal wall of the bladder. This is most consistent with a form of cancer called Transitional Cell Carcinoma (TCC), which can arise anywhere in the urinary tract but is most commonly found in the bladder itself.
Based on the size of the mass and Oliver's clinical signs, it was decided that radiation therapy would be the best initial treatment as this would have the best chance of reducing the size of the tumor, improving his symptoms, and most importantly preventing the obstruction of urine flow by the mass. It was elected to proceed with a radiation protocol called Hypofractionated Radiation Therapy, with Radiation Oncologist, Dr. Chris Bloom. This involves giving once weekly radiation doses for a total of four treatments.
The first step of his treatment plan was to perform a CT scan of his chest and abdomen. This would allow not only for a full examination of his lungs, abdominal organs, and bones to look for metastasis, but is also how radiation therapy is targeted to the mass in the bladder while sparing all of the critical normal structures in the area such as the colon and the spinal cord. The CT scan identified enlargement of the liver and spleen and signs of peritonitis, or inflammation of the tissues surrounding the abdominal organs which raised concern that there could potentially be metastasis, or spread, of Oliver's cancer outside of the bladder. Samples of all three of these lesions were obtained and did not identify any overt spread of his cancer.
Oliver underwent his four radiation treatments without complication. His tumor had demonstrated strong initial size reduction even by the final treatment.
Due to the potential risk of metastasis with TCC, it was then elected to follow up radiation therapy with chemotherapy with Medical Oncologist, Dr. Carissa Norquest, to hopefully slow down or prevent this eventual spread. It was elected to be proceed with a series of intravenous chemo infusions called mitoxantrone, which are given once every three weeks. He has received two doses so far with no major complications and he will undergo a planned five treatments total. Periodic recheck imaging of his chest and abdomen will be performed to monitor his tumor and potential sites of metastasis. Once finished, other options may be considered for ongoing management.
In addition to Oliver’s oncology treatment plan, he also had an evaluation at Care Center’s Integrative Medicine Department with Dr. Caitlin Schmidt. This evaluation focused on Traditional Chinese Veterinary Medicine (TCVM) and an integrative approach to treating his underlying diagnosis. The evaluation also included creating a Food Therapy plan where certain ingredients within the diet can help support Oliver’s underlying Traditional Chinese Veterinary Medicine. The goal of Oliver’s TCVM plan is to integrate TCVM into Oliver’s conventional treatment plan helping to establish balance in the body by reinforcing the body’s ability to withstand disease. TCVM treatments can also aid in avoiding any side effects from his current treatments while also helping to manage clinical signs of conventional treatment. Further considerations for Oliver’s TCVM plan may include adjustments to his Food Therapy plan and acupuncture treatments.
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