I euthanized a dog a few weeks ago for bladder cancer — specifically transitional cell carcinoma (TCC), the most common type of bladder cancer veterinarians diagnose. I give this owner credit for being strong enough to let her dog go before her dog’s suffering became too profound.

This is one of those diseases that doesn’t always give owners a lot of warning that things are about to get bad … really bad … so stepping in sooner rather than later is often in a pet’s best interests. I thought that passing along the information my home euthanasia and hospice care practice sends to the owners of pets that have been diagnosed with TCC might help others to deal with this difficult diagnosis.

What is Transitional Cell Carcinoma?

Transitional cell carcinoma is an aggressive, malignant cancer of the urinary bladder that affects dogs, cats, and other domestic pets. Oftentimes it invades into the urethra and/or ureters, causing obstruction of the urinary tract and disruption of normal urine flow. Animals usually present to their veterinarian for an inability to urinate or difficult urination, blood in the urine, or urinary incontinence.

is most likely to metastasize to local or regional lymph nodes, but can spread to any organ system via the bloodstream. It is commonly diagnosed by a combination of urinalysis, urine sediment cytology, bladder tumor antigen testing on a urine sample, ultrasound of the urinary bladder and urethra, and biopsy of the affected area.

How is it Treated?

TCC is a difficult disease to treat surgically, but if the tumor is localized to a specific area, surgical resection with or without a tube cystostomy (i.e., placement of a permanent urinary catheter) may be an option. Most cases of TCC must be treated with chemotherapy or radiation due to the nature and location of the tumor. The two most common chemotherapeutic agents used for treatment of TCC are doxorubicin and piroxicam, both of which can be used in combination with other chemotherapeutic drugs.

As cost is often a limiting factor in what treatments are viable, it is important to remember that none of the treatments for TCC are curative. Surgery and radiation therapies are often expensive procedures, while chemotherapy can be a more affordable option.

What Symptoms Can Present as the Disease Progresses?

Early Stages

  • Straining to urinate
  • Urinary incontinence or frequent urination
  • Bloody urine
  • Licking the penis or vulva
  • Decreased appetite
  • Redness or swelling at the penis tip or vulva

Late Stages

  • Persistent early stages
  • Vomiting
  • Continued weight loss
  • Painful abdomen
  • Reclusive behavior
  • Exercise intolerance
  • Difficulty sitting and walking
  • Constant pacing
  • Urine scalding
  • Possible constipation
  • Anorexia

Crisis — Immediate Veterinary Assistance Needed Regardless of the Disease

  • Difficulty breathing
  • Prolonged seizures
  • Uncontrollable vomiting/diarrhea
  • Sudden collapse
  • Profuse bleeding — internal or external
  • Crying/whining from pain*

*It should be noted that most animals will instinctually hide their pain. Vocalization of any sort that is out of the ordinary for your pet may indicate that their pain and anxiety has become too much for them to bear. If your pet vocalizes due to pain or anxiety, please consult with your tending veterinarian immediately.

What is the Prognosis for Transitional Cell Carcinoma?

As with any disease, prognosis is dependent on the extent of the disease and the treatment chosen. With surgical intervention, in which an attempt was made to remove as much of the tumor as possible, there should be an increase in survival time. Chemotherapy, in addition to surgery, may improve survival time better still. Chemotherapy alone may also increase survival time.

Regardless of treatment, if the tumor blocks the passage of urine, an unpleasant, painful death is imminent within one to two days. Humane euthanasia should seriously be considered to alleviate suffering. A personalized treatment plan is important to slow the progression of TCC. Talk to your veterinarian about the best treatment protocol for your pet.

© 2011 Home to Heaven, P.C. Content may not be reproduced without written consent from Home to Heaven, P.C.

Dr. Jennifer Coates

Image: Javier Brosch / via Shutterstock