We talked about the liver, the lungs and other organs as well.

我們還談到了肝臟、肺和其他器官。

So just removing the tumor out of the mouth of the dog is not going to, you know, cure the dogs of these cancer.

是以，僅僅切除狗嘴裡的腫瘤並不能治癒狗的癌症。

Hey, everybody, welcome back to the blog.

大家好，歡迎回到博客。

This blog is all about oral malignant melanoma.

本博客主要介紹口腔惡性黑色素瘤。

I just also dropped another video about melanoma.

我剛剛還發布了另一個關於黑色素瘤的視頻。

So if you're watching this one, I would love for you to go back.

所以，如果你正在看這部電影，我很希望你能回去看看。

There will be a link below about the other video, because there I will talk an overview just about what melanoma is and some of the other locations that we see it.

下面會有另一段視頻的鏈接，因為在那裡我將概述什麼是黑色素瘤，以及我們看到黑色素瘤的一些其他部位。

So I talked about dermal melanoma in that video.

所以，我在視頻中談到了真皮黑色素瘤。

We talked about digit melanoma as well.

我們還談到了數字黑色素瘤。

But in this video, we're going to focus on oral malignant melanoma, which is the number one location and the most common oral cancer that we see.

但在本視頻中，我們將重點介紹口腔惡性黑色素瘤，它是我們最常見的口腔癌。

So let's dive in.

那我們就開始吧。

We're going to be covering surgery, radiation, systemic therapy, such as the immunotherapy vaccine and some of the prognostic factors.

我們將介紹手術、放療、全身治療（如免疫療法疫苗）以及一些預後因素。

So let's dive in.

那我們就開始吧。

Let's break it down.

讓我們來分析一下。

So here we are at oral malignant melanoma.

現在我們看到的是口腔惡性黑色素瘤。

So of the oral tumors, malignant melanoma is the most common one, but it is not the only tumor that we see in the mouth of dogs.

是以，在口腔腫瘤中，惡性黑色素瘤是最常見的一種，但它並不是我們在狗的口腔中看到的唯一腫瘤。

We also see things like fibrosarcomas and squamous cell carcinomas.

我們還能看到纖維肉瘤和鱗狀細胞癌。

And a good rule in general for tumors of the mouth in dogs is that they have a better prognosis if it's of the lower jaw, the mandible, and towards the nose of the dog as opposed to further back.

一般來說，狗的口腔腫瘤有一個很好的治療原則，那就是如果腫瘤位於下頜、下顎和狗鼻子的方向，預後會更好，而不是更靠後。

And a lot of it has to do with accessibility for surgery and being more surgically resectable.

這在很大程度上與手術的可及性和可切除性有關。

So it's easier to remove a tumor that's of the mandible as opposed to the upper jaw and towards the nose of the dog.

是以，相對於上顎和狗鼻子的腫瘤，下顎的腫瘤更容易切除。

The upper jaw is connected to a lot of the nasal bones and can really start to be more complicated to do surgery.

上頜骨與很多鼻骨相連，做起手術來確實比較複雜。

So that is just a good rule for all oral tumors in general.

是以，這只是一個適用於所有口腔腫瘤的好規則。

So lower jaw more towards the nose of the dog, as opposed to towards the back of the mouth of the dog is going to be easier.

是以，下頜更靠近狗的鼻子，而不是狗的嘴後部會更容易一些。

And those tend to have a better prognosis.

而這些人的預後往往較好。

And a lot of that is they can remove them more likely with surgical margins.

其中很大一部分原因是，他們可以通過手術邊緣更容易地切除它們。

But so which are the dogs that we tend to see oral malignant melanoma?

那麼，哪些是我們常見的口腔惡性黑色素瘤犬呢？

I told you it tends to be heavily pigmented breeds.

我告訴過你，這往往是色素含量高的品種。

Those are going to be dogs like Scotties.

這些狗就像蘇格蘭狗一樣。

We do see them in other breeds as well.

我們在其他品種中也能看到它們。

Golden Retrievers are over-representative, Chows, Poodles, Dachshunds.

金毛尋回獵犬、秋沙犬、貴賓犬和臘腸犬的比例偏高。

We see them in black Labradors, unfortunately, as well.

不幸的是，我們在黑色拉布拉多犬身上也能看到它們。

I say that because I have black Labradors, if you don't know that.

我這麼說是因為我養的是黑色拉布拉多犬，如果你不知道的話。

And we see them in mixed breed dogs as well.

我們在混種犬中也能看到它們。

Tends to be a cancer of middle-aged and older dogs.

往往是中老年犬的癌症。

And these are cancers that, you know, I think about is two battlefronts.

這些癌症，你知道，我認為是兩個戰場。

They're highly locally invasive.

它們具有很強的在地入侵性。

They often can be growing into the bone in the mouth, upper and lower bone, depending where they are.

它們通常會生長到口腔、上部和下部的骨頭裡，具體位置取決於它們生長的位置。

And the second battlefront is they're highly metastatic.

第二個戰線是它們的高度轉移性。

So they can spread to those lymph nodes.

是以，它們會擴散到這些淋巴結。

We talked about the liver, the lungs, and other organs as well.

我們還談到了肝臟、肺和其他器官。

So just removing the tumor out of the mouth of the dog is not going to, you know, prevent the growth of these cancer and they're very, very highly metastatic.

是以，僅僅從狗的嘴裡切除腫瘤並不能阻止這些癌症的生長，它們的轉移性非常非常高。

And I will warn you every once in a while, you will get a biopsy and they'll say that this was a benign one of the mouth.

我還要提醒你，偶爾你會去做活檢，他們會說這是口腔良性腫瘤。

And in general, most dogs that have an oral melanoma, it is malignant until proven otherwise.

一般來說，大多數患有口腔黑色素瘤的狗狗都是惡性的，除非另有證明。

And I've seen ones that have had those biopsies that suggest a benign behavior or a benign biopsy, and they just tend to be malignant.

我還見過一些活檢結果表明是良性行為或良性活檢的患者，結果卻往往是惡性的。

So I would just be warned.

所以，我只是想提醒一下。

Some of the ones that are more lip can do better and also be easier to do than some of the ones that are more invasive into bone.

一些脣部手術比一些侵入骨骼的手術效果更好，也更容易操作。

But again, they tend to be a pretty aggressive cancer, both in the mouth and with a high metastatic rate.

但同樣的，它們往往是一種相當具有侵襲性的癌症，無論是在口腔內還是在轉移率方面都很高。

For things that have been shown to be prognosis, size has definitely been shown to be prognosis.

對於已被證明是預後的事情，大小肯定已被證明是預後。

And when we talk about the staging system for that, size comes into play.

當我們談到分期系統時，尺寸就會發揮作用。

And so it's, it's broken down, but the smaller we can find them, the better that they do and whether or not they've metastasized to the local lymph nodes and whether or not they have spread distantly to the lungs and the different organs that we've talked about have been shown to be prognostic.

是以，它被分解了，但我們能發現的越小，它們就越好，它們是否轉移到了局部淋巴結，是否遠處擴散到了肺部，以及我們談到的不同器官，都被證明是預後的關鍵。

Also other things, incomplete margins.

此外，還有其他一些不完整的邊距。

So dogs that have incomplete margins in one study were three and a half more times likely to die of tumor related causes, whether it was regrowth or metastasis.

是以，在一項研究中，邊緣不完整的狗死於腫瘤相關原因（無論是再生還是轉移）的機率要高出三倍半。

So just really emphasizing how important it is to try to find these tumors early and deal with them either with surgery or radiation or some of the things that we'll talk about.

是以，我們需要強調的是，及早發現這些腫瘤，並通過手術、放射治療或我們將要談到的其他方法來治療它們是多麼重要。

So again, just really important.

所以還是那句話，真的很重要。

Also just something else to emphasize with the highly metastatic rate is these lymph nodes.

另外，需要強調的是這些淋巴結的高度轉移率。

In dogs that had big lymph nodes in one study, 70% had metastasis, but normal lymph nodes in the study, 40% still had metastasis.

在一項研究中，淋巴結腫大的狗有 70% 發生了轉移，但在淋巴結正常的狗中，仍有 40% 發生了轉移。

Just going to emphasize that normal lymph nodes should definitely be worked up with lymph node aspirates.

我只是想強調，正常的淋巴結一定要做淋巴結穿刺。

So just really important that you can't always say, Oh, the dog's lymph nodes are normal.

所以，重要的是，你不能總是說，哦，狗狗的淋巴結是正常的。

They didn't need to be aspirated.

它們不需要吸氣。

So again, this is a highly metastatic cancer and it's just something that we want to emphasize.

是以，我們再次強調，這是一種高度轉移性癌症。

And also the lymph nodes are positive for metastasis that changes the stage and changes the prognosis for the dog.

此外，淋巴結轉移陽性也會改變狗狗的分期和預後。

So it's why we want to do it.

這就是我們想這麼做的原因。

So for the what test does your dog need?

那麼，您的狗狗需要進行哪些測試呢？

Lymph node aspirates, chest x-rays, ultrasound are going to be part of the workup.

淋巴結穿刺、胸部 X 光檢查、超音波檢查都是檢查的一部分。

And I do recommend that before surgery.

我確實建議在手術前這樣做。

So if the mouth melanomas, the oral melanomas are surgical can be removed if they're not too big, you know, lower towards the front of the mouth.

是以，如果口腔黑色素瘤（口腔黑色素瘤）不是太大，可以通過手術切除，你知道的，就是向口腔前下方切除。

Surgery is going to be our best treatment option for the dermal ones, the digit ones.

手術將是我們治療真皮層和數字層的最佳選擇。

You know, surgery is definitely going to be the primary treatment of choice for the local disease.

要知道，手術肯定是治療局部疾病的首選方法。

So where that tumor is growing.

腫瘤生長的位置

But the problem is a lot of these ones, especially towards the back of the mouth can be very invasive into bone.

但問題是，很多這樣的牙齒，尤其是口腔後部的牙齒，會對骨頭造成很大的傷害。

And so if there's any concern, we will often do a CT scan.

是以，如果有任何疑慮，我們通常會做 CT 掃描。

Another really important thing is to do that CT before surgery and not try to remove it and then have to try to go back and figure out where they didn't get margins and things like that.

另一件非常重要的事情是在手術前做 CT，而不是試圖切除它，然後不得不試圖回去找出他們沒有得到邊緣和類似的東西。

So really a CT scan for these complicated ones, these large ones is going to be really helpful.

是以，CT 掃描對於這些複雜的、大塊的腫瘤確實很有幫助。

And these are ones that I often think a good idea to see a board certified surgeon first because these do often require removal of part of the jaw or they're going to tell us that surgery is not an option.

我通常認為，最好先去看有執照的外科醫生，因為這些病症通常需要切除部分下頜，否則他們會告訴我們手術是不可行的。

And then we're going to look for a plan B like radiation, which we're going to talk about in the next part.

然後，我們要尋找一種 B 計劃，比如輻射，我們將在下一部分討論。

All right.

好的

So radiation actually plays an important role for these dogs with either incomplete margins or non-resectable non-surgical melanoma of the mouth.

是以，對於邊緣不完整或無法切除的口腔非手術黑色素瘤患犬，放射治療實際上發揮著重要作用。

And even though technically melanoma is considered a radiation resistant tumor, that sounds bad, right?

儘管從技術上講，黑色素瘤被認為是一種抗輻射腫瘤，但這聽起來很糟糕，對嗎？

It's not going to respond to radiation, Dr. Sue.

它不會對輻射有反應的 蘇醫生

There are ways that the radiation oncologists have figured out protocols.

放射腫瘤學家們已經想出了一些辦法。

And what that means for you and your dog is that the protocols, the take home message is they actually give a higher dose per treatment.

這對您和您的愛犬來說意味著，治療方案，也就是每次治療的劑量會更大。

Don't worry about that part.

這部分不用擔心。

What I want to know is that it usually means they're not getting those daily radiation protocols with a lot of side effects and each radiation treatment in dogs and cats requires anesthesia, but they're usually coming in once or twice a week, usually weekly for four or six treatments.

我想知道的是，這通常意味著它們沒有接受那些副作用很大的日常放射方案，而且貓狗的每次放射治療都需要麻醉，但它們通常每週來一到兩次，通常每週進行四到六次治療。

Talk to your radiation oncologist.

請諮詢放射腫瘤科醫生。

We'll put a link below.

我們將在下面提供鏈接。

And I usually leave it up to the radiation oncologist because I'm a medical oncologist and not a radiation oncologist.

我通常會讓腫瘤放射科醫生來決定，因為我是腫瘤內科醫生，而不是腫瘤放射科醫生。

And sometimes protocols are changing, but the take home message is because of the way that melanoma cells respond to radiation, they usually do a weekly radiation for about four or six treatments.

有時，治療方案也在不斷變化，但有一點值得注意的是，由於黑色素瘤細胞對放射線的反應方式，他們通常每週進行一次放射治療，每次治療大約四到六次。

And that means not a lot of anesthesia and not a lot of skin and mouth side effects.

這意味著不需要大量的麻醉，也不會對皮膚和口腔產生副作用。

So not a lot of burning and things like that.

是以，沒有很多燃燒之類的東西。

And so it could be a really good alternative option for these non-surgical cases.

是以，對於這些非手術病例來說，這可能是一個非常好的替代選擇。

It's often referred to a hypo fractionated protocol.

它通常被稱為低分餾方案。

Just that's what they call it with pretty decent response rates.

他們就是這麼叫的，而且回覆率還不錯。

So I will often use radiation in these non-surgical cases and send them to a radiation oncologist after talking to the surgeon.

是以，我通常會在這些非手術病例中使用放射治療，並在與外科醫生溝通後將其送至放射腫瘤專家處。

So we all have to work together on these cases.

是以，在這些案件中，我們必須齊心協力。

A lot of the times the radiation oncologist will treat the lymph nodes.

很多時候，放射腫瘤科醫生會對淋巴結進行治療。

If they were confirmed to be positive with lymph node Asperger's or even prophylactically, they will just treat the neck area as well.

如果證實淋巴結阿斯伯格氏症呈陽性，甚至是預防性的，他們也會只對頸部進行治療。

If there are any microscopic cells, that is an advantage of radiation as well is that we can treat the lymph nodes and kill any of those cancer cells with radiation.

如果有任何微小細胞，這也是放射治療的一個優勢，因為我們可以治療淋巴結，用放射治療殺死任何癌細胞。

So now we've treated the local disease with surgery, the mouth maybe with radiation, but now we need to do something with that second battlefront, right?

現在，我們已經通過手術治療了局部疾病，口腔也可能接受了放射治療，但現在我們需要在第二戰場上有所作為，對嗎？

The systemic disease, preventing the cancer from metastasizing, you know, is our goal and therapy is always better before the cancer is metastasized and the treatment that we're typically going to be talking about immunotherapy is definitely most effective before the cancer is metastasized.

全身性疾病、防止癌症轉移是我們的目標，而治療總是在癌症轉移之前進行為好，我們通常所說的免疫療法無疑在癌症轉移之前最為有效。

That's why we want to do those chest x-rays and ultrasound and lymph node Asperger's.

這就是為什麼我們要做胸部 X 光檢查、超音波檢查和淋巴結阿斯伯格檢查。

Chemo has not been shown to be super effective for this.

化療的效果並不理想。

People have looked at Carbo, Platinum, a couple of other chemotherapy drugs, but there's been a little bit of efficacy, but just not, you know, not super effective.

人們研究過 Carbo、Platinum 和其他一些化療藥物，但都有一點療效，只是你知道，不是超級有效。

So there's been a lot of research back from the days of my residency at the AMC with the canine immunotherapy melanoma vaccine.

是以，從我在美國醫學會實習的時候開始，就有很多關於犬用黑色素瘤免疫療法疫苗的研究。

And again, I always remind people when we talk about vaccines, because we think about like giving your dog the vaccine for rabies to prevent an infectious disease.

再說一次，當我們談論疫苗時，我總是提醒人們，因為我們會想到給狗注射狂犬病疫苗來預防傳染病。

This is a vaccine.

這是一種疫苗。

This is an immunotherapy after your pet has been diagnosed with a cancer.

這是在寵物被診斷出患有癌症後的一種免疫療法。

It's an immunotherapy vaccine to use as a treatment after the cancer is metastasized and the cancer has been confirmed and cannot be used to prevent the cancer.

這是一種免疫療法疫苗，用於癌症轉移和癌症確診後的治療，不能用於預防癌症。

And this is a vaccine that is now available commercially.

而這種疫苗現在已經可以在市場上買到。

It's called the onset vaccine.

這就是所謂的發病疫苗。

It's a DNA plasmid vaccine targets something called the tyrosinase in the melanoma cancer and has been shown.

這是一種 DNA 質粒疫苗，針對的是黑色素瘤中一種叫做酪氨酸酶的東西，並且已經得到證實。

And there are studies looking at it for both the melanoma oral form and the digit as well.

此外，還有針對黑色素瘤口腔形式和數字形式的研究。

And for the oral one, if you looked at the dog's disease free interval, so these are dogs that did not have metastasis and then had surgery or radiation, something to control the local disease in the mouth and then have the melanoma vaccine.

至於口服藥物，如果你看一下狗的無病間隔期，那麼這些狗都沒有發生轉移，然後進行了手術或放射治療，控制了口腔局部疾病，然後接種了黑色素瘤疫苗。

Their cancer did not either come back or metastasize for about 16 months, which is great.

在大約 16 個月的時間裡，他們的癌症沒有復發或轉移，這非常好。

Usually with just surgery alone for melanoma, we see our survival times around six to nine months and median survival times of about 22 months or about 680 days.

通常情況下，單純手術治療黑色素瘤的存活時間約為 6 到 9 個月，中位存活時間約為 22 個月或 680 天。

So definitely an improvement there. 70% of the dogs are alive at one year and about 30% of the dogs are alive at two years.

是以，這無疑是一種進步。70% 的狗在一年後還活著，大約 30% 的狗在兩年後還活著。

How the vaccine works.

疫苗如何發揮作用

It's an intramuscular injection.

這是一種肌肉注射。

It's given two weeks apart for four doses.

每隔兩週服用一次，共服用四次。

So it takes two months to do and then the dogs get a vaccine booster every six months for the remainder of their life usually.

是以，注射疫苗需要兩個月的時間，然後在狗的餘生中，通常每六個月注射一次疫苗加強劑。

And that is something that I've been doing since the vaccine was approved, I want to say in about 2008 and we continue to use.

自從這種疫苗在 2008 年獲得準許以來，我一直在使用這種疫苗，而且我們還在繼續使用。

And I think the vaccine is now available through VI, was originally through Marielle.

我想疫苗現在可以通過VI獲得，最初是通過瑪瑞爾獲得的。

So that, you know, something to talk to your cancer specialist and it is only available in general from cancer specialists.

是以，你知道，這需要與你的癌症專家溝通，而且一般只有癌症專家才能提供。

So it's not going to be something that you're going to get from your general practitioner.

所以，這不是你從普通醫生那裡能得到的東西。

So you can talk to them about it or see a cancer specialist, but definitely the systemic therapy that I recommend for my patients with malignant melanoma, both digital and the oral one as well.

所以，你可以和他們談談，或者去看癌症專家，但我肯定會向惡性黑色素瘤患者推薦全身治療，包括數字療法和口腔療法。

And that wraps up our video on oral malignant melanoma.

口腔惡性黑色素瘤視頻到此結束。

I hope you found it helpful.

希望對您有所幫助。

Don't forget there is a part, another part where you can go and get that overview on melanoma.

別忘了還有一部分，另一部分可以讓你瞭解黑色素瘤的概況。

If you haven't yet watched it, please let me know what other topics you'd like to see.

如果您還沒有看過，請告訴我您還想看哪些主題。

Don't forget to subscribe and also don't forget how important early detection is when we talked about size being important and how hard it is to do a really good, you know, exam and we need to be careful when we're going in our own pet's mouth and your veterinarian, a great opportunity for them and a veterinary technician to get a great oral exam is when they're going in for their dentals.

不要忘了訂閱，也不要忘了早期發現是多麼重要，當我們談到尺寸是很重要的，以及做一次真正好的檢查是多麼困難，你知道，當我們進入自己寵物的口腔時，我們需要小心謹慎，而你的獸醫，他們和獸醫技術員做一次很好的口腔檢查的好機會就是在他們去看牙醫的時候。

And so for most middle-aged and older dogs, we're recommending dentals one to two times a year.

是以，對於大多數中老年犬，我們建議每年進行一到兩次牙科治療。

So that's going to be another great way, not only to get their teeth clean, but to evaluate for these oral tumors.

是以，這將是另一種很好的方法，不僅能清潔牙齒，還能評估這些口腔腫瘤。

So again, I hope that you found this video helpful.

所以，還是那句話，希望這段視頻對你有所幫助。

Thanks so much for watching.

感謝您的收看。

And I look forward to seeing you at the next video.

我期待著在下一次視頻會議上見到你們。