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Canine and Feline Geriatric Oncology

Honoring the Human–Animal Bond

Second Edition

Dr. Alice Villalobos
with Laurie Kaplan, MSC

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To Dr. Gordon H. Theilen, mentor, teacher, researcher, colleague, and inspiration to many creative leaders who helped develop the rapidly growing, multidisciplinary field of veterinary oncology. I dedicate this book to Dr. Theilen, my great mentor, who guided me, a student oncophile, through his visionary and first mock residency program in veterinary oncology at UC Davis, School of Veterinary Medicine, from 1969 to 1972. Dr. Theilen has continued to advise and inspire me with his wonderful courage, character, and generosity over the years. Dr. Theilen was the first President of the Veterinary Cancer Society and a notable international forefather in veterinary cancer medicine and research. We celebrated his 80th Birthday in May of 2008 at the Theilen Tribute Symposium, where the Veterinary Cancer Society gave him the first Theilen Tribute Award for lifetime achievement in oncology. I thank Dr. Theilen for giving us an autobiographical account of his illustrious career in his book, The Boy with the Wounded Thumb, EditPros LLC, Davis, CA 95616, 2017.

To Antonio and Alicia Villalobos, my wonderful parents, who held on to each other and their five children with amazing love and courage through thick and thin for 65 years. Their strength, encouragement, and example in dealing with the joys and adversities of life and aging will live as long as their family has life.

I also dedicate this book in honor of the late Dr. Johan de Vos of the Netherlands, who was an inspirational leader for European and veterinary oncologists, worldwide.


The amount of information that applies to contemporary veterinary geriatric oncology is mounting at a frenetic pace. It is generated from the hard work of thousands of clinical researchers and authors of scientific publications in oncology, hematology, gerontology, radiation oncology, internal medicine, surgery, immunology, nutrition, sociology, epidemiology, and research in all related fields. This book draws from the texts and the milieu of references available. Instead of reprinting material, the author delivers applied knowledge to individual cases. For more in-depth detail, readers are referred most notably to the following general references used for this book, listed alphabetically by title:

Disclaimer: Geriatric patient oncology care and client communications are ultimately the attending doctor's responsibility. Author and publisher shall not be liable for any loss related to the use of information in this textbook. Readers are encouraged to check and verify doses and schedules and current information or consult with specialists. Some excellent resources available online include:

  • (clinical trials database)
  • 2017 Residency reading list
  • How the Immune System Sees and Destroys Tumors, Jeffrey S. Weber, MD, PhD, Moffitt Cancer Center, Tampa, Florida.
  • World Small Animal Veterinary Association, 2014. Guidelines for Recognition, Assessment and Treatment of Pain, Journal of Small Animal Practice.
  • (information on five thousand – mostly NIH – clinical research studies
  • (full text biomedical articles dated back to 1966)
  • (provides current information on human oncology)
  • Veterinary Information Network (interactive exchange)
  • (VIN's client information resource)
  • (the Veterinary Society of Surgical Oncology)
  • (clinician consults with Dr. Anthony Moore)
  • default.aspx (pet hospice resource)
  • (the Argus Institute for Families and Veterinary Medicine counseling support featuring a Making Decisions booklet)
  • (about pet loss grief by Moria Anderson Allen, M.Ed.)
  • (is pet loss equivalent to loss of a loved one?)
  • (clinical trials resource)
  • (grief support, rainbow bridge, and Monday candle ceremony)
  • (pet loss support)
  • (stereotactic radiation information from Neil Mauldin, DVM, ACVIM, ACVR)


Canine and Feline Geriatric Oncology distills out the most important useful information needed by veterinary practitioners and teams to deal with geriatric cancer patients and their carers. Veterinarians contact me daily to fill in the gaps left between the lines in their textbooks. When I was lecturing in Beijing, the head of oncology at the Agricultural University told me that she slept with my book for three months and that it helped her with her students, clients, and patients. During the World Veterinary Cancer Congress, in Brazil, an oncologist, who translated the First Edition, said that she knew my mind and another oncologist said, “We see our books walking, when we see you and Dr. Theilen.” In Portugal, a surgeon told me that he had my textbook right next to his Ettinger! Drs. Mark Gendizer and Virginia Quelch said their staff uses the book often.

This Second Edition text draws from an overwhelming deluge of information that overloads practitioners in the rapidly growing field of oncology and end of life care. We have new technology and information from genomics, proteomics, metabolomics, immunogenomics, immuno-oncology (onco-immunology), and nutrigenomics. Researchers may use artificial intelligence to extract information and find the keys to open the gates of many cellular pathways and map the molecular biology of specific tumors. Data would be used to suggest which drugs and immunotherapies would be best to use for the cancer patient for precision therapy.

These technological keys are guiding better diagnostics, earlier detection of cancer, and the development of targeted therapies and immunotherapy. Bioengineering technology enhances the capabilities of radiation therapy, interventional therapy, and electrochemotherapy (electroporation) as new and improved weapons to battle cancer. Further advances in medical technology and research will allow us to extend the health and longevity of our geriatric oncology patients with combinations of newer, less toxic, targeted therapy such as small molecules and vaccine therapy from the growing field of immuno-oncology.

Tumors are organized into five large categories, according to tissue of origin: carcinomas, sarcomas, blood cancer, nervous system tumors, and miscellaneous/unknown. Tumors are also organized by location: skin, head and neck, chest, abdomen, and bone and blood (lymphoid). Sorting tumors with this perspective may assist practitioners with the initial decision-making process, to improve the diagnostic approach and expedite treatment plans.

This text is a unique reference for veterinary students, interns, residents, attending doctors, and nursing personnel challenged with the rigors of decision making and caring for geriatric oncology patients. It is a helpful resource for highly motivated pet owners. Its greatest contribution may be in the fields of end of life care (Pawspice), communication, attachment, the human–animal bond, decision making, bioethics, and philosophy. The H5M2 Quality of Life scale helps the veterinary team guide carers through the maze of decision making for their geriatric pets in Pawspice and hospice care.

Cases are presented that highlight issues in geriatric oncology and in the management of interpersonal relationships with various types of clients. This multilevel approach offers readers scientific subject matter, mixed with cases overlaid with situated knowledge harvested over many years of experience. Victory and frustration are inherent in the management of elderly oncology patients and readers are cautioned to recognize and avert compassion fatigue with uplifting self-care as a key wellness strategy.

This tour through geriatric oncology blends elements of attachment, the human–animal bond, end of life Pawspice, and hospice care with compassion. All facets of practice are woven into the reality of applying cancer therapy with empathy, adjusted for variable client preferences and financial situations. This is what veterinary teams do every day in practice. This book is a comprehensive resource for those learning how to do it better.

May this second edition help you negotiate the ebb and flow of emotions as senescent cancer patients and their deeply bonded families challenge and enrich your career.