Managing cancer in general practice

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A patient with cancer receives chemotherapy at a veterinarian visit.

Canine cancer occurs at about the human rate, and nearly half of all dogs older than 10 years develop the disease.¹ Although less is known about the feline cancer rate, some types of the disease are more common in cats including lymphoma.¹

In an education session at the 2025 WVC conference in Las Vegas, Nevada, Rachel Venable, DVM, MS, DACVIM (Oncology), noted that the prevalence of cancer in dogs is what makes it so important that veterinary teams not only evaluate canine patients and know what to look for but also understand treatment options. In cases where clients decline a referral to a veterinary oncologist, the patient will need treatment from its’ primary practitioner.²

Barriers to specialty care

There are various reasons why a patient with cancer may not be referred to an oncologist. According to Venable, reasons may be related to client finances or an inability to take time off from work to make an appointment. Lack of access to a specialist can also be an issue, especially for pet owners in certain areas of the US that require traveling a great distance for an appointment.²

“Most oncologists are located in major metropolitan areas. So, if you live outside of that, there's actually multiple states that don't even have oncologist,” Venable said. “[And] sometimes it can be an issue when clients just clearly can't get in, or it's a long wait time.”

A barrier to care may also be because many oncologists are so booked up that the specialty clinic requires a definitive diagnosis of cancer to get in to have an appointment. Venable noted that referring clients to an oncologist that offers teleconsulting services may help bridge the gap in access to care.²

Still, Venable said, in other cases, a client’s biases or past experiences drive their decision not to seek treatment with an oncologist.

Treating cancer in general practice

A patient’s treatment plan will depend on a variety of factors. The type of malignant tumor, as well as its’ location, size, grade and stage all factor into treatment decisions.²

Overall, Venable said, there are 4 pillars for treating patients with cancer. They include surgery, radiation, chemotherapy and immunotherapy. “Oral chemotherapy can include drugs such as cyclophosphamide, chlorambucil, lomustine and many others,” Venable said. “Oral chemotherapy does not require the same level of administration and handling in USP 800 because compounding of the medication is not required. This means you do not have as high a risk of exposure and only requires gloves for handling.”²

Venable also discussed using targeted therapies such as toceranib phosphate (Palladia; Zoetis) and verdinexor tablets (Laverdia-CA1; Dechra) in general practice for treating patients with cancer. Furthermore, medications for pain as well as antibiotics can be administered to these patients.²

Palliative care

“A lot of times these are older dogs,” Venable said. “People may not want to do one of those major treatments for various reasons, or it could be something where it's metastasizing everywhere. And so that's something to keep in mind.”

With palliative care, there is emphasis on quality of life and the patient’s comfort. A general practitioner can prescribe therapeutic drugs for helping a patient with nausea control, to stimulate appetite, and as an antidiarrheal, in cases of weight loss and gastrointestinal upset. Venable also suggested adjusting food to make it more bland and easier for the pet to digest.²

“For pet owners who do not believe in euthanasia, high doses of morphine or morphine type drugs can be prescribed for their pet,” Venable said. “My experience with pet owners who do not believe in euthanasia, is that they are fine giving these medications to help calm their pets and make the passing more peaceful.”

Takeaway

How a cancer case is resolved depends on many factors including the cancer type, its’ location in the body and the extent of the disease. However, it is important that veterinarians are able to recognize cancer and have some familiarity with available treatment options.

Venable emphasized that there is no right or wrong way answer to managing cancer, and that should be communicated to clients. She noted that they will often feel pressure to make the best decision for their pet, and that a lot of emotion comes with a cancer diagnosis, so communication is key.

“A way to just kind of let them off the hook is to sit and tell them that there's no right or wrong. There's a lot of different options, and it's more important that they understand the expectations,” she said.

References

1. Cancer in pets. American Veterinary Medical Association. Accessed March 3, 2025. https://www.avma.org/resources/pet-owners/petcare/cancer-pets#:~:text=Approximately%201%20in%204%20dogs,rate%20of%20cancer%20in%20cats.
2. Venable R. Cancer treatment options for primary practitioners. what to do when owners decline referral. Presented at: WVC conference; March 2-5, 2025. Las Vegas, NV.