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Dr Tommy 動物腫瘤治療錄 - Oncology Cases, Hong Kong (2026)

25/12/2022

Case: 鼻腔腺腫瘤 Nasal adenocarcinoma

本案9歲半德蘭牧羊犬打乞嗤多左同流鼻血, 經診斷為鼻腔腺腫瘤 (nasal adenocarcinoma). 之後進行了為期3日立體定位放射治療 (Stereotactic radiation therapy). 4個月後CT顯示非常良好縮細及控制. 現在狗狗生活如常. 副作用包括甩毛及慢性鼻炎. 要知道, 腫瘤已破壞鼻腔, 加上放射治療, 鼻腔組織唔會回復正常狀態, 所以有部分貓貓或狗狗, 會有長期鼻炎. 佢會比其他動物更容易有鼻敏感, 轉天氣容易打乞嗤, 流鼻水等. 一般可以用藥物幫助, 加上好多貓狗都會適應到, 問題不大.

腫瘤嘅變化同起伏, 有啲時後估計唔到. 作為主人, 我地最希望可以為佢哋提升或者保持生活質素. 現今有好多唔同種類嘅治療方案, 將來都會不斷發展. 所以無論咩情況, 主人都一定會選擇到合適嘅療程, 最緊要保持平常心, 唔好容易放棄. 有咩問題或疑難, 都要討論. 我地醫護團隊一路同你地並肩作戰. 來年繼續加油 !!!!! 聖誕快樂同預祝新年快樂. 最緊要身體健康 :)

The presenting case is a 9.5 yo Shetland sheepdog who presented with epistaxis and frequent sneezing. Diagnostic results indicated nasal adenocarcinoma. The patient underwent stereotactic radiation treatment of 3 days. 4 months later, a recheck CT scan noted very good reduction of the tumor. Side effects included hair loss around the nasal area, and residual rhinitis. It should be noted that the presence of the nasal tumor has already eroded and damaged the internal structures (turbinates) within the nasal cavity. With the addition of radiation treatment, the nasal turbinates will no longer return to normal, resulting in rhinitis. This indicates the patient is more prone to allergies, with occasional sneezing and nasal discharge. These can usually be managed with supportive medications, and most cats and dogs can cope with this with minor issues.

Cancer progression is unpredictable. As pet owners, our goal is to provide the best or maintain quality of life for our dear fluffy friends. There are multiple treatment options for cancer, and further developments are expected. That is why, no matter the situation, owners will be able to choose the most optimal care for their pets. The most important thing is to keep a calm demeanour at all times and move forward with sheer determination and perseverance. If there are any difficulties or concerns, do bring it up and discuss. The team of medical professionals are here to battle alongside you! Keep it up and be ready for any challenges in the upcoming year !!! Merry Christmas and wishing you all a happy new year! Here's to good health and luck :)

#腫瘤 #寵物 #放射治療 #貓 #狗 #動物腫瘤治療 #動物癌症 #動物腫瘤 #豐盈 #豐盈動物腫瘤中心 #電療 #動物放射治療 #動物電療 #癌症治療 #加油

05/12/2022

Case: 惡性軟組織肉瘤 soft tissue sarcoma

本案9歲半貓貓左邊面生左個腫瘤, 侵蝕了上顎骨. 經診斷為惡性軟組織肉瘤, 期後進行了3日嘅立體定向放射治療. 情況穩定之後, 再做了一個療程化療.

圖中所見放射治療副作用, 例如甩毛, 初期有皮膚炎等. 毛有機會生長慢啲，或者以後未必生得到.

5個月後, 腫瘤達到緩解. CT所見治療反應非常好, 貓貓如今生活一切正常,

惡性軟組織肉瘤通常係用手術切除, 不過需要大範圍切除. 本案貓貓左邊面嘅位置係難以100%切除, 加上惡性, 很快會覆發. 這類腫瘤, 可以先手術切除, 再進行放射治療亦合適. 或者放射治療加化療, 就同本案一樣.

應付不同腫瘤, 都會有不同合適嘅治療组合.

The presenting case is a 9.5-year-old cat with a left sided facial mass with lysis of the maxillary bone. The diagnosis revealed soft tissue sarcoma. The cat underwent stereotactic radiation for 3 days. Afterwards, a course of chemotherapy was completed.

Side effects from the radiation treatment (shown in picture) included hair loss and dermatitis around the irradiated site. Hair regrowth may take longer, or may be permanently lost.

5 months later, the cat achieved remission. Recheck CT noted a very good treatment response. She is currently living a good quality of life as usual.

The typical treatment for soft tissue sarcoma involves wide margin surgical resection. However, the location at the left facial area would mean that clear margins are not possible to obtain, and the tumor will relapse quickly afterwards. A possible treatment combination can include surgical resection first followed by radiotherapy. Or radiotherapy first followed by chemotherapy, as was the presenting case.

There are different optimal treatment combinations for different types of tumors.

#腫瘤 #寵物 #放射治療 #貓狗 #動物腫瘤治療 #動物腫瘤 #動物癌症 #豐盈動物腫瘤中心 #電療 #動物放射治療 #動物電療 #癌症治療

18/11/2022

Case 7: 口腔淋巴癌

本案13歲哥基, 右上嘴角生左個腫瘤, 經診斷為口腔上皮性淋巴癌, 已擴散到附近淋巴. 傳統治療淋巴癌係用化療, 不過由於本案腫瘤係一個獨立固體, 加上淋巴癌對放射治療非常有反應, 狗狗進行了為期10日嘅治療, 嘴角腫瘤同附近淋巴一齊接受放射治療. 副作用有甩毛,口腔發炎等等.

由於反應理想, 未做完療程已經見到腫瘤縮細, 達到緩解. 狗狗現在亦即將準備做一個療程嘅化療, 加強控制, 始終淋巴癌係有機會周圍走. 獨立固體淋巴瘤, 例如係鼻腔, 縱隔位置, 亦都非常適合放射治療.

傳統化療CHOP 現時都係首選, 不過好多個案都很快見到腫瘤反彈. 有主人可能會問, 如果我位毛孩淋巴癌冇一個獨立固體, 而係全身性, 可否做電療? 係人類，有半身或全身性嘅電療. 現在係外國已有研究進行中, 動物對於呢種療程有無效, 同埋可唔可以承受到副作用. 隨住科技同醫療發展, 相信遲啲會有更理想嘅方案可以提供到比毛孩同主人!

The presenting case is a 13yo Welsh Corgi who presented with a mass on the right buccal area. Diagnosis revealed epitheliotropic lymphoma, with metastasis to the regional lymph nodes. The traditional treatment for lymphoma is chemotherapy. However, lymphomas are particularly sensitive to radiation, and in the present case, the mass is solitary. Hence, the dog underwent a conventional protocol of 10 sessions. The primary tumor and the affected lymph nodes are treated in the same session. Side effects include hair loss and mucositis.

Due to the rapid response to radiation, the mass has visibly shrunk in size even before the treatment has completed, achieving remission. The patient is being prepared to perform a course of chemotherapy for added control, as lymphoma is a cancer that will spread elsewhere. For solitary lymphomas, such as those in the nasal cavity or in the mediastinum, radiation is also very effective.

The traditional chemotherapy CHOP protocol is usually the first line treatment for lymphoma, but many cases unfortunately relapse during or soon after treatment. Some owners may ask whether radiation treatment is possible if the lymphoma is generalized without any solitary lesions. In humans, there is something called half body or whole-body irradiation. There has been preliminary research in the use of such protocols in dogs and cats, investigating its efficacy and the associated side effects. With the rapid advancement in the science and medical fields, I look forward to the development of new treatment options that are suitable for pets!

#腫瘤 #寵物 #放射治療 #貓狗 #動物腫瘤治療 #動物腫瘤 #動物癌症 #豐盈動物腫瘤中心 #電療 #動物放射治療 #動物電療 #癌症治療 #淋巴癌

06/11/2022

甚麼是化療? What is Chemotherapy?

當主人聽到化療兩個字, 腦海會浮現一啲恐怖嘅副作用同畫面. 化療係用藥物去治療癌症, 有幾種做法, 可以係:

1) 唯一治療, 通常用係血癌, 淋巴癌; 或者一啲已經擴散，後期嘅癌症
2) 做化療縮細腫瘤, 然後再做其他治療如手術, 放射治療, 加強清除效果
3) 先做其他治療如手術, 放射治療, 再做化療, 去處理前者清除唔到嘅腫瘤或加強控制

A) 化療一般要做幾耐?
- 視乎甚麼癌症. 同埋佢係以上1, 2, 3 邊種情況.
- 例如淋巴癌, 傳統治療’CHOP’ 要一星期一次, 起碼要做3-4個月.
- 有某些化療針係每3-4星期一次
- 要定期驗血, 睇睇白血球, 血小板指數如何, 如果過低就需要延後當日嘅治療. 如果副作用太嚴重, 亦要延後.
-*** 化療係有一個療程要跟足, 如果斷斷續續去做會失去效力, 比腫瘤有機會反彈. 記得要跟足指示***.

B) 化療有無口服?
- 有. 口服同針劑都有. 不過每種藥功效唔同, 對每種癌症反應唔同, 所以要睇情況.

C) 有甚麼副作用?
- 化療除左攻擊癌症細胞, 亦會攻擊正常細胞, 所以最常見副作用係影響骨髓，腸胃同埋毛髮.
- 白血球, 血小板會變低, 有機會影響佢止血功能, 容易受感染.
- 有機會發燒, 嘔，肚屙，無食慾, 疲倦, 血尿, 甩毛
- 有啲化療藥對心臟唔好, 心臟有問題嘅毛孩係唔適合用

D) 我好擔心副作用, 應該點做?
- ***首先, 每位毛孩反應唔同, 有啲完全無問題, 有少部份會比較大反應. 如果有嘔，肚屙，無食慾, 就需要用藥物控制, 食得清淡, 好似腸胃炎咁處理***.
- 白血球, 血小板會變低, 通常每7日驗血, 睇睇情況. 呢個係要等身體自己慢慢升返上黎
- 如果太嚴重，有需要留院，吊鹽水護理
- 如果副作用真係對某位毛孩太厲害, 一般會係下一次療程減小化療劑量, 或者用另一種代替. 同埋會有適當護理藥物. 如果要選擇停止治療, 要先同醫生商量

E) ***口服化療, 係可以比主人番屋企餵, 不過要記得帶醫療手套, 同埋做化療嘅毛孩, 残留物會係係大小便屙出黎, 所以主人要帶手套同小心執好排泄物. 建議化療後 2-3日都要小心執好排泄物. 如果想保守同安全啲, 可以加多幾日. 孕婦，小朋友要避免接觸排泄物, 同埋化療藥. 如果唔小心掂到，請用洗手液清潔好. *** 除左呢啲之外, 你係可以如常同佢地生活,唔需要擔心.

***同人一樣，我相信每位主人對化療亦持有唔同睇法. 其實我地要攞個平均位, 治療癌症vs 副作用會影響生活呢兩點. 有時會困擾, 可能化療對呢種癌症非常有效, 但係點準備都好, 副作用都比較厲害. 到時就心痛, 係咪唔應該做落去. 其實同所有治療方案一樣, 最緊要溝通好，要有心理準備突如其來嘅變化, 為佢地選擇最適合嘅療程, 增強生活質素. 治療無對與錯. 呢個係一個好難打嘅仗, 家人,醫護團隊, 朋友, 同路人都會一路同佢地並肩作戰! 路係難行, 但要繼續走下去. 💪🦵***

To owners, the term chemotherapy may conjure up unpleasant images of side effects. Chemotherapy refers to the use of chemotherapeutics in the treatment of cancer. There are several ways to use this:

1) Primary treatment, usually used for hematopoietic tumours (Lymphoma, Leukemia, blood-related...etc), or those diseases that have already spread, advanced stages.
2) Neo-adjuvant treatment, where chemotherapy is used first to shrink the tumor, followed by better control with surgery and/or radiation
3) Adjuvant treatment, where surgery and/or radiation is performed first, followed by chemotherapy to eliminate/control any microscopic disease or spread of disease that is not controlled by the former treatment options.

A) How long does chemotherapy last?
- It depends on the tumor type, and which of the above options (1, 2, 3) we are situated in
- E.g., Lymphoma. The treatment is known as CHOP protocol, where the patient is treated once a week, up to a total of 3-4 months.
- For some other protocols, treatment maybe once every 3-4 weeks
- Regular blood tests are necessary to monitor for any changes in the white blood cell and platelet counts. If these are deemed at an unacceptable level, the treatment that day will be delayed. If side effects are too severe from the previous week, then treatment for this week may be delayed.
- ***There is a fixed protocol for each chemotherapy option. Owners need to follow this strictly and not perform it intermittently as they see fit. Otherwise, the medications will not be as effective, and the tumor will relapse***.

B) Are there any oral pills for chemotherapy?
- Yes. There are injectables and oral pills. However, each drug works with a different mechanism and some would be better suited to certain tumors. Hence, it depends on the patient.

C) What type of side effects are we looking at?
- Chemotherapy does not differentiate between killing normal cells and tumor cells. Hence, common side effects are those of the bone marrow, gastrointestinal system and skin.
- White blood cell and platelet counts will decrease, and these may impact the patient’s ability to clot properly, and they may be susceptible to secondary infections
- Fever, vomiting, diarrhea, lethargy, reduced appetite, blood in urine, hair loss are some common side effects
- Some chemotherapeutics may not be suitable for patients with heart disease

D) I am very concerned about side effects. What should I do?
- ***Every pet responds to different medications with varying responses. In general, most pets tolerate chemotherapy well, but a small group may experience some severe side effects. If they are vomiting and experiencing diarrhea, then appropriate medications must be considered***.
- For white blood cells, platelet counts, this can be monitored with a blood test weekly
- For severe cases, the pet may need to be hospitalized for intravenous fluids and supportive care
- If a pet is unable to tolerate chemotherapy, the vet in charge may reduce the dose during the next treatment, or switch to a different drug. There will also be supportive medications that will be prescribed to the owner. Owners need to discuss with their primary clinician if they wish to stop treatment.

E) ***For oral pills, these can be prescribed to the owner to medicate the pet at home. Wear protective gloves when handling the medications, and do not crush tablets or split capsules open. The breakdown products from the medication are eliminated in the urine and f***s for 2-3 days, so ensure proper hygiene and disposal of these waste products. This is a rough guideline. To be on the conservative side, you could continue the hygiene and disposal protocol for another few days further. Children and the pregnant are advised to avoid handling the waste products and the chemotherapy medications. If there is accidental contact, wash it off with soap and plenty of water. *** Apart from this, there is no need to worry as you can interact normally with an animal that has received chemotherapy.

***Same in human patients, I am sure every pet owner has different opinions about chemotherapy. The most important thing is to strike a balance between treating the problem vs management of side effects and considering whether it significantly deteriorates quality of life. This can be difficult sometimes, as the treatment may be effective against cancer, but regardless of preparations, the pet still succumbs to some severe side effects. Pet owners may be hesitant and question their own decisions and whether the treatment must be stopped. This doesn’t just apply to chemotherapy. With any cancer treatment options, the important thing is to communicate well and be well prepared for any unexpected events and choose the most appropriate treatment for them to improve quality of life. There is no right or wrong. This is indeed a tough battle, but friends, families, other patients and the hospital team will be fighting alongside you. The road ahead is full of challenges, but you gotta do what you gotta do. 💪🦵***

#腫瘤 #寵物 #化療 #貓 #狗 #動物腫瘤治療 #動物癌症 #動物腫瘤 #豐盈 #豐盈動物腫瘤中心 #癌症治療 #加油 #副作用

26/10/2022

Case 6: 狗狗最常見嘅皮膚腫瘤 - 肥大細胞腫瘤 (Mast cell tumours in dogs)

放射治療跟手術不同地方, 係會慢慢擊殺腫瘤, 做完治療之後3-4個月都繼續擊殺，達到緩解 (Remission).

本案13歲唐狗, 右前手診斷肥大細胞腫瘤， CT顯示已擴散到附近嘅淋巴，進行了為期5次(一星期一次)嘅舒緩放射治療. 右前手腫瘤及受影響嘅淋巴都一齊接受治療. 2個月後, 淋巴及右前手腫瘤有良好縮細及控制. 狗狗現在生活正常. 所見副作用包括甩毛，皮膚紅腫等等。

舒緩放射治療, 用嘅劑量比起進激放射治療少. 如果有需要，係可以隔接近半年再做放射治療。進激治療，通常要比一年時間正常細胞去康復先可以再做。

肥大細胞腫瘤係狗狗最常見嘅皮膚腫瘤,一般做法要手術大範圍切除, +/- 放射治療，+/-化療, +/-標靶藥. 如果牽涉到手術難以完全清除位置，例如本案嘅前手, 加上已擴散到淋巴, 就可以利用放射治療 +/- 化療, 標靶藥.

The main difference between RT and surgery is that the effects of RT will continue to remain and attack tumour cells for up to 3-4 months, achieving remission.

The presenting case is a 13 yo Mongrel who presented with a mast cell tumour on the right distal forelimb, with metastasis to the regional lymph nodes on CT scan. A palliative radiation protocol was performed once weekly for 5 treatments on both the primary tumour and the affected lymph nodes. 2 months later, the lymph nodes have returned to normal size, and the primary tumour is reduced and well under control. The dog is living normally with a good quality of life. Noted side effects include hair loss and redness of the skin.

The radiation dose used for palliative RT is less compared to definitive RT. If necessary, another treatment can be performed about 6 months later. For definitive protocols, it would usually take about a year for normal cells to recover until a second round of treatment can be pursued.

Mast cell tumors are the most common skin tumours in dogs. The typical treatment is wide surgical resection, +/- adjuvant radiation, +/-chemotherapy, +/- targeted therapy. If the tumour is located at a site that makes complete surgical resection difficult, such as the presenting case, plus spread to the lymph nodes, then radiation treatment is an acceptable alternative, +/- adjuvant chemotherapy, targeted therapy.

#腫瘤 #寵物 #放射治療 #貓狗 #動物腫瘤治療 #動物腫瘤 #動物癌症 #豐盈動物腫瘤中心 #電療 #動物放射治療 #動物電療 #癌症治療 #努力 #肥大細胞腫瘤

18/10/2022

Case 5: 鼻腔腺腫瘤, 進激治療 Nasal adenocarcinoma, definitive treatment

本案11歲比利時瑪連萊犬, 主人留意到狗狗鼻樑上凸起, 打乞嗤多左同流鼻血, 經診斷為鼻腔腺腫瘤 (nasal adenocarcinoma), 腫瘤已破壞鼻骨, 在皮膚上突出黎 (黃箭嘴), 之後進行了為期12日嘅放射治療 (Conventional protocol), 5個月後CT 顯示非常良好縮細及控制. 除左圖中甩毛及短暫輕微皮膚發炎，生活一齊正常.

****好多主人都擔心麻醉風險. 我亦講過, 放射治療唔會痛，每次所需時間大約15-30分鐘, 用嘅麻醉藥量比起手術少. 風險不是零, 不過只要檢查後身體無大問題, 一般唔需要太擔心. 最重要係平衡治療腫瘤同身體頂唔頂得順，期後生活質素等等. *****

如果麻醉對某些毛孩比較高風險, 就只能選擇較少次數嘅放射療程，或者選擇其他治療. 視乎情況而定.

The owners of this 11 yo Belgian Malinois noted a lump on the nose (Yellow arrow), sneezing and epistaxis (Nasal bleeding). He was diagnosed with nasal adenocarcinoma with bone lysis and extension towards the skin. The dog underwent a conventional radiation protocol of 12 sessions. A recheck CT 5 months later showed good volume reduction and control of the tumor. Apart from mild hair loss and dermatitis (as pictured), the dog is living normally.

***General anesthesia remains to be a major concern among owners. As I’ve stated before, radiation treatment does not cause pain, and each treatment takes roughly 15-30 minutes. The anesthetic dose is a lot lower compared to that used for surgeries. The risk is not zero. However, with good overall health and prior checkup, the procedure is generally safe. The most important thing is to balance out the pros and cons between treating the tumour versus the side effects/tolerance of the body, quality of life...etc. ***

For pets that are high risk for general anesthesia, it may be best to perform a radiation protocol with fewer sessions or proceed for other therapies instead.

#腫瘤 #寵物 #放射治療 #貓 #狗 #動物腫瘤治療 #麻醉 #動物癌症 #動物腫瘤 #豐盈 #豐盈動物腫瘤中心 #電療 #動物放射治療 #動物電療 #癌症治療 #加油 #比利時瑪連萊犬 #瑪連萊犬

11/10/2022

Case 4: 送比主人嘅禮物 A gift to the owners

本案13歲法虎, 有抽筋及神經症狀, MRI 診斷右腦有個大腫瘤,懷疑膠質瘤 (Glioma), 嚴重腦水腫, 壓住其他位置, 腦內壓上升. 小狗進行一個為期3日立體定位放射治療 (Stereotactic radiation therapy). 麻醉穩定, 康復狀態良好. 四個月後返嚟照MRI, 腫瘤接近完全消失, 生活已回復正常, 亦無接受其他治療. (黃箭嘴顯示腫瘤, 藍箭嘴顯示腦水腫)

法國鬥牛犬，麻醉比一般狗狗高風險啲, 但如果密切觀察同小心控制麻醉，係可以安全完成.

未做治療前，預計狗狗只有2-3星期時間. 對於主人，今日嘅報告係一份好好嘅禮物. 繼續努力!

The presenting case is a 13-year-old French Bulldog that presented with seizures and neurological symptoms. Diagnosis via MRI reveals a huge brain mass on the right side, suspected to be a glioma, with extensive edema (swelling) and compression of intra-cranial structures, causing elevated intra-cranial pressure. The dog underwent stereotactic radiation treatment for 3 days.

4 months later, a recheck MRI scan noted a near complete response. The dog is currently living normally with a good quality of life, and she did not receive any additional treatment.

General anesthesia for French bulldogs tends to be slightly riskier than other breeds. However, with good monitoring and control of anesthesia, procedures can generally be safely performed.

Before treatment, the dog was estimated to have a poor prognosis, with only a few weeks left. Today’s MRI report is one of the best gifts owners could ask for. Keep it up!

#腫瘤 #寵物 #放射治療 #貓狗 #動物腫瘤治療 #麻醉 #動物腫瘤 #動物癌症 #磁力共振 #豐盈動物腫瘤中心 #電療 #動物放射治療 #動物電療 #癌症治療 #法國鬥牛犬 #法虎 #努力

02/10/2022

Case 3: 貓惡性膽管癌, 手術切割範圍嘅理論 Invasive biliary adenocarcinoma in a cat, surgical margins

除左介紹本案，我亦想主人明白所有腫瘤手術切割範圍嘅理論.

1) 點解個腫瘤咁細，但切割嘅傷口可以咁大?

- 腫瘤係唔可能用肉眼去判斷佢嘅範圍有幾大，因為微觀嘅腫瘤細胞 (Microscopic disease)係睇唔到，要用顯微鏡先得.

****所以，切左腫瘤，係一定一定要送去化驗所化驗。因為病理學醫生會判斷佢係邊種腫瘤，第幾期，同咪切唔切得乾淨。呢啲全部對於毛孩後續嘅治療同照顧係非常重要****

*****每一種腫瘤需要嘅切割範圍都有唔同，所以係一個完美世界，應該要先抽針或割取組織，先化驗，睇下係咩類型腫瘤，然後手術嘅時候會更加清楚知道個切割範圍. 當然，亦有時候係可以直接切除而唔需要事先化驗.*****

2) 醫生，索性切大啲，咪唔洗煩囉 !

- 當然可以，但作為醫生我要做得更好。如果無必要咁大嘅傷口，點解要令毛孩痛啲/辛苦啲？亦都唔係每個位置可以大範圍切割例如手腳，面部. 呢啲傷口未必可以聯針縫合，有需要皮瓣，值皮...etc. 所以，手術前嘅規劃係好重要. 我先可以更理想為毛孩做好個療程

3) 手術切割後嘅化驗報告話已經乾淨切除 (Completely excised)，係咪可以放鬆 ?

****係病理學醫生角度，佢係顯微鏡下認為係乾淨, 但唔係100%代表個治療已經完成，腫瘤唔會復發。要視乎係邊種腫瘤，同埋第幾期. 有啲非常惡性嘅腫瘤，報告話乾淨切割，亦都可以有機會好快復發. *****

本案嘅貓貓被診斷惡性膽管癌, 先前已進行部份肝臟切割, 現在已經沿住腹腔壁擴散, 形成圖中所見情況, 令到貓貓唔舒服. 手術切割後，病人康復良好，胃口各樣亦不錯. 可惜腫瘤擴散, 現在亦要開始進行其他療程.

Apart from sharing the present case, I would like to introduce owners to the concept of surgical margins.

1) If the tumour is small, why is the surgical wound so large?

- It is impossible to determine the extent of the tumour just with the naked eye. Microscopic residual disease will require pathologists and the use of microscopes for evaluation.

*****Hence, whenever a tumour has been surgically excised, ideally it should be sent to the laboratory for histopathology analysis. The pathologist will be able to determine the type of tumour, the grade and whether the excision is complete or not, which are all factors that will affect our decision making and prognosis for the patient.*****

******Every tumour has different surgical margins. In a perfect world, it is best to take a sample and send it for analysis before surgery to determine the type and grade of tumour, and this would allow the surgeon to better plan for the surgery.******

2) Doctor, how about we just remove as large as possible without having to worry?

- Of course you can, but I would like to do better than that. If a large wound is unnecessary, why put our pets through that extra pain and suffering? Also, not every location is amenable to wide surgical excision such as the limbs, distal extremities, face...etc. Hence, it is important not to underestimate the value of pre-surgical planning.

3) The pathology report stated the tumour to be completely excised. Can I feel relieved now?

****From the pathologist’s perspective, it is deemed to be excised completely under the microscope, but it’s not 100% certain that the disease is cured, and no further treatment is needed. It really depends on the type of tumour and the grade. Some malignant, high grade tumours, even with completely excised margins, can still recur quite quickly in just a few months or less.*****

The present cat was diagnosed with invasive biliary adenocarcinoma, and he has undergone a partial liver lobectomy (removal). The tumour has metastasized and spread along the abdominal wall, causing lesions as seen in the picture, which results in discomfort and deteriorated quality of life for the cat. After surgical resection, the cat has recovered well, and his appetite and demeanor have returned to normal. However, further treatment is necessary due to the tumour having spread elsewhere.

26/09/2022

動物放射治療 PART 2 Radiation treatment in Dogs and Cats PART 2

1) 動物放射治療有邊幾種療程 ?
- 一般分做進激 (Definitive)或者舒緩 (palliative)
進激意思係盡量清除同消滅個腫瘤, 控制腫瘤嘅時間最長, 療程通常做12-18次, 星期一至五，六日休息.

- 舒緩意思係想縮細腫瘤, 令到病人舒服, 控制腫瘤嘅時間短暫, 療程通常做5-6次, 一星期一次或兩次

******至於用邊種治療, 就視乎病人嘅情況, 放射治療醫生嘅建議, 同埋主人嘅意願.*******

- 成日見我講立體定位放射治療 (stereotactic radiation therapy), 佢係一種技術, 治療係進激為主. 療程通常做3-5次, 每日或者隔日.

2) 放射治療有咩副作用?
- 副作用分為急性同慢性.

- 急性同常係治療後2-3星期開始發生, 一般會維持短短幾星期, 有適當護理同藥物, 係會好返. 例如脫毛, 皮膚發炎, 口腔炎, 氣管炎, 結膜炎, 乾眼症, 輕微鼻炎..etc

- 慢性有可能係治療後半年至一年發生, 一般會維持長時間，甚至永久, 例如永久脫毛, 毛髮變白色, 骨壞死, 氣管或食道收窄, 長久嘅傷口, 白內障, 慢性鼻炎....etc

***** 以上只不過係例子，並唔會全部發生. 發生嘅副作用係視乎毛孩接受放射治療嘅位置. 如果係鼻腔，預計會有鼻炎，脫毛, 皮膚發炎. 如果係口腔, 預計會有口腔炎, 皮膚發炎...etc *******

***** 就算係同一種惡性腫瘤，接受同樣嘅放射治療, 唔係每隻動物都會有副作用. 有啲係完全無副作用, 但唔好誤解係治療無效!*****

普遍黎講, 暫時我見全部接受治療嘅毛孩都適應唔錯，冇嚴重嘅副作用.

3) 有部分主人問: 係相見到綠色個個頭盔有咩用?
- 用來固定病人及做定位CT (simulation CT). 每次治療都會帶著, 確保放射範圍跟定位CT吻合

4) 乜野係定位CT (Simulation CT)? 同普通CT, PET CT有咩分別?
- 顧名思義, 定位CT 係用黎定位，畫圖，規劃放射治療範圍及所用劑量.
- 普通 CT 主要用黎診斷同規劃手術範圍.
- PET CT 係腫瘤科好常用, 詳細會係下次講解.

5) 如果我毛孩完成左一個放射治療療程, 係同一個位置有需要嘅可以最快幾時再做得?
- 起碼接近1年後, 因為要比足夠時間正常細胞去恢復過來. 如果要近啲，就要視乎情況.

1) What are the different types of protocols with radiation treatment?
- To make it simple, there are two types, namely Definitive and palliative

- Definitive protocol means we are trying to eliminate the disease or try to eradicate as much as possible. The aim is to maximize tumor control and survival times. Typical treatment involves 12-18 sessions, Mon-Fri, with the weekends off.

- Palliative protocol means we are trying to palliate the patient through reduction of the disease. The aim is not to maximize tumor control and survival times, but rather to soothe the patient. Typical treatment involves 5-6 sessions, once or twice weekly.

***** As for what type of protocol is utilized for the patient, this will depend on the patient’s condition, the radiation oncologist’s recommendation and the owner’s decision.******

- I’ve mentioned a few times about stereotactic radiation therapy. This is a type of radiation technique, and its use is usually definitive-intent. Treatment involves 3-5 sessions, either consecutively or every other day.

2) What are the side effects of radiation treatment?
- Side effects are divided into acute and chronic

- Acute side effects usually occur 2-3 weeks after the initiation of radiation treatment and usually lasts for a couple of weeks. With suitable nursing care and medications, they will recover. Examples include alopecia (hair loss), dermatitis, mucositis, pharyngitis, tracheitis, conjunctivitis, keratoconjunctivitis sicca, rhinitis......etc

- Chronic side effects may occur 6 months to a year after finishing radiation treatment. They are usually permanent and irreversible. Examples include permanent alopecia (hair loss), hair coat turn white, bone necrosis, strictures of the esophagus/trachea, non-healing wound, cataract, chronic rhinitis.....etc

*****The above listed side effects are just examples and they do not all occur on the same patient that received radiation treatment. The type of side effects that occur will depend on the location that was irradiated. For example, if the nasal cavity was irradiated, we would expect rhinitis, hair loss, dermatitis. If the oral cavity was irradiated, we would expect hair loss, mucositis...etc ******

****** Even if it’s the same type of cancer in another patient that received a similar radiation treatment, that does not indicate both patients will experience the same side effects. Some pets tolerate the side effects very well and would not manifest at all. However, a lack of side effects does not mean the radiation did not work ! *******

In general, Most pets that received radiation treatment tolerated the effects well, and there has not been any severe issues that I've encountered so far.

3) Some owners have asked: what’s the green thing enveloping the dog/cat’s head in the picture?
- That is a thermoplastic mould which is used for CT planning, same as in human medicine.

4) What is Simulation CT? How is it different from the normal CT or PET CT?
- Simulation CT is used for radiation planning, calculating the doses and measuring and mapping the area of radiation

- Normal CT is usually used for the diagnosis of diseases and pre-surgical planning.

- PET CT is very commonly used in oncology patients in humans. I will discuss this in detail soon.

5) My pet just finished a course of radiation treatment. If necessary, at what point can he/she undergo another course around the same area?

- Ideally up to a year after the first course, as normal tissues need enough time to recover. If earlier is necessary, this can be discussed based on the patient's condition.

#腫瘤 #癌症 #寵物 #放射治療 #貓狗 #動物放射治療 #動物電療 #動物腫瘤 #動物癌症 #豐盈動物腫瘤中心 #電療 #動物腫瘤治療

20/09/2022

Case 2: 生活質素重要性 The importance of quality of life

我分享腫瘤個案，除左睇治療反應，亦都可以比主人作為參考. 以下嘅例子係非常適合討論生活質素 (quality of life)

本案係一隻十歲嘅安哥拉貓, 求診時發現神情呆滯, 唔食野, 嘔吐, 有神經症狀例如抽筋, 手腳無力, 轉圈. 磁力共震診斷腦膜瘤 (Meningioma). 腦膜瘤多數係良性, 咁點解要治療? 因為如果呢種瘤繼續變大, 會增加腦內壓, 產生水腫，發炎，同影響行動,平衡, 及神經症狀 (視乎壓主咩位置). 嚴重可以致命. 一般治療方法係手術切除,但因為本案嘅腫瘤範圍太大, 手術風險評估極高, 最後決定做一個為期3日嘅立體定位放射治療 (Stereotactic radiation therapy). 麻醉期間穩定, 康復狀態不錯.

四個月後, 磁力共震顯示腫瘤有縮小跡象, 腦水腫嘅情況幾乎康復.

係腫瘤學，治療反應一般分為完全緩解 (Complete remission/response), 部分緩解 (Partial remission/response), 病況穩定 (Stable disease) 及病況惡化 (Progressive disease). 如果腫瘤有縮小, 達成緩解狀態 (remission), 這是最理想. 若果腫瘤大小差唔多, 亦代表腫瘤被剎停, 稱為病況穩定 (Stable disease), 這也是理想. 案中嘅腫瘤縮小嘅範圍不多, 亦叫病況穩定 (Stable disease).

***** 所以，如果醫生同你講腫瘤在治療前後大小差唔多, 並不代表治療無效. 而是病況穩定, 亦是好消息. 就算只有少過30%嘅變化，已經大大舒緩腦內壓, 增加生活質素.

每次呢位小朋友返嚟覆診, 知道佢呢段時間食得玩得瞓得, 主人又開心, 係好令人振奮. 覆診主要留意腦水腫及腦內壓. 腦部放射治療初期, 會令到水腫情況嚴重, 所以要食類固醇控制.

當時貓貓被判斷只剩下幾日嘅時間. 至今接近半年, 如常生活, 亦無接受其他治療.

對於用放射治療去控制貓貓腦腫瘤, 數據甚少。係其中一個論文, 接受療程嘅貓貓可以擁有1-2年嘅良好生活質素同壽命. 多過2年都有, 而且貓貓都因為其他因素而逝世.

我期望所有病人可以擁有屬於自己嘅奇蹟.

****腦腫瘤暫時都係無方法100%根治. 不過見到毛孩由唔舒服到生活正常，主人由傷心徬徨到開心, 值唔值? 值! 因為呢個畫面係無價. ****

The purpose of sharing cases is twofold. Apart from observing treatment responses, they also serve as good examples for other pet owners. This case presents a very good example of demonstrating the value of ‘quality of life’.

The present case is a 10-year-old Female Angora that presented with mental dullness, inappetance, vomiting, with neurological deficits such as seizures, weakness and circling.

Feline meningiomas are usually benign. So why do we need to treat? As the tumours grow, they cause compression and invasion of the surrounding brain structures, resulting in inflammation, edema (swelling) and various neurological signs depending on what part of the brain is affected. This affects quality of life severely. Severe cases can lead to death.

The ideal treatment of feline meningiomas is surgical resection. With tumours that are too large or difficult to access, and an increased risk of general anesthesia, as in this case, radiation treatment is an alternative. The cat then underwent a stereotactic radiation protocol of 3 days. During the treatment, the patient remained stable.

4 months later, a recheck MRI scan indicated a mild reduction in tumour volume, with almost complete resolution of peritumoral edema (swelling).

In oncology, treatment responses are typically divided into complete remission/response, partial remission/response, stable disease and progressive disease. If the tumour has substantial reduction in size, achieving remission, that would be optimal. If the tumour has neither increased or decreased in size, that is termed stable disease and is also a good thing. In this case, the cat is classified to be in stable disease.

***Owners should be aware that a lack of reduction in tumour size after treatment does not indicate treatment failure. It only indicates stable disease which is also a good thing! Even a reduction in tumour size of less than 30% can significantly reduce intracranial pressure and improve quality of life. *****

Every time the cat came back for a recheck, I was particularly stoked to hear and see that she is doing well like her usual self. The main things I assess during a recheck would include brain swelling and intracranial pressure. Shortly after radiation treatment, brain swelling usually worsens initially, and this requires the use of steroids.

Before the treatment began, the cat was deemed to have a few remaining days left and a very poor prognosis. About 6 months later (now), the cat is doing very well and having a good quality of life.

Data regarding the treatment of feline brain tumors with radiation is lacking. The available literature indicated an average lifespan of 1-2 years, with some exceeding the 2-year mark. Most cats in that study eventually passed away due to other morbidities unrelated to the tumour.

Every patient deserves to have their own miracle.

****As of now, Brain tumours are generally incurable. However, when you notice the patient improving and living normally, and owners getting happy and relieved, is this worth it? Yes. Totally worth it.******

#腫瘤 #癌症 #寵物 #放射治療 #貓狗 #動物放射治療 #動物電療 #麻醉 #動物腫瘤 #動物癌症 #電腦素描 #磁力共振 #豐盈動物腫瘤中心 #電療 #化療 #免疫治療 #外科 #食療 #動物腫瘤治療

13/09/2022

毛孩腫瘤常見問題Part 1 (Cancer in Pets FAQ Part 1)

希望大家過了一個愉快嘅中秋假期。這幾天收到不少主人問相同嘅問題，我係呢到做個綜合。

1) 惡性腫瘤有甚麼治療方案?

- 動物現有嘅例如手術，放射治療，化療，標靶治療，免疫治療 (發展階段)，熱消融治療，冷凍治療，補品食療（中西配方), 微創介入治療 (發展階段)

2) 放射治療係咪對動物係全新療程 ?

- 唔係。1906年，一位德國科學家及獸醫嘗試用放射治療去醫動物. 隨著多年嘅發展, 已經去到今時今日嘅設備同先進技術. 美國嘅獸醫大學同醫院好早期已經有得做放射治療. 早年嘅時候，都有主人帶埋寶貝飛去個邊去醫. 慶幸嘅係，香港今日終於有得做.

3) 我隻小狗/貓有腫瘤。我想進行放射治療，不想進行手術. 可以嗎 ?
- 雖然我講過，放射治療理論上係可以用係唔同位置或唔同惡性腫瘤. 但要記得，每一種癌症，都有自身不同地方。就算係同一種癌症，在身體其他位置都會有不同反應。每一位毛孩亦處於不同年齡，品種，性別，身體狀況及結構。******所以,每一隻腫瘤做完放射療程，反應效果係會唔同。每一位治療方案係需要針對佢情況已定，沒有一套統一的. ******

如果個腫瘤係鼻腔，一定考慮放射治療。如果係一個高風險手術位置, 手術未必有效清除,例如腦，心臟，頸部接近大動脈, 咁係絕對可以考慮放射治療. 如果腫瘤係一個適合做手術嘅位置，但基於種種原因, 主人反對手術，例如口腔腫瘤，需要切部份或全個上下顎，或牽涉截肢嘅骨癌, 咁係絕對可以考慮放射治療.

舉個簡單例子: 一隻9歲金毛尋回犬不幸係背脊有惡性腫瘤A. 如果無擴散，視乎大少同粘連情況, 我建議做手術大範圍切割, +/- 化療, +/- 免疫治療 + 補品食療

同一隻金毛尋回犬係左前手有惡性腫瘤A, 由於很難100%切除 (除非主人同意截肢), 否則我會建議手術切割, 加放射治療, +/- 化療, +/- 免疫治療 + 補品食療.

同一隻金毛尋回犬係左前手有惡性腫瘤A, 但已經擴散到肝，肺部, 咁究竟做手術或放射治療成效有幾多 ? 我會建議做+/- 化療, +/- 免疫治療, + 補品食療.

以上嘅例子，如果我改成一隻更年老嘅貓狗, 身體有其他問題, 麻醉高風險, 或者係惡性腫瘤BCDEF, 加埋唔同嘅惡性級別 (Grading)同期數(staging, 早期，晚期), 咁我以上建議嘅療程又會有改變.

*******所以，唔好混淆，因為朋友隻毛孩做到某個治療，唔代表其他可以.*******

4) 我隻小狗/貓可唔可以做幾個唔同嘅治療方案?

- 同上面一樣，視乎個位病人嘅情況而定。當然，若果治療配合多方面，控制腫瘤固然會好啲，但唔代表你100%做晒全部以上治療就係最有效／對佢最好!!!! 如果腫瘤比較大粒或者係一個比較難切除乾淨嘅位置, 牽涉太多重要神經及血管，可以先做放射治療縮細, 再做手術. 另一種情況係先做手術，但我知道係無可能100%切除, 後續我會再加放射治療 +/-其他.

5) 如果我選擇咩都唔做，可以嗎 ?

- 先澄清, 無野係叫’ 咩都唔做’. 因為’咩都唔做’, 由得佢自生自滅係好殘忍, 作為主人點可以忍心見到自己家庭一份子受苦. 因為動物唔識表達, 只可以依靠你地去做判斷. *****每一位主人對惡性腫瘤同生命嘅睇法都唔同, 所以做嘅決定都會唔同, 但要尊重大家. 最重要係保持毛孩生活質素 (quality of life). 可能主人會擔心麻醉，種種治療嘅副作用或其他考慮因素. 就算唔選擇以上嘅治療, 無論點都應該要做紓緩治療 (palliative care). *******

紓緩治療可以包括補品食療（中西配方）, 同藥物治療. 如果佢痛，止痛。佢肚屙，止屙。唔食嘢，要餵食。如果唔得，嘗試開胃藥。都唔得，可能要镇静裝餵食管. 我地一定有方法令佢舒服.

唔好擔心自己嘅睇法, 同主診醫生商量. 如果你睇醫生，我係用專業知識解答你嘅問題，同一時間，我亦以主人身份同你分析究竟你應該點行下一步. 你要話比我聽你想治療去到幾盡，我地一齊幫毛孩走過難關. 陪佢哋多啲。動物其實好有性。佢地知呢場戰鬥，有你地陪伴係佢嘅動力.

如果去到差唔多時候，生活質素已經好差, 可以商量比唔比佢舒服咁離去.

6) 我隻小狗/貓可唔可以食呢款補品食療?

- 如果你地留意以上所有治療，無論你選擇做或唔做，你會發現補品食療係唯一一個咩情況下都會做. 好多時候，主人未見醫生之前亦都自行開始比毛孩唔同種類嘅supplements。經 Dr Google 及朋友介紹，實在有太多資訊。我會建議主人可以同醫生商量, 研究每一位毛孩適唔適合食用. Supplements 每個月都有新野, 有啲時候醫生都未接觸過. 所以主人可以同醫生分享，咁可以有更多資料幫各位病人.

我無可能係呢個 post解釋所有補品食療. 詳細我會開一啲專講營養同補品食療嘅Post. 雖然表面上無乜副作用，但如果食多左或重複或相撞，可能會有反效果或者無用.

大家繼續努力!

I hope everyone had a fun and pleasant mid-Autumn Festival. I will summarize several common questions that I’ve encountered from pet owners over the past few days.

1) What are the different treatment modalities for cancer?

- As of now, treatment options include surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy (Trial stage), thermo-ablation, cryoablation, and dietary supplements/nutrition (Chinese and/or Western), interventional oncology (Developmental stage)

2) Is radiation therapy a new thing in animals?

- Nope. In 1906, a German Scientist and Veterinarian was the first to use radiation treatment in animals. Technological advances and expertise have occurred throughout the course of decades. Many Veterinary Universities and Hospitals in the United States have been treating pets with radiation treatment many years ago. Some pet owners in Hong Kong have even brought their beloved pets to the United States for radiation treatment. Luckily, this treatment modality is now available in Hong Kong.

3) My pet is diagnosed with cancer. I would like to proceed for radiation treatment but not surgery. Is this ok?

- As I’ve stated, every tumour is unique, and there are underlying differences in behaviour and prognosis even if it’s the same type of tumour in a different location. Every dog/cat possesses anatomical and physiological differences, and variations in breed, gender, age and health issues complicates the big picture further. Every tumour responds differently to the effects of radiation treatment. Hence, there is no universal treatment protocol. Each treatment plan should be tailor-made for the exact individual.

If the tumour resides in the nasal cavity, radiation treatment is the choice to go. If the tumour resides in an area where surgical resection is difficult or poses high risks, such as brain, heart, neck (close to vital structures), then radiation treatment can certainly be considered. If the tumour resides in an area where surgical resection is possible, but the owner refuses due to the invasiveness and concerns such as comestic reasons, such as oral cavity tumours requiring maxillectomy or mandibulectomy, or amputation due to bone tumours, then radiation treatment can certainly be considered.

Let’s have a look at 1 example. A 9-year-old Golden Retriever was diagnosed with a malignant tumour A on his back. If the tumour has not spread elsewhere, and depending on the size and associated adhesions, I would recommend surgical resection with wide margins, +/- chemotherapy, +/- immunotherapy + dietary/supplements.

If the same Golden Retriever is diagnosed with a malignant tumour A on his left forelimb, surgery would be unable to obtain clean margins, unless the entire limb is amputated. In this sense, if the owner refuses amputation, a better treatment may include surgery plus radiation treatment, +/- chemotherapy, +/- immunotherapy, + dietary/supplements.

If the same Golden Retriever is diagnosed with a malignant tumour A on his left forelimb, with distant metastasis (spread) to the liver and lungs, then how much would surgery and radiation treatment help in this case? I would recommend +/- chemotherapy, +/- immunotherapy, + dietary/supplements.

In the above examples, If the Golden Retriever is older, with co-morbidities, higher anaesthesia risk, or maybe it’s diagnosed with malignant tumour BCDEF, with further differences in grading and staging of the tumour, then obviously the above treatment plans would change. Hence, pet owners should be aware that, one treatment protocol does not fit all.

4) Can my dog/cat perform several different treatment modalities?

- Certainly. However, it depends on the patient’s situation as stated above. If we combine a multi-modal approach, then we can control the tumour more effectively. If the tumour is too large to be surgically resected, plus proximity to nearby vital nerves and blood vessels, then a protocol involving radiation treatment first to shrink the tumour, followed by surgical resection, makes sense. Another example would be: if the surgeon knows it is impossible to resect the tumour 100% on the first surgery, then it maybe necessary to add further treatment such as radiation, +/- others.

5) If I choose to do nothing, is this ok?

- First, I need to clarify that there is no such thing as ‘doing nothing’. If we do nothing, it is cruel to the animal itself. As owners, it is devastating to see a part of our family member suffer. As pets are unable to effectively communicate with us, they rely on pet owners to make every decision and judgement. However, every owner may have different definitions or perceptions towards life itself or treating cancer. Hence, every owner’s decision making will be different, and this is something we should respect. The most important thing, however, is to maintain the pet’s quality of life, regardless of what you choose. With the above treatment modalities, you maybe worried of the anaesthetic risks, side effects from various treatments or other considerations. However, even if you do not choose any of the above aggressive treatment options, you should continue to go for palliative care.

Palliative care includes dietary/supplements, medications. If the pet is painful, treat the pain. If diarrhoea occurs, treat the diarrhoea. If he/she does not eat, assist feeding. If that doesn’t help, try appetite stimulants. If both aren’t helping, it may even be necessary to give him/her a sedation and insert a feeding tube. There are ways to make pets feel better.

Do not worry about your own thoughts or opinions. Do speak openly to the veterinarian in charge. If you come for a consultation, I am using my professional knowledge to solve your questions. At the same time, I am standing on a pet owner’s perspective to guide you in the decision-making process. You need to let me know how aggressive you want to fight this battle, and we will help the pet alongside. Stay with them more often, as animals can feel that you are supporting them, and this support is vital during this tough time.

When the time has come, and quality of life has deteriorated, it maybe necessary to discuss letting go and putting him to sleep.

6) Can my pet receive this type of supplement/food?

- If you noticed the above different treatment options, you could see that, regardless of whether you choose to pursue them, there is one option where you can always use, and that is nutritional supplements/food. Most owners have even started giving their pets various types of supplements before seeing the vet. There is a plethora of information from friends and Dr Google. I recommend a discussion with the vet to ensure our pets are having the proper nutrition and supplements for his condition/disease. Numerous supplements exist and they are produced at a faster rate than ever. Sometimes, vets may not have seen or heard such products before. Hence, it would be a good idea for the owner to share these supplements so that we are better able to decide and investigate its use for the patient.

It is impossible for me to talk about the types of food and supplements that are suitable for each individual patient here. I will have to cover these sections in detail in a few other posts. For now, do bear in mind that having an excess of supplements or inappropriate combinations can sometimes makes things worse, or render the treatment useless.

Stay strong !

#動物腫瘤治療 #動物放射治療 #動物癌症 #豐盈動物腫瘤中心 #免疫治療 #放射治療 #外科 #食療 #腫瘤 #寵物 #貓狗 #毛孩 #舒緩治療

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