Certain combinations are indelibly etched in our minds as cohesive partnerships. For example, can you think of peanut butter without contemplating jelly? I challenge you to hear the word “ying” and not think of “yang.” If someone says “tequila,” I’m guaranteed to think of a lime. Don’t judge — I’m sure you have your own particular groupings you’d never think to separate.
When it comes to veterinary medicine, the specialties of oncology and surgery are an example of equally inseparable grouping.
At first glance, the connection between the two may not be apparent. Surgeons are often stereotyped as arrogant, cold, egocentric, and harsh. They are the “carpenters” of bodies, who willingly carve flesh and bones in an effort to impart a detached and impersonal “quick fix” to a problem.
Oncologists, conversely, are perceived as continuously compassionate and endlessly optimistic, possessing traits necessary to somehow deliver devastatingly harsh news while simultaneously maintaining an outlook of hope and inspiration.
Whether these stereotypes are true or not isn’t the important debate. What we do know is that the adage “a chance to cut is a chance to cure” is especially pertinent for oncology cases. When it comes to the majority of cancers I treat, when I’m able to recommend a patient’s tumor burden be reduced using some form of surgical excision, their survival time is likely to be significantly increased no matter the diagnosis.
When feasible, and medically indicated, my preference is to have tumors surgically removed before attempting to treat them with any of the other weapons I have in my treatment arsenal, such as chemotherapy or immunotherapy. Furthermore, in many cases I recommend the oncologic surgery be performed by a board certified veterinary surgeon rather than by the pet’s primary care doctor.
The advantages to utilizing a veterinary surgeon for complex tumor removal are innumerable. The foremost being that they possess extensive training in, and have access to the tools necessary to practice, the fundamental principles of surgical oncology (SO).
Some of the basic tenets of SO include (but are not limited to):
- Careful pre-surgical planning of the removal of skin and subcutaneous tumors such that any remaining scar tissue could be potentially incorporated into a post-surgical radiation field should excision be incomplete. This includes understanding how to orient a scar such that radiation therapy can be delivered without extensive damage to healthy tissue. Poor planning can lead to disastrous outcomes for pets.
- Performing a thorough exploration of the entire anatomical cavity from which an internal tumor is removed (e.g., a full abdominal exploratory surgery for cases of removal of an intestinal mass). In order to accomplish this, a surgeon must create an incision long enough to permit adequate access to the region they are examining. All too often I see a patient diagnosed with an abdominal tumor with a surgical incision only a few centimeters in length. This immediately raises concern that the veterinarian who performed the procedure was unable to adequately assess all of the anatomical structures in the abdomen and may have missed other organs that should have been biopsied.
- Using a different set of surgical instruments, gowns, and gloves during closure of the skin or a body cavity following tumor removal. If these objects are not changed, it is theoretically possible to (inadvertently) physically transfer tumor cells attached to the objects' surfaces from one site in the body to another.
Primary care veterinarians often indicate that owners are reluctant to seek consultation with a board certified surgeon because of concern for expense. I challenge those doctors to encourage reluctant owners to consider the value of information they could obtain from meeting with a surgeon.
I also challenge veterinarians to disclose any limitations they may face in their ability to perform oncological surgeries (e.g., not having the resources necessary to change surgical instruments when necessary), their comfort level with the procedure in question, and to be familiar with the results of studies indicating the outcome for pets with certain tumors can be improved when a board-certified veterinary surgeon, rather than their primary care veterinarian, performs the procedure.
I challenge owners to think about whom they would rather have performing a complicated oncological surgery on their pet: a person who performs that particular surgery once every other month versus one that performs that surgery twice or more per week.
Lastly, I challenge the specialists to 1) present owners with all available options, not solely the “ideal” plan, 2) continue to train general practitioners in the proper way to approach oncological surgeries, and 3) uphold the medical and surgical standards to which they were trained in the first place.
Oncology and surgery go together exceptionally well. I’m fortunate to have worked alongside, and to personally know, some of the most outstanding veterinary surgeons in the field. I can’t work to the fullest of my capabilities without the help of these amazing individuals, and likewise I’d like to think they couldn’t be as successful managing their cancer cases without my input.
We may not mix as palatably as chocolate and peanut butter, but we’re pretty darn close in our ability to create an outcome that’s nothing short of amazing.
For more information on how to find a board certified veterinary surgeon near you, visit the American College of Veterinary Surgeons (ACVS)
For more information on the field of veterinary surgical oncology and why seeking a veterinary surgeon for your pets oncological surgery is important, visit the Veterinary Society of Surgical Oncology (VSSO)
Dr. Joanne Intile