The veterinary surgeon as expert witness.
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Combining treatment modalities is indicated when single modality treatment does not result in adequate tumor control, or if the cosmetic or functional outcome of single modality treatment is less than desirable. The combination of surgery and radiation has proven useful in the treatment of both human and veterinary patients. Surgery can be used to remove large, bulky tumors whereas radiation therapy eliminates the subclinical disease adjacent to the tumor mass that invades important normal tissue structures. If properly combined, the result should be better tumor control combined with a better functional and cosmetic outcome. Radiation therapy can be administered preoperatively, postoperatively, and intraoperatively, depending on a variety of factors. Radiation therapy combined with hyperthermia has a strong scientific rationale. Hyperthermia is particularly effective against some cells, such as those in late S-phase, that are resistant to radiation therapy. Nutrient-deprived cells and cells with low pH are also very sensitive to hyperthermia, and these may reflect areas in a tumor where hypoxia may be present. Therapeutic gain has been shown in randomized clinical trials combining radiation therapy and hyperthermia in tumor bearing dogs. However, the disadvantage of hyperthermia for both human and veterinary tumors remains the inability to adequately maintain uniform temperatures to the tumors. Chemotherapy is an important adjuvant to radiation therapy for the control of distant tumor spread. The scientific rationale for combining chemotherapy with radiation therapy for local control is less clear, and is complex because of a variety of factors.
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Tremendous change and progress have occurred in the field of oncology over the last several decades. Progression in diagnostic techniques, patient support, adjuvant therapies and surgeon training has allowed the field of surgical oncology to make continued improvements in the human cancer field. Although a relatively young field, veterinary surgical oncology has followed in the progressive footsteps of our human counterparts. This article describes the evolution of this rapidly expanding field of veterinary medicine.
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The use of radiofrequency (RF) energy has become very popular in human and veterinary arthroscopic surgery since the late 1990s. Both monopolar and bipolar RF units are available. Application of RF energy to joint capsular tissue leads to immediate tissue shrinkage that is both power and temperature dependent. Changes in joint capsular tissue have been noted at temperatures greater than 65 degrees C. Treatment of articular cartilage with RF energy leads to immediate chondrocyte damage. This damage is also power and temperature dependent and is observed at temperatures as low as 45 degrees C. Caution should be used when applying RF energy within a joint to prevent or minimize articular cartilage injury.
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Since the first description of feline hyperthyroidism in 1978, numerous treatment options for hyperthyroidism have been reported. Surgical removal of enlarged, autonomously functioning thyroid glands is one of the most commonly used treatment options. Affected cats must have a careful pre-operative evaluation to detect concurrent medical conditions such as renal disease or cardiomyopathy. Since more than 80% of hyperthyroid cats have neoplastic changes in both thyroid glands, bilateral thyroidectomy is necessary for treatment of the majority of hyperthyroid cats. Several different thyroidectomy techniques have been developed in an attempt to minimise potential post-operative complications associated with bilateral thyroidectomy such as hypocalcemia or recurrence of hyperthyroidism. Damage to or removal of all four parathyroid glands during bilateral thyroidectomy causes hypocalcemia, the most common post-operative complication. Recurrence of hyperthyroidism can occur months after initial thyroidectomy if residual adenomatous thyroid tissue is retained in the surgical site. The most effective surgical techniques for bilateral thyroidectomy involve preservation of at least one external parathyroid gland on the surface of the thyroid capsule. Additionally, the majority of the thyroid capsule must be removed to ensure that all neoplastic thyroid tissue is removed. The most recently described feline thyroidectomy techniques involve sequential removal of bilaterally affected thyroid glands. Staging a bilateral thyroidectomy allows time for ipsilateral parathyroid tissue to revascularise before the second thyroid gland is removed and the blood supply to the contralateral parathyroid glands is potentially interrupted. Thyroidectomy is a very effective treatment option for hyperthyroid cats. Surgical treatment of hyperthyroidism in cats offers permanent cure without chronic medical management. No specialised equipment other than standard surgical instrumentation and facilities are necessary. With practice, feline thyroidectomy can become a routine procedure in most veterinary hospitals.
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