Treatment of feline colonic adenocarcinoma

Arteaga TA, McKnight J and Bergman PJ. A review of 18 cases of feline colonic adenocarcinoma treated with subtotal colectomies and adjuvant carboplatin. J Am Anim Hosp Assoc. 2012; 48: 399-404.

Adenocarcinoma is the second most common gastrointestinal tumor in cats and the most common tumor found in the colon. Colonic adenocarcinoma is both locally invasive and frequently has advanced metastasis at the time of presentation. Aggressive local surgery (subtotal colectomy) improves survival time in cats, but patients eventually succumb to metastasis, warranting adjuvant treatment with chemotherapy. Carboplatin is an alkylating platinum-based chemotherapeutic agent and has been shown to have efficacy in humans and dogs with carcinomas. Limited previous studies have shown mild to moderate efficacy and safety of carboplatin in cats with carcinomas, meriting its investigation as an adjuvant therapy for colonic adenocarcinomas.
 
This retrospective study evaluated signalment, diagnostic findings, disease-free interval, survival time, chemotherapeutic toxicoses, and prognostic factors for 18 cats with colonic adenocarcinoma treated with subtotal colectomy and monthly carboplatin. Interestingly, cats initially presenting with weight loss had a longer median disease-free interval (290 days versus 75 days), suggesting that a more chronic disease course occurs when weight loss is present. Four cats without weight loss had distant metastasis and a more acute presentation. Median survival time for all cats was 269 days, with cats without distant metastasis surviving 340 days and cats with distant metastasis surviving 200 days. For comparison, in a previous study, cats treated with subtotal colectomy alone lived only 56 days. Carboplatin toxicities reported included low-grade neutropenia, thrombocytopenia, and gastrointestinal toxicity, none of which required reduction or delay in treatment. One cat developed azotemia and carboplatin treatment was stopped after the fifth monthly dose. In conclusion, cats with colonic adenocarcinoma commonly present with colonic obstruction and usually remain patent after subtotal colectomy, but in the end, they are often euthanized due to metastasis, warranting early adjuvant chemotherapy. In this study, carboplatin was shown to have minimal toxicity and to be a viable adjunct for treating this disease. [GO]

See also: Green ML, Smith JD and Kass PH. Surgical versus non-surgical treatment of feline small intestinal adenocarcinoma and the influence of metastasis on long-term survival in 18 cats (2000-2007). Can Vet J. 2011; 52: 1101-5. [Free, full text article]

Related blog articles:
Feline intestinal cancer (March 2011)

More on cat health:
Winn Feline Foundation Library
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Arteaga TA, McKnight J and Bergman PJ. A review of 18 cases of feline colonic adenocarcinoma treated with subtotal colectomies and adjuvant carboplatin. J Am Anim Hosp Assoc. 2012; 48: 399-404.

Adenocarcinoma is the second most common gastrointestinal tumor in cats and the most common tumor found in the colon. Colonic adenocarcinoma is both locally invasive and frequently has advanced metastasis at the time of presentation. Aggressive local surgery (subtotal colectomy) improves survival time in cats, but patients eventually succumb to metastasis, warranting adjuvant treatment with chemotherapy. Carboplatin is an alkylating platinum-based chemotherapeutic agent and has been shown to have efficacy in humans and dogs with carcinomas. Limited previous studies have shown mild to moderate efficacy and safety of carboplatin in cats with carcinomas, meriting its investigation as an adjuvant therapy for colonic adenocarcinomas.
 
This retrospective study evaluated signalment, diagnostic findings, disease-free interval, survival time, chemotherapeutic toxicoses, and prognostic factors for 18 cats with colonic adenocarcinoma treated with subtotal colectomy and monthly carboplatin. Interestingly, cats initially presenting with weight loss had a longer median disease-free interval (290 days versus 75 days), suggesting that a more chronic disease course occurs when weight loss is present. Four cats without weight loss had distant metastasis and a more acute presentation. Median survival time for all cats was 269 days, with cats without distant metastasis surviving 340 days and cats with distant metastasis surviving 200 days. For comparison, in a previous study, cats treated with subtotal colectomy alone lived only 56 days. Carboplatin toxicities reported included low-grade neutropenia, thrombocytopenia, and gastrointestinal toxicity, none of which required reduction or delay in treatment. One cat developed azotemia and carboplatin treatment was stopped after the fifth monthly dose. In conclusion, cats with colonic adenocarcinoma commonly present with colonic obstruction and usually remain patent after subtotal colectomy, but in the end, they are often euthanized due to metastasis, warranting early adjuvant chemotherapy. In this study, carboplatin was shown to have minimal toxicity and to be a viable adjunct for treating this disease. [GO]

See also: Green ML, Smith JD and Kass PH. Surgical versus non-surgical treatment of feline small intestinal adenocarcinoma and the influence of metastasis on long-term survival in 18 cats (2000-2007). Can Vet J. 2011; 52: 1101-5. [Free, full text article]

Related blog articles:
Feline intestinal cancer (March 2011)

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

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Judge rules University of Louisville's hospital is public and subject to Open Records Act; it may appeal

The University of Louisville's hospital is a public entity, a Jefferson Circuit Court judge has ruled in a lawsuit filed to get access to the university's deals with other health providers.

Judge Martin McDonald ruled yesterday in favor of The Courier-Journal, WHAS-TV and the American Civil Liberties Union, noting that the university makes or approves all appointments to University Hospital's board of directors. The university had argued that the board, and thus the hospital, was not a public agency under the state Open Records Act.

The hospital said it might appeal the ruling. McDonald gave it 30 days to give him the records being sought, along with arguments about why they should be exempt" under exceptions to the law, reports The C-J's Andrew Wolfson. "He gave the news organizations at the ACLU 20 days to respond to any claimed exemptions." The hospital has said revealing contracts would put it at a competitive disadvantage.

The suit began after the university refused to let the plaintiffs see records related to its proposed merger with Jewish Hospital & St. Mary's HealthCare and Lexington-based St. Joseph Health Care System. Gov. Steve Beshear vetoed the merger on grounds that a public hospital should not be bound by a religious organization's health-care policies. This month the hospital announced a new deal with KentuckyOne Health, which includes the faith-based entities, but said reproductive services would not be affected despite a policy of "respect" for Catholic health directives. (Read more)

The University of Louisville's hospital is a public entity, a Jefferson Circuit Court judge has ruled in a lawsuit filed to get access to the university's deals with other health providers.

Judge Martin McDonald ruled yesterday in favor of The Courier-Journal, WHAS-TV and the American Civil Liberties Union, noting that the university makes or approves all appointments to University Hospital's board of directors. The university had argued that the board, and thus the hospital, was not a public agency under the state Open Records Act.

The hospital said it might appeal the ruling. McDonald gave it 30 days to give him the records being sought, along with arguments about why they should be exempt" under exceptions to the law, reports The C-J's Andrew Wolfson. "He gave the news organizations at the ACLU 20 days to respond to any claimed exemptions." The hospital has said revealing contracts would put it at a competitive disadvantage.

The suit began after the university refused to let the plaintiffs see records related to its proposed merger with Jewish Hospital & St. Mary's HealthCare and Lexington-based St. Joseph Health Care System. Gov. Steve Beshear vetoed the merger on grounds that a public hospital should not be bound by a religious organization's health-care policies. This month the hospital announced a new deal with KentuckyOne Health, which includes the faith-based entities, but said reproductive services would not be affected despite a policy of "respect" for Catholic health directives. (Read more)

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Christian Co. Health Dept. to stop providing cancer screens, contraceptives to residents of other counties

As of Jan. 1, the Christian County Health Department will not provide contraceptives or cancer screening to indigent patients if they do not reside in the county. Nick Tabor of the Kentucky New Era reports the department will provide those services to other counties' residents if the county in which they reside has signed a contract with Christian County before the Jan. 1 deadline agreeing to repay Christian County for those services. Tabor writes that the policy is not applicable to those services that are covered by state or federal government reimbursements.

The health department's move was prompted by a budget deficit that is close to $200,000, some of it traceable to a lack of reimbursement for contraceptive care. Mark Pyle, director of the department, told Tabor that residents of both Todd and Trigg counties often seek services in Christian County and Christian county taxpayers foot that bill. Pyle explained that there’s nothing in state law saying the health departments have to serve anyone who comes in, regardless of residence.

The New Era is behind a paywall. To obtain a subscription, go here.

As of Jan. 1, the Christian County Health Department will not provide contraceptives or cancer screening to indigent patients if they do not reside in the county. Nick Tabor of the Kentucky New Era reports the department will provide those services to other counties' residents if the county in which they reside has signed a contract with Christian County before the Jan. 1 deadline agreeing to repay Christian County for those services. Tabor writes that the policy is not applicable to those services that are covered by state or federal government reimbursements.

The health department's move was prompted by a budget deficit that is close to $200,000, some of it traceable to a lack of reimbursement for contraceptive care. Mark Pyle, director of the department, told Tabor that residents of both Todd and Trigg counties often seek services in Christian County and Christian county taxpayers foot that bill. Pyle explained that there’s nothing in state law saying the health departments have to serve anyone who comes in, regardless of residence.

The New Era is behind a paywall. To obtain a subscription, go here.

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UK, ARH planning efforts against high rate of heart-disease deaths and limited availability of proper food in Perry County

The death rate from heart disease is nearly twice as high in Perry County (Wikipedia map) as in Kentucky as a whole, so there's no better time than now to announce that the University of Kentucky Medical Center is close to finalizing a three-year agreement with Hazard Appalachian Regional Healthcare Medical Center to provide continuing care, outreach and education to local physicians and county residents, including more and better information about heart-healthy food choices. Bailey Richards of the Hazard Herald reports that this last task is daunting, particularly since availability of good food is an issue in remote parts of the county.

Richards writes that a 2011 study of the heart-healthy food options in Perry County "showed that the area severely lacks low-fat and low-sodium options." Kevin Luley, a registered nurse at the UK Medical Center and winner of the "Heart Health in Rural Kentucky" grant, surveyed all of the restaurants and grocery stores in Perry County and found that most do not have many off-the-shelf options for a healthy diet. Of all of the items available at the restaurants in Perry County, fewer than 6 percent were considered healthy. (Residents can consult their own smartphones for that information. It should also be posted or available upon request.) Of a standard list of produce items, on average only 60 percent were found at the local grocery stores, Luley found. (Read more)

The death rate from heart disease is nearly twice as high in Perry County (Wikipedia map) as in Kentucky as a whole, so there's no better time than now to announce that the University of Kentucky Medical Center is close to finalizing a three-year agreement with Hazard Appalachian Regional Healthcare Medical Center to provide continuing care, outreach and education to local physicians and county residents, including more and better information about heart-healthy food choices. Bailey Richards of the Hazard Herald reports that this last task is daunting, particularly since availability of good food is an issue in remote parts of the county.

Richards writes that a 2011 study of the heart-healthy food options in Perry County "showed that the area severely lacks low-fat and low-sodium options." Kevin Luley, a registered nurse at the UK Medical Center and winner of the "Heart Health in Rural Kentucky" grant, surveyed all of the restaurants and grocery stores in Perry County and found that most do not have many off-the-shelf options for a healthy diet. Of all of the items available at the restaurants in Perry County, fewer than 6 percent were considered healthy. (Residents can consult their own smartphones for that information. It should also be posted or available upon request.) Of a standard list of produce items, on average only 60 percent were found at the local grocery stores, Luley found. (Read more)

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UK music therapy helps manage surgical anxiety, pain, recovery

A University of Kentucky study has found that music therapy can reduce pain before, during and after a surgical procedure, and shorten recovery time. The study report, published in the Southern Medical Journal, showed music was also useful in managing surgical anxiety. According to Lori Gooding, UK director of music therapy and lead author of the report, the music should be selected by trained personnel with a mind toward specific guidelines for music selection in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. Gooding suggests patients be offered several playlists from which to choose so they can have something to suit their tastes as well as the medical protocol. (UK video)



Gooding writes that the tempo, rhythm and volume of the music should be carefully controlled to maximize its effect. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. The UK Music Therapy program was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, a unique partnership between the UK School of Music and UK HealthCare. (Read more)

A University of Kentucky study has found that music therapy can reduce pain before, during and after a surgical procedure, and shorten recovery time. The study report, published in the Southern Medical Journal, showed music was also useful in managing surgical anxiety. According to Lori Gooding, UK director of music therapy and lead author of the report, the music should be selected by trained personnel with a mind toward specific guidelines for music selection in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. Gooding suggests patients be offered several playlists from which to choose so they can have something to suit their tastes as well as the medical protocol. (UK video)



Gooding writes that the tempo, rhythm and volume of the music should be carefully controlled to maximize its effect. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. The UK Music Therapy program was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, a unique partnership between the UK School of Music and UK HealthCare. (Read more)

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High Levels Of LDL Cholesterol Better For Living Healthy Lives!

High Levels Of LDL Cholesterol Better For Living Longer, Healthier Lives!

The Japan Society for Lipid Nutrition has drawn up new guidelines stating that high cholesterol levels are better for living longer, defying conventional wisdom.

Research is now disproving those that state the LDL Cholesterol is BAD Cholesterol Myth!

In 2007, the Japan society set diagnostic criteria for hyperlipemia, or elevated levels of lipids in the bloodstream, flagging LDL cholesterol levels of at least 140 mg/dl and HDL levels less than 40 mg/dl as dangerous for both men and women. To explain why they set the levels as they did they stated:

"According to domestic and foreign research, the higher LDL levels become, the more arterial stiffening advances. Correspondingly, incidence of heart disease also rises. We concluded that LDL cholesterol levels more than 140 mg/dl could easily cause heart disease," said Hirotsugu Ueshima, professor emeritus at Shiga University of Medical Science, who devised the atherosclerosis society's criteria.

However, Tomohito Hamazaki, a professor at Toyama University's Institute of Natural Medicine, who, in fact, compiled the new cholesterol levels guidelines for the Japan Society for Lipid Nutrition, countered Ueshima's argument.

"When examining all causes of death, such as cancer, pneumonia and heart disease, the number of deaths attributable to LDL cholesterol levels exceeding 140 mg/dl is less than people with lower LDL cholesterol levels." –Prof. Tomohito Hamazaki

The lipid nutrition society guidelines do not posit new criteria, but Hamazaki cited some study results to prove his thesis.

According to a eight-year study of about 26,000 men and women in Isehara, Kanagawa Prefecture, the death rate of men whose LDL cholesterol levels were between 100 mg/dl and 160 mg/dl was low, while the rate rose for those with LDL cholesterol levels of less than 100 mg/dl!

The LDL figures exhibited less influence on women, but the death rate still rose for women with LDL cholesterol levels less than 120 mg/dl.

A separate study of 16,850 patients nationwide who had suffered a cerebral stroke showed the death rate for people with hyperlipemia (high blood fatty acid levels) from a cerebral stroke was lower, and their symptoms more slight than those whom had lower lipid levels.

"Cholesterolis an essential component for the creation of cell membranes and hormones. It's not recommended to lower LDL figures by means of dietary intake and medication," stated Hamazaki.

Additional differences exist between men and women's LDL figures.

"When women reach menopause, their cholesterol figures rise sharply, yet do not affect the arteriosclerosis process or development of heart diseases. At the very least, cholesterol criteria is not necessary for women,"-Hiroyuki Tanaka, director of Niko Clinic in Takeo, Saga Prefecture.

This study, along with other studies, leads one to the conclusion that optimal LDL levels are within the 120-160 mg/dl range.

The body needs LDL in the healing process for things such as Autoimmune Diseases, Heart Attacks and Strokes. Why would you ever want to hinder the healing processes of the human body?

-Dr. Walter K. Crooks    

High Levels Of LDL Cholesterol Better For Living Longer, Healthier Lives!

The Japan Society for Lipid Nutrition has drawn up new guidelines stating that high cholesterol levels are better for living longer, defying conventional wisdom.

Research is now disproving those that state the LDL Cholesterol is BAD Cholesterol Myth!

In 2007, the Japan society set diagnostic criteria for hyperlipemia, or elevated levels of lipids in the bloodstream, flagging LDL cholesterol levels of at least 140 mg/dl and HDL levels less than 40 mg/dl as dangerous for both men and women. To explain why they set the levels as they did they stated:

"According to domestic and foreign research, the higher LDL levels become, the more arterial stiffening advances. Correspondingly, incidence of heart disease also rises. We concluded that LDL cholesterol levels more than 140 mg/dl could easily cause heart disease," said Hirotsugu Ueshima, professor emeritus at Shiga University of Medical Science, who devised the atherosclerosis society's criteria.

However, Tomohito Hamazaki, a professor at Toyama University's Institute of Natural Medicine, who, in fact, compiled the new cholesterol levels guidelines for the Japan Society for Lipid Nutrition, countered Ueshima's argument.

"When examining all causes of death, such as cancer, pneumonia and heart disease, the number of deaths attributable to LDL cholesterol levels exceeding 140 mg/dl is less than people with lower LDL cholesterol levels." –Prof. Tomohito Hamazaki

The lipid nutrition society guidelines do not posit new criteria, but Hamazaki cited some study results to prove his thesis.

According to a eight-year study of about 26,000 men and women in Isehara, Kanagawa Prefecture, the death rate of men whose LDL cholesterol levels were between 100 mg/dl and 160 mg/dl was low, while the rate rose for those with LDL cholesterol levels of less than 100 mg/dl!

The LDL figures exhibited less influence on women, but the death rate still rose for women with LDL cholesterol levels less than 120 mg/dl.

A separate study of 16,850 patients nationwide who had suffered a cerebral stroke showed the death rate for people with hyperlipemia (high blood fatty acid levels) from a cerebral stroke was lower, and their symptoms more slight than those whom had lower lipid levels.

"Cholesterolis an essential component for the creation of cell membranes and hormones. It's not recommended to lower LDL figures by means of dietary intake and medication," stated Hamazaki.

Additional differences exist between men and women's LDL figures.

"When women reach menopause, their cholesterol figures rise sharply, yet do not affect the arteriosclerosis process or development of heart diseases. At the very least, cholesterol criteria is not necessary for women,"-Hiroyuki Tanaka, director of Niko Clinic in Takeo, Saga Prefecture.

This study, along with other studies, leads one to the conclusion that optimal LDL levels are within the 120-160 mg/dl range.

The body needs LDL in the healing process for things such as Autoimmune Diseases, Heart Attacks and Strokes. Why would you ever want to hinder the healing processes of the human body?

-Dr. Walter K. Crooks    

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U of L doctors wary of KentuckyOne's promise of autonomy

Doctors at Louisville's University Hospital are expressing concerns that the partnership with KentuckyOne Health and the Catholic health rules that come with that merger might affect patient care. Assurances that their concerns are unfounded have been coming from KentuckyOne's majority owner, Denver-based Catholic Health Initiatives. Anxiety over doctors' medical freedom to treat patients as they feel is necessary is being fueled as staff and physicians are being asked to "respect" Catholic health directives, The Courier-Journal reports.

Sheila Reynertson, advocacy coordinator for the New York-based MergerWatch Project, who tracks secular-religious hospital mergers, told The C-J's Laura Ungar that such language puts doctors in "a difficult position." For instance, she explains, "cancer doctors may wonder about prescribing birth control to prevent pregnancy, she said. Catholic directives include a ban on sterilization, abortions, and euthanasia and say Catholic health institutions can't "promote or condone contraceptive practices." Gary Mans, spokesman for the U of L Health Sciences Center, said he doesn't believe doctors and staff will feel constrained by the directives. (Read more)

Doctors at Louisville's University Hospital are expressing concerns that the partnership with KentuckyOne Health and the Catholic health rules that come with that merger might affect patient care. Assurances that their concerns are unfounded have been coming from KentuckyOne's majority owner, Denver-based Catholic Health Initiatives. Anxiety over doctors' medical freedom to treat patients as they feel is necessary is being fueled as staff and physicians are being asked to "respect" Catholic health directives, The Courier-Journal reports.

Sheila Reynertson, advocacy coordinator for the New York-based MergerWatch Project, who tracks secular-religious hospital mergers, told The C-J's Laura Ungar that such language puts doctors in "a difficult position." For instance, she explains, "cancer doctors may wonder about prescribing birth control to prevent pregnancy, she said. Catholic directives include a ban on sterilization, abortions, and euthanasia and say Catholic health institutions can't "promote or condone contraceptive practices." Gary Mans, spokesman for the U of L Health Sciences Center, said he doesn't believe doctors and staff will feel constrained by the directives. (Read more)

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