Page 568 - Small Animal Clinical Nutrition 5th Edition

Cancer 589

recovery of animals. Dogs and cats in the pre-clinical or “silent”
Table 30-1. Phases of clinical and metabolic alterations in
VetBooks.ir weight despite a good appetite. cancer patients. Metabolic changes
phase may appear clinically normal but may gradually lose
Clinical changes
Phase
Plasma amino acid profiles and serum lactate concentrations,
parameters associated with tumor cell progression in the canine 1 Preclinical, silent phase Hyperlactatemia
No obvious clinical signs Hyperinsulinemia
cancer model, have not been used clinically to assess the nutri- Altered blood amino
tional status of veterinary cancer patients. Likewise, biomarkers acid profiles
2 Early clinical signs Similar metabolic
associated with tumor growth and subsequent nutritional sup-
Anorexia changes
port such as serum creatine kinase (Fascetti et al, 1997); mito- Lethargy
gen-activated protein kinase (MAPK) (Saker et al, 2002); Mild weight loss
More susceptible to side
serum mineral content including zinc, chromium, iron and
effects from chemotherapy,
total iron-binding capacity (Kazmierski et al, 2001) and the etc.
vascular endothelial growth factor (VEGF) system, including 3 Cachexia Similar changes but
Anorexia more profound
VEGF and the VEGF receptors, Flt-1and KDR (Millanta et
Lethargy
al, 2006) have yet to be instituted clinically. Acute-phase reac- More susceptible to side
tant proteins, although not specific for cancer, can be measured effects from chemotherapy,
etc.
in serum and can predict prognosis and response to therapy.
4 Recovery Metabolic changes
The combination of certain acute-phase proteins can be more Remission may persist
powerful than one assay (others include C-reactive protein and Changes secondary to
surgery, chemotherapy
alpha-fetoprotein). Alpha 1-acid glycoprotein is an acute-phase
or radiation therapy
protein that is increased in cats with cancer, and has been used
to predict loss of remission for dogs (but not cats) with lym-
phoma (Selting et al, 2000; Correa et al, 2001; Hahn et al,
1999). been thin at nine to 12 months of age. Among intact dogs, a
In certain tumors, grading the degree of malignancy histo- thin body condition at nine to 12 months of age reduced the
logically predicts biologic behavior. Although a direct relation- risk of breast cancer. Results of this study suggest that nutri-
ship between tumor grade and nutritional status including can- tional factors resulting in altered body composition early in life
cer cachexia has not been established, it is thought that more may be important in canine breast cancer. A case-control study
aggressive cancers tend to cause more pronounced systemic evaluated the possible relationship between diet and dietary
effects on body condition. Conversely, even a benign tumor can management in 86 healthy control dogs and 102 dogs with
significantly affect the nutritional status of a dog or cat if it mammary gland tumors or mammary gland dysplasia (Perez-
interferes with intake or assimilation. Oral tumors such as SSC Alenza et al, 1998). Body composition, diet and reproductive
in cats may inhibit food intake, and intestinal tumors such as history were reviewed. Nutritional status was evaluated from
lymphomas can cause poor nutrient absorption, decreased serum selenium and retinol values and adipose fatty acid pro-
appetite and diarrhea.Tumor grade may correlate with survival, files. Obesity at one year of age and an obese body condition
metastatic rate, disease-free interval or with frequency or speed score (BCS) one year before diagnosis are significantly related
of local recurrence. Not only can a prognosis be determined to a higher prevalence of mammary tumors and cell dysplasias
based on tumor grade, but more aggressive nutritional therapies in dogs. Additionally, intake of homemade meals vs. commer-
may be applied to higher grade tumors. Clearly, no single “gold cial foods is significantly related to a higher incidence of tumors
standard” test exists for determining a cancer patient’s nutri- and dysplasias; increased intake of red meat (beef, pork) strong-
tional status. ly influences disease incidence. Results from this study indicat-
ed that obesity at one year of age was independently and signif-
Risk Factors icantly associated with risk of developing mammary tumors
Numerous studies have outlined risk factors of certain nutrients and dysplasia. A five-year retrospective study evaluated the dis-
and their relationship to development of cancer. For example, tribution of BCS values for dogs with and without histological-
decreased fiber and increased fat have been most commonly ly and behaviorally malignant neoplasms (Weeth et al, 2007).
incriminated as causal factors for the development of a wide A total of 14,760 dogs (1,777 with cancer; 12,893 controls) met
variety of malignant conditions of the gastrointestinal (GI) the inclusion criteria. Dogs with cancer were further allocated
tract, breast and urinary bladder in people. into the general categories of sarcoma (n = 582), carcinoma (n
Existing data are controversial regarding the cause and effect = 428) or round cell tumor (n = 767) based on histologic clas-
relationship between diet and cancer in pets. One group of sification of tumor cells. Using a 9-point BCS system, 21.6 and
investigators conducted a case-controlled study of nutritional 14.8% of dogs were classified as overweight or obese, respec-
factors and canine breast cancer (Sonnenschein et al, 1991). tively. Overall, the mean BCS of all dogs with cancer was 5.4 ±
Neither a high-fat diet nor obesity one year before diagnosis 1.2 vs. 5.3 ± 1.2 for noncancer controls. Investigators reported
increased the risk of breast cancer. However, the risk of breast a significantly lower prevalence of overweight and obese dogs
cancer was significantly reduced among neutered dogs that had with cancer compared to control dogs without cancer. The