Clinical techniques in small animal molecular oncology

The diagnosis, staging, and treatment of tumors in veterinary as well as human oncology have traditionally incorporated elements of anatomic extent of neoplasia through various clinical and pathologic methods. These clinicopathological methods have been the basis for the development of the tumor, node, and metastasis and grading systems, which have translated into clinically significant advances over the last 20 to 30 years. Unfortunately, there continues to be significant limitations to this system when prognostication and therapeutic decisions need to be made specific to a patient. For example, completely resected and cleanly staged phenotypically identical grade II mast cell tumors in dogs can have opposing clinical outcomes. In addition, dogs or cats with identical stage and grade lymphoma can have significantly divergent responses to the same multi-agent chemotherapy protocol. Numerous nonanatomic neoplastic molecular prognostic factors have been recently identified and have the potential to improve on the presently available tumor, node, and metastasis- and grading-based systems. To date in human oncology, single nonanatomic factors have only occasionally translated into efficient and independent prognostic factors, which speaks to the heterogeneity of cancer. Therefore, the use of panels of factors have been encouraged that will allow for the development of a molecular prognostic index, which can then be used in concert with presently available systems. This review will summarize how to best utilize presently available tumor, node, and metastasis- and grading-based systems, and incorporate newly available molecular prognostic factors.