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SURVEY OF BELGIAN TERVUREN WITH GASTIC CARCINOMA
Please complete the following questionnaire for any Belgian Tervuren that you have owned that currently
has or had stomach cancer.
This dog(s) must have lived with you in the years between and including 1990
and present. If you need additional space to record information, please include an additional page. **Please
complete a separate survey instrument for each affected dog. This study has been approved by the American
Belgian Tervuren Club (ABTC) board and the ABTC Health Education Committee, and is being sponsored by
Completing the remainder of the survey should only take 5-10 minutes. If you don’t remember all the details,
please complete what you can. We will contact you or your veterinarian later, if we need to.
1. Please provide us with some basic information about your dog with stomach cancer. Neuter status refers to
the sex of the dog (female=F, female spayed=FS, male=M, male castrated=MC).
Age at death:
2. What is/was the AKC registered name of your dog which has/had stomach cancer? If your dog is/was not
AKC registered but is/was registered with a different registry, please list his/her registered name and the
registry/country in which the dog was registered. If your dog was not registered, but you know his/her
parentage, please list the name of his/her sire and dam.
3. Please provide your dog’s call name. If this is not the same name that the veterinarian that treated your dog for
stomach cancer would have in the medical record, please tell us the name the veterinarian would have known for
4. When you think back on your dog’s course of disease, what was/were the earliest clinical signs that you
noticed with your dog? (Please check all that apply.)
Not eating/picky eating
Depression/decreased activity □ Other-please explain
5. As time went on, what clinical signs did your dog exhibit? (Please check all that apply.) Not eating/picky eating
Depression/decreased activity □ Other-please explain
6. Which of the following diagnostic tests were performed ultimately leading to the diagnosis of stomach cancer in your dog? (Please check all that apply.) Abdominal xrays
CT (cat) scan of the abdomen to evaluate the stomach
Aspirates of the mass with evaluation of the sample
Endoscopy (gastroscopy) to visualize the mass
Biopsies of the mass taken during endoscopy (gastroscopy)
Surgery to evaluate the stomach or to remove the mass
Biopsies of the mass taken during a surgery
Autopsy/necropsy after my dog was euthanized
7. Was a definitive diagnosis of stomach cancer obtained by biopsy or by examination of samples aspirated from a stomach mass (tumor)? Please check all answers that apply to your dog. □ Yes, a definitive diagnosis of stomach cancer was obtained by biopsy or examination of aspirates of the mass (tumor) while the dog was alive.
□ Yes, a definitive diagnosis of stomach cancer was obtained/confirmed after euthanasia and an autopsy/necropsy with analysis of tissue taken from the stomach mass (tumor).
□ No, a diagnosis of stomach cancer was not confirmed but was suspected based on the presence of a mass (tumor) in the stomach. Biopsy samples or aspirates taken during endoscopy did not yield a definitive diagnosis of stomach cancer.
□ No, a diagnosis of stomach cancer was not confirmed but was suspected based on the presence of a mass (tumor) in the stomach. Biopsy samples taken during surgery did not yield a definitive diagnosis of stomach cancer.
□ No, a diagnosis of stomach cancer was not confirmed but was suspected based on the presence of a mass (tumor) in the stomach. No aspirates or biopsies were taken. 8. If your pet had surgery or autopsy/necropsy, please recall if there were any metastases (spread of cancer to other organs). If yes, what organs were involved? 9. Did you treat your dog that had stomach cancer? Yes □ No □ 10. If you did treat your dog, which of the following treatments were provided? (Check all that apply and circle the medication that was given, if it is listed.) Antibiotics
Steroids (Prednisone, Prednisilone, Triamcinalone, other)
Antiemetics (Reglan=metaclopramide, Tegretrol=thorazine, Cerenia, ,Zofran, other)
Gastric protectants (sucralfate=Carafate, Pepto-bismol, other)
Treatment for heartburn/antacids (Tagamet, Pepsid, Zantac, Tums, other)
Pain medications (Tramadol, Rimadyl, Deramaxx, Prevacox, fentanyl patch, other)
Surgical exploration with removal of the mass
Chemotherapy following surgical removal of the mass
Chemotherapy without surgical removal of the mass
Other-please list medications not listed above
11. Did the treatment that you tried improve the quality of your dog’s life? Yes □ No □ 12. If your dog’s quality of life improved after treatment was initiated, how would you rate your dog’s quality of life during the time that you saw improvement? Excellent □ Good □ Fair □ Poor □ 13. Please estimate the length of time for which this improvement in quality of life was sustained. Indicate if this number represents days, weeks, or months by circling one of these options. 14. Please estimate the length of time from first clinical signs/symptoms to the time that he/she was euthanized. Indicate if this number represents days, weeks, or months by circling one of these options. 15. Please estimate the length of time from diagnosis (endoscopy, biopsy, surgery, or necropsy) to the time that he/she was euthanized. Indicate if this number represents days, weeks, or months by circling one of these options. 16. Please provide your name and contact information for us to contact you in the future, if we have additional questions pertaining to this study. Contact information is confidential and will only be used to obtain additional information for this study. Individual information will not be disclosed, and all information will be presented in a grouped format. Your name: Phone number(s): Email address: Snail mail address: 17. We would like to contact the veterinarian who diagnosed and/or treated your dog with stomach cancer. If you don’t mind that your veterinarian be contacted about your dog with stomach cancer, please provide contact information. If you don’t have all of the veterinarian’s contact information readily available, please complete what you can. The veterinarian can be located by several methods using available databases. Veterinarian’s name (first and last, if possible): Name of Hospital or Clinic where your dog was treated: City in which the animal hospital is located: Veterinarian’s phone number: Please initial below to indicate your permission for us to review your pet’s medical records pertaining to the stomach cancer, including endoscopy reports, surgery reports, histopathology reports, and/or autopsy/necropsy reports. ***Please include copies of any of the above reports that you have in your possession when you return this survey.*** You may return your survey by US mail to the following address: Dr. Cathy Greenfield or Dr. Marina Manashirova University of Illinois College of Veterinary Medicine 1008 West Hazelwood Drive Urbana, IL 61802 You may also return your completed survey as an email attachment sent to: Dr. Greenfield
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