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This guide is provided for information and support. It does not replace your veterinarian's personalized advice: every cancer and every animal is different. At the slightest doubt, talk to our team; that is exactly what we are here for. If you need us, call 514 223-1197.
Go now: these come before everything else on this page
The rest of this page is about decisions that can wait a few days. These cannot. One is enough: you do not have to tick several, and you do not have to work out which one is worst. Leave, and call on the way.
- Breathing is hard. Fast while lying quietly, the belly pushing with every breath, the neck stretched forward, or the mouth open if it is a cat. When a tumor involves the chest or the lungs, fluid can build up around the lungs within hours. Handle them as little as possible, leave them in the position they chose, and go.
- The gums are pale or white, they are weak or cold, they stagger, they collapse, they cannot get up. A mass on the spleen or the liver can bleed suddenly inside the abdomen, with not one drop of blood visible. There is no warning, and it does not wait until morning. And if they get up on their own after a few minutes and seem better, go anyway: an internal bleed can stop and then start again, and it is the second time that is the worst.
- Bleeding that will not stop: from the nose, the mouth, the bladder, or a mass that has broken open. Press firmly and keep pressing, with a clean cloth, and go. Do not wrap anything tightly around a limb.
- Flatness, shivering, refusing food, or fever, in the two weeks after a chemotherapy session. White blood cells can drop in that window, and an infection on that ground is treated now, not at the next appointment. You do not need a thermometer to call: an animal who has gone flat in those two weeks is reason enough. Call the centre giving the treatment first; if no one answers, a 24/7 emergency centre.
- Vomiting or diarrhea that will not stop after a treatment, water that will not stay down, or blood in either. An animal losing fluid faster than they take it in dehydrates fast.
- Going back and forth to urinate, straining, and nothing comes out, or only a few drops. In an animal with a bladder or urethral tumor, this is a blockage until proven otherwise, and a blockage does not wait overnight.
- A seizure, circling that will not stop, pressing their head into a wall or a piece of furniture, or not recognizing you. Note the time and how long it lasted: it is the first thing we will ask.
- A leg gives out suddenly, they cry, they will not put it down at all. In a dog with a bone tumor, the bone can break with no accident at all. Do not walk them.
- They are in pain and their medication is no longer holding it. Pain that has outrun the plan in place is an emergency in its own right. It can be caught up, but not by waiting for Monday. Do not try anything from your own medicine cabinet in the meantime: human painkillers are dangerous in both species, and acetaminophen is fatal to cats.
- A mass swells suddenly, turns red, feels hot, and they vomit, drool, or go down. In an animal with a mast cell tumor, a handled mass can release what it holds all at once. In the meantime, stop handling it, and keep them from licking or chewing it.
One is enough
You do not have to decide which of these counts most. If one of them sounds like your animal, go. If you are unsure, call anyway: sorting this out is our job, not yours. We have no service outside our opening hours; in the evening, overnight and on weekends, a 24/7 emergency centre answers, and nobody will hold it against you for calling when it turned out to be nothing.
Give no home medications
This section comes early on purpose. You have just read a list that talks about pain, and the medicine cabinet is ten feet away. This is the moment to be very clear: here, the move that comes from the very best intention is also the one that kills. And on this page in particular, there is one more box that must not be opened before the samples are taken.
Acetaminophen (Tylenol)
Deadly to cats, even a single tablet. There is no safe dose. In dogs it attacks the liver. If your pet has swallowed some, that is an immediate emergency.
Ibuprofen (Advil), naproxen (Aleve), aspirin
Stomach ulcers and kidney damage, in dogs as well as cats, and cats are affected at smaller amounts than dogs. Never a human anti-inflammatory, whatever the reason. In a small animal, a single tablet can be enough.
Steroids left over from another time
This is the one that belongs to this page. If lymphoma is suspected, steroids can cloud the samples and reduce how well chemotherapy works afterwards. They bring quick relief, they make everything look better, and they can put the diagnosis out of reach. If someone offers you steroids before the samples are taken, ask the question.
Leftover prescriptions
The painkiller prescribed to the other animal in the house, or the one left from an episode six months ago. A prescription is worked out for one animal, one problem and one weight: it does not transfer, and a dog's tablet given to a cat is one of the most common poisonings we see.
Supplements and natural products
Mushrooms, antioxidants, oils, teas, powders bought online. Several interact with cancer treatment, some are dangerous on their own, and the specialist needs to know what your animal is getting before building a plan. Do not start anything without asking first: the answer is often yes, but it comes after the question.
Nothing by mouth, and here is exactly why
It is not that everything is poison. It is that the timing is wrong. Relieving the pain of an animal with cancer is a real priority, not a luxury, and it is exactly what we want to do: it is a clinic decision, made once we know what we are treating and what shape the kidneys and liver are in. If your animal is in pain tonight, what they need is not a tablet, it is a phone call.
What you were just told, and what you do not have to decide today
You may still be in the parking lot. You heard the word, and after that a blur. Plenty of people leave an appointment like that unable to repeat what was said, even to someone they love. It does not mean you listened badly. It means the brain protects itself, and the information will have to be given a second time. We will give it as many times as it takes.
Cancer is not one disease
It is a family of diseases that behave in very different ways. Two dogs with the word "cancer" in their file can be facing months that look nothing alike. Three questions decide almost everything that follows.
Which one?
The exact type of cell involved.
Where?
The organ affected, and whether the mass can be reached.
How far?
Whether the disease has stayed in one place or already settled somewhere else.
You may only have one answer out of three right now, and it may be a presumed one. That is exactly what the next step is for, and it starts now: ask how long to expect when the sample is taken.
What you do not have to do today
You do not have to choose a treatment, say yes or no to chemotherapy, or book anything. A decision made in the hour after the news is a decision made without information. The only situations that cannot wait are the ones in the red list at the top of this page.
What is genuinely urgent, though
One thing, and it often surprises people: if lymphoma is suspected, steroids should not be started before the samples are taken. Prednisone brings quick relief and makes everything look better, but it can cloud the samples and it can reduce how well chemotherapy works afterwards. If someone offers steroids before the diagnosis is confirmed, ask the question. This is one of the few things on this page where the order really matters.
A word you are going to hear: staging
Behind the term is a simple idea: before choosing a treatment, we want to know how far the disease has traveled. A specialist cannot build a plan without that map, and you cannot compare two options without it either. That is what happens here, first.
One last thing before we go further
If your animal is still themselves, still eating, still meeting you at the door, still sleeping on the bed: that counts, and it is not fooling you. Good news and bad news can share the same week.
Looking for the specific disease?
Our condition guides, for the cancer you have just been given a name for. They carry the detail this page does not repeat: the signs, the possible treatments, and what is known about the outlook.
What gets done here, before a specialist enters the picture
An oncology consultation that starts with no results is a consultation where you will be told tests are needed. Better to do them here, while you take in the news. It is time gained, and it is time when there is nothing else for you to do but wait.
The exam and the history
It looks like the ordinary part; it is often the most useful. We feel every lymph node we can reach, look for masses other than the one that brought you in, and assess pain.
And we listen: how long, what changed, what seemed like nothing at the time. None of what you tell us arrives too late. What you saw at home, nobody else saw, and now is when it becomes useful.
Bloodwork
Our analysers are on site: blood and urine are read here. We are looking at three things. Whether the kidneys and liver could handle a treatment, if you choose one. Whether the blood count already shows something. And whether there is an abnormality that travels with certain cancers, such as a high calcium, which changes both the diagnosis and what we do immediately.
The needle: cytology
This is the step that answers fastest. We put a fine needle into the mass or the lymph node and spread the cells on a slide. It is quick, it is usually done on an awake animal, and it is closer to a blood draw than to surgery. For some diseases, such as lymphoma or mast cell tumors, cytology is often enough to name the disease.
The sample is taken at the clinic. Depending on the case, it happens during the consultation or at a visit booked for it. From there, the slide may be read here or sent to a reference laboratory that writes the microscopic description: both routes are real, and your veterinarian chooses based on what we are looking for. They will tell you which one, and why.
Biopsy and histopathology
For many solid tumors, a piece of tissue is needed, not just cells. That is what allows a grade, meaning how aggressive the tumor is, and what confirms whether a mass that was removed came out completely.
How long results take
Some tests are run here, in our own laboratory, and the result sometimes comes back during the visit itself. Other samples go to an outside laboratory. How long it takes depends on the test and on where it goes: ask your veterinarian which of the two applies and how long to expect, that is the question to ask when the sample is taken.
Ask as well how the result will reach you, and on which number. It sounds like an administrative question and it will save you a week of watching the phone.
Imaging
Two questions, two tools. Chest radiographs look for whether the disease has moved to the lungs, and they are almost always the first images requested. Abdominal ultrasound looks at the liver, spleen, abdominal lymph nodes and bladder.
Ultrasound does two very different jobs here. During our opening hours, our team can take a focused look on the spot to answer a single question, such as whether there is free fluid in the abdomen, and that fluid can be tapped or drained right here when it is called for. The full organ by organ ultrasound is a separate, planned appointment, and it also takes place here: either with our own team, or with a specialized imaging team that travels to us.
Which test answers which question
- What is the mass?
- Cytology first. Biopsy if cytology does not settle it, or if the grade is needed.
- Is it aggressive?
- Histopathology, with the grade.
- Has it spread?
- Chest radiographs, abdominal ultrasound, and aspirates of the lymph nodes nearest the mass.
- Could they tolerate treatment?
- Bloodwork, and the physical exam.
- Exactly where is the tumor, and how deep does it go?
- CT or MRI, at a specialty centre. That is the imaging we do not have here, and the specialist often repeats it anyway so it matches their surgical or radiation planning.
What we do not do here, and it needs saying
We have neither CT nor MRI. When those images are needed, they are done at the specialty centre, sometimes on the day of the consultation, depending on the centre.
We also do not do everything
The workup is scaled. If a result would change nothing about what you are going to decide, there is no reason to run it, and we will tell you so. You are entitled to ask, about every test proposed: what does this change? That is a good question, not a rude one.
Ask for your file
At the end, ask for a copy of everything: reports, images, laboratory results, and the slides if they are here. Ask as well for the file to be sent to the specialist. Both are things you ask for, and a copy in your bag depends on nobody: it means no test gets repeated because a file did not arrive.
What an oncology consultation actually involves
What a veterinary oncologist is
A veterinarian who, after their degree, spent several more years training on nothing but cancer, and then passed a certifying exam. In practice you may meet more than one: the specialist who handles medical treatment and chemotherapy, the one who does radiation, and the surgeon for complex procedures. They work the same file together.
A referral is not a transfer
This is the most common misunderstanding, and it worries people more than it should. You are not changing veterinarians. The specialist gives an opinion and, if you choose a treatment, takes on the specialized part of it. We stay your clinic: the one nearby, the one that has known your animal for years, and the one you call when something is off on a Tuesday.
What the first appointment looks like
It is a long consultation, longer than a usual visit. The specialist reads through the whole file, examines your animal, and sometimes repeats imaging so they have it in their own format. Then they lay out the options. Usually no treatment starts that day: you leave with a proposed plan and time to think.
What chemotherapy is, in animals
The word brings up what people have seen in humans, and it is not the same thing. In veterinary medicine, the stated goal is quality of life before length of life. Protocols are built so the animal feels well most of the time, even where that means giving up some control over the disease. Most dogs and cats keep their coat. Most days are ordinary days. The hard days, when there are any, cluster after a session, and they are managed with medication you are given in advance.
The other half needs saying right away. A minority react more strongly and need to be hospitalized to be brought back. It is uncommon, it is treatable, and it is exactly why the red list at the top of this page exists: it tells you who to call, and in what order.
Radiation
It is used mainly for tumors that cannot be fully removed, or to relieve pain that no medication is touching. Each session is done under general anesthetic, because the animal has to stay perfectly still, and it is offered at a small number of centres. It is the treatment that asks for the most travel: ask how many sessions and at what interval at the very first meeting.
Surgery: some here, some elsewhere
We remove skin and subcutaneous masses here with appropriate margins, mammary tumors, some mast cell tumors, and the tissue goes for histopathology whenever the result changes what comes next. Some abdominal masses are also removed here, the spleen among them, and the abdomen can be opened to go and look at what imaging does not show.
Soft tissue surgery happens here, during our opening hours: a wound or a bite to clean, explore, drain, stitch closed or leave open; an abscess to open; an ear hematoma to drain; a mass in or under the skin to remove; an abdomen to open for a swallowed object or an infected uterus. Depending on the case, it is done under sedation or under general anesthesia. When it happens depends on how urgent it is and on the day's schedule: call us and we will tell you what to do and when to come in. When removed tissue needs to be analyzed, it goes to an outside laboratory.
What goes out on referral is the surgery that needs a specialty setup: the jaw, the nasal cavity, the chest, the skull, extensive reconstruction, and any mass that imaging shows is sitting against something that must not be touched.
And if the question of amputation comes up, as it often does with a bone cancer, put it to us directly: we will tell you what happens here and what goes elsewhere for your animal in particular. It is a question that deserves a real answer, not a guess.
What we do not do, said plainly
We do not give chemotherapy protocols, we do not do radiation, we do not do specialty oncologic surgery, and we have neither CT nor MRI. A general practice that claimed otherwise would be doing you a disservice.
Chemotherapy and radiation are not given here; the follow-up between sessions is: the monitoring bloodwork your protocol calls for is drawn and read with us.
What a week on treatment looks like
It depends entirely on the protocol, and it is the first thing to have spelled out. Some treatments are given at home, by mouth, every day. Others mean a trip to the centre at set intervals, with a blood test before each session to check the body has recovered. That blood test is exactly the kind of check that happens here, closer to home. Ask the specialist whether that works in your case: over months, it saves a great many trips.
Going to the consultation commits you to nothing
You can go, listen, ask your questions, and then decide no. Nobody will hold it against you, and what you bring back is useful either way: it makes the coming months more predictable, treatment or no treatment.
What to bring, and the questions to write down before you go
You will not remember half of what gets said. Nobody does. Two things change that: writing the questions down beforehand, and not going alone.
What to bring
- A copy of your file: reports, laboratory results, images. Ask as well for it to be sent directly, but a copy in your bag depends on nobody.
- The medications themselves, in their containers, not a list from memory. Supplements and natural products as well: some interfere with treatment, and the specialist needs to know about them.
- Two weeks of notes, however rough. What they eat, how much they sleep, what they have stopped doing, what has changed. It is worth more than a long account improvised on the spot.
- A video on your phone if something comes and goes: a limp, a cough, noisy breathing. It never happens in the exam room.
- Whatever food they will actually accept, and their blanket.
Bring someone with you
One person listens, the other writes. If you have to go alone, ask permission to record the conversation on your phone: most specialists agree, and you will listen back.
Take them in writing. An appointment where you read from your list is an appointment you leave with answers.
About the disease
- Which cancer is this exactly? Is it confirmed, or still presumed?
- Has it spread anywhere? How do you know, and what is still to be checked?
- Without treatment, what do the next few weeks look like? What will I see first?
About the options
- What are all the options, including doing nothing beyond comfort care?
- For each one: what are we trying to gain, time, comfort, or both?
- Which do you recommend for them, and why for them in particular?
- What happens if it does not work? Is there a plan B, and when would we know?
About everyday life
- What does a typical week on this treatment look like? How many trips, and to where?
- How will they feel in the days after a session?
- What do I watch for at home, and at which sign do I call?
- Are there precautions in the house: children, anyone pregnant, the other animals, the litter box and the waste?
- Will they still be able to take their walks, go to the park, sleep on the bed?
About what comes next
- When something happens, who do I call, you or my clinic? On which number in the evening and on weekends?
- What will be done at your centre, and what could be done at my clinic, closer to home?
- At what point will we know it is no longer worth continuing? I want to talk about that now, not when we are there.
- Can I call you back after I have thought about it?
If you keep only one, keep the fifteenth
It is the one people regret not asking. Naming the stopping point in advance takes away the fear of getting it wrong on the day, and it turns a lonely decision into a prepared one.
What we do, over the months that follow
The specialty centre handles the treatment. We handle the life around it, and that is where most of the days happen.
Pain
It comes before everything else. Cancer pain is treatable, often well, and it is treated better when nobody waits for it to settle in. Dogs and cats hide it with unsettling skill: a cat in pain does not complain, they withdraw, they stop jumping as high, they groom less. If you see that, say so, even if you are not sure. We adjust, and we adjust again: a pain plan is never set once and left alone.
Appetite and nausea
An animal that stops eating loses ground quickly, and appetite is often the first thing to move. There are medications for nausea and for appetite, and there are also very simple adjustments: warming the food, smaller portions, a change of texture. Call before it drags on: two days are easier to make up than ten.
Monitoring between sessions
Some protocols call for a blood test before each treatment, to check the bone marrow has recovered.
Chemotherapy and radiation are not given here; the follow-up between sessions is: the monitoring bloodwork your protocol calls for is drawn and read with us. Ask the specialist about it: it is one trip fewer, every time.
Medication
Supportive prescriptions, refills, what might run low before the weekend: that is here, during our opening hours.
And the rule at the top of this page holds for this whole period, with no exceptions: nothing from your own cabinet, never a human anti-inflammatory or painkiller, and no supplement or natural product started without asking first.
The rest of medicine does not stop
Weight, teeth, parasites, arthritis: all of it still exists, and some of it matters more than before. An animal losing weight because their teeth hurt is losing weight the cancer did not take. For vaccines during treatment, talk to us first: the answer depends on the protocol and on the timing.
Your observation is worth an exam
You see your animal every day. We see them for a few minutes at a time, now and then. The most reliable marker is also the simplest: note each evening whether the day was a good one or a bad one. When the bad ones start to outnumber the good, or when the things they loved most no longer interest them, that is the moment to talk, not to wait.
We will tell you the truth when it changes
Including when it goes the wrong way, including when a treatment is no longer giving what we hoped. You will not learn it from a vague sentence on the phone.
Precautions at home during chemotherapy
Chemotherapy drugs are partly cleared through urine and stool for the few days after a dose. The centre giving the treatment will hand you their written instructions: that version is the one that counts, because it depends on the drug used.
Generally, you wear gloves to pick up stool, urine and vomit, and to clean the litter box, seal it in a closed bag, wash anything soiled separately, and keep those tasks away from children and from anyone pregnant or breastfeeding.
If the treatment is given at home, by mouth, the precautions last longer: up to a week after each dose, depending on the drug. Handle the tablets with gloves, never split or crush them, keep them in their original container, and anyone pregnant, breastfeeding or trying to conceive should not handle them at all.
Ask for the instructions in writing and put them on the fridge: nobody remembers them from memory on a Tuesday night.
Choosing not to treat is a legitimate decision
Let us say it straight away, with no hedging: choosing not to pursue cancer treatment is a legitimate medical decision. It is not giving up, it is not a failure, and it is not evidence that you loved them less. It is a choice families make every day, including families who had every reason to choose otherwise.
Not treating the cancer is not the same as not caring for your animal
This is the confusion that does the most damage, so it deserves to be taken apart. Comfort care is active care: controlling pain, supporting appetite, easing breathing, draining fluid that is in the way, maintaining hydration, protecting sleep. There is real medical work in that, and it happens here.
There are good reasons that belong to the animal
Great age. Other diseases that would take up all the room. A temperament that would make every trip to a specialty centre an ordeal, and there will be many trips. A tumor where the treatment would take away more comfort than it gives back. Those are medical reasons, not excuses.
And there are yours
Your situation, your family, what you are able to carry right now. They belong to you. You owe nobody an explanation, least of all us.
What we will not do
We will not ask you twice. We will not bring the question back at every visit. We will not make you feel you have let someone down. From the moment it is decided, our job is that your animal is as well as they can be, for as long as they can be, and that they are not in pain.
And you can change your mind
In either direction. Some families start with comfort care and decide, two weeks later, to go and see a specialist. Others stop a treatment that is under way because it is no longer the right thing. Neither direction is a step backwards.
The honest limit
Comfort care is not aimed at slowing the disease. It makes the time liveable, and there will come a point when it is no longer enough. You will not have to work that out alone: it is a conversation we will have together, and it starts well before the last day.
When that moment comes closer, there are tools for putting words to what you are seeing, and a guide that explains what follows with the same directness as this page.
Your questions
The questions that come up most on the phone, and two people do not always dare to ask.
I have just been told. Do I have to decide something today?
Are they in pain right now, and would I be able to tell?
How long do they have?
Will chemotherapy make them as sick as it makes people?
Will they lose their fur?
Do I really need an oncologist? Can you not treat them here?
Is it dangerous for my family to have an animal on chemotherapy at home?
My animal is old. Is it really worth it?
Can I ask for a second opinion?
And if I decide not to treat? Will you judge me?
What this page was trying to tell you
One red situation is enough to leave right now. Nothing from your own cabinet, ever. The workup happens here and it takes days, not months. A referral is an opinion, not a transfer, and going commits you to nothing. And if you decide not to treat, that is a legitimate medical decision, and nobody here will ask you to justify it.