Indications and Recommendations for Referral of Oncologic CasesJune 17, 2019

Oncology Notes

Indications and Recommendations for Referral of Oncologic Cases

Written by Kelvin Kow, DVM, MS, DACVIM (Oncology)

Common indications for referral of oncologic cases include Lymphoma, Mast Cell Tumors, Hemoabdomen/Hemangiosarcoma, Osteosarcoma, Soft Tissue Sarcomas and Oral tumors. The majority of patients with these condition benefit from treatment with an improved quality of life but there are instances where the presenting condition can be especially challenging to treat and frustrating for clients due to advanced diseases states or metastatic disease.  Symptoms and exam findings of metastatic disease at presentation are very broad but the most common signs seen include unexplained weight loss, exercise intolerance, coughing, enlarged draining lymph nodes and unexplained body cavity effusions.

If a client consents to basic staging, 3-view chest radiographs are most helpful in suspected carcinomas or sarcomas where the metastatic pattern can include the lungs.  Chest radiographs for dogs with round cell tumors such as Lymphoma or Mast Cell Tumors are also reasonable but not always the top priority depending on the client’s goals and financial resources.

One of the more frustrating and avoidable scenarios faced are Mast Cell Tumors or Soft Tissue Sarcomas that have been present for extended periods with clients unaware or unconcerned of their presence.  Aspirates and body mapping of any dermal or subcutaneous mass should be recommended as MCTs and STSs can so easily mimic the appearance and feel of benign skin/SQ masses.  If a client declines these diagnostics, this should be specifically documented in the medical record.

Osteosarcoma/Primary bone tumors should be on the differential list for any large or giant breed dog with unexplained lameness.  While many do indeed have an orthopedic or sports injuries, OSA is not uncommon and pathologic fractures have very few viable options including either humane euthanasia or limb amputation.

If you are unsure of the need for referral, a phone consultation with an oncologist is available and we do our best to return these calls within 24 hours of them being requested.

About Dr. Kow

Kelvin Kow, DVM, MS, DACVIM (Oncology)

KowKDr. Kow completed a degree in molecular biology in 1997 at Tulane University in New Orleans, Louisiana and spent 2 years as a research scientist prior to veterinary school at LSU. He was a rotating intern at Colorado State University’s and selected to remain as a medical oncology resident at CSU’s Animal Cancer Center (ACC) and became board certified in Medical Oncology in the American College of Veterinary Internal Medicine (ACVIM) in 2007. Kelvin subsequently completed a Masters degree and research fellowship in medical oncology at the ACC.

He was an Assistant Professor of Medical Oncology at Oregon State University until 2009 when he joined the faculty of the University of Florida College of Veterinary Medicine.  He was the program director of UF’s ACVIM medical oncology residency training program and service chief of the Oncology.  Kelvin was the founding oncologist at Fitzpatrick Referrals Oncology hospital in Guildford, Surrey, United Kingdom for the past two years and is excited to return to the US and to explore the Seacoast.

Dr. Kow serves on the ACVIM medical oncology examination committee and was also a member of the executive committee of the Veterinary Cancer Society.  His oncologic interests include lymphoproliferative diseases,  musculoskeletal oncology, targeted anti-cancer therapies, palliative cancer care and management of radiotherapy patients.   He has lectured nationally and internationally and continues to publish in the field of veterinary oncology.

24 Hour Emergency & Specialty

Boston West Veterinary Emergency and Specialty

Natick, MA 01760


Capital District Veterinary Referral Hospital

Latham, NY 12110


Massachusetts Veterinary Referral Hospital

Woburn, MA 01801


Port City Veterinary Referral Hospital

Portsmouth, NH 03801


General Practice, Emergency & Specialty

Bulger Veterinary Hospital

Lawrence, MA 01843
ER: 978.725.5544 GP: 978.682.9905