Canine Bladder Cancer

My Princess, Ginger, is a 12.5 year old Sheltie with a heart of gold. She was diagnosed with bladder cancer (TCC) just about a month ago after a urinary tract infection that cleared up, but she still had to pee more frequently. Other than that symptom, there didn't appear to be anything else wrong. An ultrasound revealed the bladder tumor, and a cytology biopsy confirmed it. However, it hasn't spread to her uretha. She's fine all night when she is sleeping and even during the day when she's not active. When she eats or when she's active, she feels the need to pee. The first squat, there is a full flow of urine. Then she has to squat 5 more times before she feels like she doesn't have to go. A lung x-ray was clear, so the cancer had not spread to the lungs. My vet said there were a couple of small spots in other internal organs, but they were small and could just be age related and without a biopsy couldn't really be confirmed as cancer. Given the fact that her lungs were clear, she was otherwise healthy, etc., we decided to treat her with a combination of piroxicam and the chemo mitoxantrone. This appears to be the latest combination drug treat. She has been on the piroxicam for almost a month without side effects. She had her first mitoxantrone chemo treatment on Jan 6. It takes about 15 minutes, and it is injected into her bloodstream. She had no side effects from that first treatment (some dogs may have GI upset for a few days after, but Ginger didn't). 10 days later, they check her blood to make sure her blood cell counts didn't get pushed to low. She didn't have a problem there. Her next chemo treatment is on Jan 27. After 3 treatments, they will check to see whether the mitoxantrone is having an anti-tumor effect and if it should be continued. I debated on what to do . . .my vet, who has dogs, said if Ginger was one of his dogs and given her current good quality of life, this is what he would do. So I'm giving it a try as long as it doesn't make her feel worse. I was really upset when she was diagnosed. I know she's 12-1/2, and Shelties typically live 12 to 14 years. So I was hoping she'd be around 14 or 15 years. But I know that with this disease, that is not likely. Now that I've gotten over the initial shock, I'm happy I found out while she doesn't seem to be sick. I can take this time to spoil my little Princess even more and let her know how much I love her. So I feel lucky she has been with me for this long without any prior problems her whole 12.5 years and that I have a chance to make her feel so special. I know that at some point in 2006, I will have to make a decision for her not to have to endure this disease, and that is hard. But I'm glad that I have the opportunity to try to push that date a little further away, not take her for granted, and just enjoy my little munchkin. Good luck to everyone here who is having the same challenge!

Please give Ginger a big long belly rub from us!!! Tim & Kathy Ray

Thank you . . . well, Ginger thanks you. :-) Little Miss Ginger Princess gets a full body massage every morning and every night!!!!

I hope Ginger is getting better by the day. My 8 year old SHeltie was just diagnosed today with bladder cancer. She has one large mass and several small ones in the cranial part of her bladder (away from he urethra). They say that so far none of her other organs have been affected. I started her on Piroxicam only today. Do you think the mitocantrone is something I should ask my vet about? I notices several years ago, maybe as many as 4 years that Lexie (my Sheltie) would squat numerous times when we would go out ...never any other symptoms until November when I noticed blood in her urine. THey gave me an atioboitic and it stopped the blood, but then it came back again last week. I pushed for an ultrasound which is where the tumors showed up. For th past few years, Lexie would make a little grunt when she got up or laid down..Now I wonder if it was becuase he bladder was sore. Did you notice anything like that with Ginger? I am hopeful that maybe she has had these tumors for a few years and they are very slow growing. If we start medication now, maybe she will live to at least 12 years old. I can sympathize with your heartbreak . Your positive attitude has helped me a bit as I think of how to get through this painful journey. Let me know how Ginger is doing, please.. You will be in my thoughts. Joanne

Joanne, Thanks for your thoughts. I'm sorry to hear about Lexie, especially since she is much younger. With Ginger, I was sort of preparing myself that she was in her senior years at 12-1/2 and wouldn't be around forever. And then the cancer thing came. I've done a lot of research and have talked to several vets, including internal medicine and oncologist specialists. Bladder cancer in dogs is very invasive (while in people, in is generally less invasive). The combination of piroxicam and mitaxantrone is the latest treatment out there. But my vet made it clear that if Ginger responded, it would give her extra months, not extra years. She gets piroxicam daily. The chemo is done every 3 weeks. It is quite expensive (about $500 per session for her weight at 23 pounds). Luckly I have pet insurance with a cancer rider which helps a lot. Every 10 days they check her blood cell counts which have been good thus far. After 3 treatments, they'll evaluate whether to continue. She did just develop a bladder infection this week, so we're now on an antibiotic. With the tumor in the bladder, infections are common. So it's important to get her urine checked regularly. I'm just starting to give Ginger Pepcid with the piroxicam. She didn't have any side effects from it for the first 7 weeks, but this week, she had some stomach upset, so they said to stop in for a few days and then start giving her Pepcid about an hour before giving her the piroxicam. I also did a lot of research when she was diagnosed. There are always exceptions and miracles, but a good summary of the prognosis is: "Treatment of bladder cancer rarely is curative and more often is used with the intention of controlling the disease temporarily, relieving partial urinary tract obstruction, and making the pet more comfortable for a variable period of time. Such an approach will usually improve your pet’s quality of life and allow you to spend more time with your pet." After doing all the research and talking with the vets, I decided to do the chemo along with the piroxicam. With the exception of having to squat numerous times when she went out, you would not have known Ginger was sick. This was the best risk to slow down the progression and maintain a good quality of life as long as possible. Ginger hasn't had any side effects from the chemo. The side effects in dogs are not as severe as in people. They don't lose their hair. Most common side effects are stomach upset, and she hasn't really had that, and then they check her blood every 10 days to make sure her cell counts are okay (the amount of chemo would be adjusted if it was affecting her immune system too much) and they watch kidney function. Here's a good at the bottom of this message regarding a clinical study summary on the piroxicam/mitoxantrone combination below. The internal medicine and oncologist that Ginger is seeing recommend this combo in cases where the cancer does not appear to have spread. Piroxicam does not have direct anti-tumor effect, but the chemo does. Good luck with Lexie. To be honest, Ginger never really had a problems her whole life until the bladder infection in November that wouldn't go away . . . I will always have Shelties and one day I'll have another . . . from all of this, I've learned that it is something I will keep a careful eye on (including urine tests and check for epithealial cells in the urine) as part of an annual physical as Shelties and Scottish Terriers have a high incidence of bladder cancer. Keep in touch and let me how things are going with Lexie! :-) Frances PURPOSE: Cyclooxygenase inhibitors show promise in chemoprevention and therapy of certain carcinomas, an effect that may be additive to that of standard chemotherapy. The purpose of this study was to evaluate the efficacy of combined therapy using the cyclooxygenase inhibitor, piroxicam, and mitoxantrone against a relevant canine model of human invasive bladder cancer. EXPERIMENTAL DESIGN: Fifty-five dogs with transitional cell carcinoma of the urinary bladder were enrolled in this nonrandomized one-armed prospective multi-institutional clinical trial. Mitoxantrone was administered i.v. (5 mg/m(2)) every 21 days for four treatments, and piroxicam was administered p.o. (0.3 mg/kg/day) for the study duration. Tumor staging was performed at baseline, day 42 and every 3 months after protocol completion. Endpoints included time-to-treatment failure and survival time (ST). RESULTS: Response data were available for 48 dogs and included one complete response, 16 partial responses, 22 with disease stabilization, and 9 with progressive disease for an overall 35.4% measurable response rate. Subjective improvement occurred in 75% of treated dogs. Median time-to-treatment failure and ST were 194 and 350 days, respectively. Using censoring and end point definitions similar to those of previous reports of dogs treated with piroxicam alone, the median ST in this study was 291 days, compared with 181 days with piroxicam alone. Diarrhea and azotemia were the most common treatment complications. CONCLUSIONS: Mitoxantrone/piroxicam induced remission more frequently than previously reported for either drug as a single agent in this canine model of invasive human transitional cell carcinoma. Additional evaluation of these drugs in combination protocols should be explored."

Frances,. Thank you so much for your reply. It is so scary to think they our babies don't seem sick but have this disease inside of them. Is Ginger's tumor in the trigone section of the bladder near the urethra? My vet, so far, has said that they felt good about the prognosis of piroxicam as it has been shown to some times shrink the tumors. I have also read a lot on these boards about Glaviola. Have you discussed that with your oncologist. Those on the boards say that it is suppose to have cancer killing results particularly in the bladder. I also wanted to share with you that my vet advised this morning that he is treating 2 dogs presently with bladder cancer. 1 was diagnosed 1.5 years ago and is still doing okay and did not opt to take any drugs at all. The seond was diagnosed 1 year ago and is on piroxicam and is just now starting to show signs of not eating and not feeling good. I believe with all my heart there is hope. If Ginger still is acting like she feels good... that is a terrific sign. Does she have multiple masses in her bladder? LExie has one large mass in the cranial part of the bladder and over time smaller ones have broken off from the large and created new smaller tumors. I am so hopeful that the piroxicam will just not spread to other organs and stay away from the trigone area (which would obstruct urination). I am so anxious to hear how Ginger's test come out after her 3 chemo's. I am taking the article you sent me (thank you) to my vet visit on Wednesday to discuss all of the options. My vet recommended the piroxicam every day for only 7 days, then every other day. I am worried that won't be enough. Please do stay in touch and let me know how Ginger is doing. We are so blessed with these amazing poets. I have Lexie's brother as well and the two of them are the sweetest . I agree...i will always have Shelties. One last question....how do you manage to ensure Ginger is emptying her bladder when you take her out. I am trying to shove a papertowl under her so I can see what is coming out. She then will squat 5 more times where nothing comes out. big hugs to Ginger from Lexie, Joanne

JoAnn, Ginger's main tumor is up at the top of the bladder and there's a smaller one next to it. Her uretha is clear (they did a cytology thing where they went up through the uretha into the bladder and took pictures). The only negative thing is that the tumor was where one of her kidneys connect to the bladder, so it was starting to block that ureter. The vet said as long as her other kidney was okay, one kidney can sustain her. Her urine flow is not obstructed at all. When she goes out, she immediately releases a large quantity of urine the first time. Then she'll sqaut a few more times when hardly anything comes out. She won't come back in the house until she's ready to. She's a stubborn little doggie with a mind of her own!!!! I don't force her to come back in, and I take her out usually every few hours. During the day when I'm at work, I have a dog walking service come by to take her out. Until this week, she has been feeling really well. But this bladder infection has gotten her feeling down. She's not eating very much. I'm hoping it's just the infection, and not a downard trend. And she has a lesion on her tail that is infected. She won't let me touch it to put anything on it, but the vet said the antibiotic should help with that too. I'm taking her back on Thursday to doublecheck that. I've read about Glaviola. If the mitoxantrone doesn't seem to help, then I might look at trying that. My focus right now is just getting her over this bladder infection and getting the tail lesion healed. She's been so friggin' healthy her whole life and then boom . . . .it all hits. Since she is pretty old, I suspect that she's had the cancer for a good while, but just never had any symptoms. They say more than 50% of older dogs die of cancer. They just don't live long enough. That's neat that you have more than 1 doggie. Since Lexie is so young, I hope the meds work well and slow the growth so she is around a long time. Being younger will hopefully help! That's neat that you have Lexie's brother. Give them both a hug from Ginger and keep in touch. I'll write later this week on how Ginger is doing. :-) Frances

Frances, Thank you again for writing back...i will say a prayer for Ginger that this infection clears up and soon (plus the one on her tail). How do you know when there is a bladder infection versus just irritation from the tumors. Is that when there is blood in the urine? Lexie started passing a few tiny blod clots last night. I went back to the vet this morning and got more antiobotics. They said it can't hurt here...only help her. How long will Ginger need to be on the chemo? after that treatment is done will she stay on the piroxicam ? I have no idea what to expect with the piroxicam. So far, she has not had any stomach upset...and is eating like a horse...I am so anxious to hear how sweet Ginger is doing and how her appointment goes on Thursday. I am sure Ginger is very aware how much you love her...there I times I swear Lexie smiles at me to let me know she understands.... with love, JOanne & Lexie

Frances, We have been thinking of you & Ginger and wantedto check in to see how she is doing. I believe you had her last chemo treatment by now. Has the infection on her tail cleared up? I have thought of you daily as I have been seraching for the right threatment for my little LExie. Please let me know how things are going.... we will keep you both in our prayers, Joanne

JoAnn, I'm sorry I haven't written. The last month has not been good since I wrote. I've been very upset. My little Ginger is gone . . .she's at the Rainbow Bridge. It appears the cancer was probably in her liver when we started the treatment, so the chemo was too late. And actually, the chemo was working on the bladder tumor because the bladder tumor had shrunk. So here's the story of the last month. First, her tail and bladder infection were healing just fine, and she seemed to be doing really well. The ultrasound showed the bladder cancer had shrunk. But then out of the blue, she stopped eating, and had some vomiting and diarrhea. We tried some different medicines for her GI tract and to manage nausea, and they seemed to work briefly. Daily, I was searching for something new for her to eat with a little success to get her to eat a little. Then she stopped eating again and would hardly drink anything. Blood tests then showed that her liver was not doing well. She refused to eat, no matter what. I had to coax her to even to get her to drink a little. Animals do that when they start failing So I had to make the tough decision . . .I didn't want her to starve to death, and when she wouldn't hardly take water, I knew that it was time. I stayed at home with her for a week, enjoying each day. On March 1, her last day with me, we had a wonderful time. We took a long walk for an hour (she walked slow, but still loved to go out) and she smelled every leaf on the ground. It was a nice afternoon, and we sat outside in the yard in the sun which she loved to do. And the 'big brown truck' even happened to stop, and she ran across the yard barking and chasing it. And then we sat on the couch and I held her while she took a nap. Late that evening, the vet came over, and she went to sleep for the last time in my arms on her couch. First, he gave her a sedative, and she got sleepy. The last thing she did out of the blue was to pick her head up from my arm, look at me, and give me a kiss. I will never forget that. It was the hardest thing I've done, but she deserved it. The next few days were terrible. Luckly (in retrospect), I had a business trip to Europe from 6 March to 11 March. That really helped me. I'm back home, missing my Ginger terribly. But she's here in spirit and in my heart. I have her ashes in a beautiful oak box with her leash and a piece of her coat, with her picture on the front of it. It is sitting on a little table in the living room right next to her seat on the couch, so she can still watch me in the house as well as the activity outside the window, like she always did every day. I'm lucky she was with me almost 13 years. I miss her so much. I know one day she'll send another little sheltie along when I'm ready. I wish the best for you and Lexie. Please keep in touch and let me know how things are going. The following is the email I sent to her friends that night (it was therapeutic to write). There are pictures in it with each section, but they don't copy into this site, so you can't see them. I'm also lucky that I have a "Ginger Book" . . . a scrapbook that I had been maintaining ever since she was a puppy. Good luck and I'll by praying for you and Lexie! Frances Dear Friends and Ginger Friends, Ginger is now in doggie heaven. She lived every day of her entire life with such enthusiasm, loyalty, and love. Today, it was my turn to listen to her and give that love back to her. She fell asleep for the final time in my arms on her couch at home . . . with the two things she loved the most . . .her "Mom" and her "home" . . .her two favorite words. While I know Ginger's friends will remember her for one of her little personality traits or another, I wanted to share a few pictures from the past year. I hope you look at them and smile. Thank you for being Ginger's friend and mine! And give your doggies, cats, other pets, and loved ones an extra hug from me and Ginger. :-) Frances Ginger June 15, 1993 – March 1, 2006 The cutest, sweetest, smartest, most loyal little Sheltie in the whole wide world with a heart of gold and a strong will and mind of her own. One of Ginger's nicknames was "Snow Doggie." She loved the snow so much. She chased snowballs. And she would sit down in the snow and eat it, while Mom would freeze. She hated the rain, but she loved the snow. Another one of Ginger's nicknames was "Couch Doggie." Ginger's favorite daytime spot was on the couch. She'd keep an eye on the window, barking at the big brown truck, dogs, someone opening a curtain or window across the street, and at the same time watching whereever her Mom went in the house. One side of the couch was Ginger's and the other side was Mom's. She'd sit on Mom's side when she wanted attention. And when her Mom came to sit down, she'd get up and move to her side without even being asked. You have to laugh at her favorite place to sleep . . .curled up behind the toilet. She never got a nickname for this. She started sleeping there when she was 6 months old after we put her training crate away. I guess she felt safe curled up there. It was so cute. Her head and legs would be curled around the back of it. Now the funniest thing to see was when she was curled up behind the toilet and she heard you sneeze. It was hilarious to see her get up and back up out of there as fast as she could so she could bark at you and run circles around you for sneezing! Ginger's house rule was "no sneezing"! Some of Ginger's other nicknames were "Ginger Muffin," "Miss Ginger," "Sweet Pea," "Ginger Puppy," and "Miss Princess." And of course, Ginger's favorite nickname was "Momma's Girl." She was a Momma's girl from the first day she came home. She always was and always will be!