Skin Cancer In Cats: Early Signs & Prevention Guide

Skin cancer in cats, while not as common as in some other animals, is still a serious concern for pet owners. Early detection is crucial for successful treatment, making it essential for cat owners to be vigilant about changes in their cat's skin. This article aims to provide a comprehensive guide on how to recognize skin cancer in cats, covering the types of skin cancer, risk factors, symptoms, diagnosis, treatment options, and preventive measures. By understanding these aspects, you can better protect your feline friend and ensure they live a long, healthy life.

Understanding Skin Cancer in Cats

Let's dive right into the crucial topic: skin cancer in cats. It's a subject that every cat owner should be aware of, even though it's not the most common feline ailment. Skin cancer in cats, just like in humans, occurs when abnormal cells grow uncontrollably in the skin. These cells can form tumors, which may be benign (non-cancerous) or malignant (cancerous). Malignant tumors can invade surrounding tissues and spread to other parts of the body, making them particularly dangerous. Understanding the types of skin cancer, risk factors, and early signs can significantly improve your cat's chances of a positive outcome. Recognizing skin cancer early can be a game-changer, and that's exactly what we're going to equip you with in this guide. So, stick around as we explore everything you need to know to keep your feline friend safe and healthy.

Types of Skin Cancer in Cats

When we talk about skin cancer in cats, it's not just one single disease. There are several types, each with its own characteristics and potential for severity. The three most common types of skin cancer in cats are squamous cell carcinoma, basal cell carcinoma, and melanoma. Squamous cell carcinoma is the most frequently diagnosed skin cancer in cats, accounting for a significant percentage of cases. It typically arises from the squamous cells, which are flat cells that make up the outer layer of the skin. This type of cancer is often linked to sun exposure, making cats with white or light-colored fur more susceptible, especially in areas with thin fur like the ears, nose, and eyelids. Basal cell carcinoma is another type, though it's less common and tends to be less aggressive. It originates from basal cells, which are found in the deepest layer of the epidermis. Unlike squamous cell carcinoma, basal cell tumors are often benign in cats, but it's still crucial to have any growth checked by a vet. Melanoma, while less common, is often the most aggressive form of skin cancer. It develops from melanocytes, the cells that produce pigment in the skin. Melanomas can be challenging to treat and can quickly spread to other parts of the body. Recognizing these different types and their potential impact is the first step in ensuring your cat receives the best possible care. Each type requires a slightly different approach, so let's dig deeper into the specifics so you're well-prepared.

Risk Factors for Skin Cancer in Cats

Knowing the risk factors for skin cancer in cats can help you take proactive steps to protect your furry friend. Several factors can increase a cat's likelihood of developing skin cancer, and being aware of these can empower you to minimize your cat's risk. One of the primary risk factors is sun exposure. Just like in humans, prolonged exposure to the sun's harmful ultraviolet (UV) rays can damage skin cells and lead to cancer. Cats with white or light-colored fur are particularly vulnerable, especially in areas such as the ears, nose, and eyelids where the fur is thinner. Think of it like this: those sun-kissed spots are also the most susceptible to sun damage. Another risk factor is age. Older cats are generally more prone to developing cancer, including skin cancer, simply because they've had more time to accumulate cellular damage. Genetics also play a role. Certain breeds may be predisposed to certain types of cancer. While there isn't a specific breed that's overwhelmingly susceptible to skin cancer, genetic predispositions can still contribute to the overall risk. Additionally, pre-existing skin conditions can sometimes increase the risk of skin cancer. Chronic inflammation or irritation of the skin can create an environment where abnormal cells are more likely to develop. Certain viral infections, such as feline leukemia virus (FeLV), can also weaken the immune system and potentially increase the risk of various cancers, including skin cancer. By understanding these risk factors, you can take informed steps to protect your cat. This might include limiting sun exposure, especially during peak hours, and regularly checking your cat's skin for any unusual changes. Regular vet check-ups are also key, as your veterinarian can help identify potential issues early on.

Recognizing the Symptoms of Skin Cancer

Early detection is key when it comes to skin cancer in cats. Being able to recognize the symptoms can make a significant difference in the outcome of treatment. Skin cancer can manifest in various ways, so it's essential to be vigilant and know what to look for. One of the most common signs is the appearance of new lumps, bumps, or sores on the skin. These can vary in size, shape, and texture. Some may be small and easily overlooked, while others can be quite noticeable. It's important to note any new skin growths and monitor them for changes. Another symptom to watch for is non-healing sores. If your cat has a wound that doesn't seem to be healing properly, it could be a sign of skin cancer. Cancerous sores often have irregular edges and may bleed or ooze. Changes in skin color or pigmentation can also be an indicator. This might include areas of redness, darkening, or unusual paleness. If you notice any unusual discoloration, it's worth getting it checked out by a vet. Ulcerations, which are open sores or lesions, are another potential symptom. These can be painful for your cat and should be addressed promptly. Hair loss in a specific area, especially if accompanied by other skin changes, can also be a sign of skin cancer. The skin in the affected area may appear irritated or inflamed. Scaly or crusty patches on the skin are another symptom to be aware of. These patches may be itchy or uncomfortable for your cat, leading to excessive scratching or grooming. It's crucial to regularly check your cat's skin for any of these symptoms. Make it a part of your routine, especially if your cat is at higher risk due to factors like light-colored fur or significant sun exposure. Early detection allows for prompt treatment, which can greatly improve your cat's prognosis. Remember, even if a symptom seems minor, it's always best to err on the side of caution and consult with your veterinarian.

Common Symptoms of Skin Cancer in Cats

Let's get down to the specifics of what symptoms you should be on the lookout for. Detecting skin cancer in its early stages can significantly improve your cat's prognosis, so knowing the warning signs is crucial. One of the most common symptoms is the appearance of new lumps or bumps on your cat's skin. These growths can vary in size, shape, and texture. They might feel hard or soft, smooth or rough. What's important is that they are new or have changed in size or appearance. Any new growth warrants a closer look. Non-healing sores are another key symptom to watch for. If your cat has a wound, cut, or sore that doesn't seem to be healing within a reasonable timeframe, it could be a sign of skin cancer. Cancerous sores often have irregular edges and may bleed or ooze. Don't dismiss a sore that just won't heal. Changes in skin color or pigmentation are also potential indicators. You might notice areas of redness, darkening, or unusual paleness on your cat's skin. These changes can be subtle, so it's important to be observant. Ulcerations, or open sores and lesions, are another symptom to be aware of. These can be painful and should be addressed by a veterinarian. Hair loss in a specific area, especially if it's accompanied by other skin changes, can also signal skin cancer. The skin in the affected area might appear irritated or inflamed. Scaly or crusty patches on the skin are another thing to keep an eye out for. These patches may be itchy or uncomfortable for your cat, leading to scratching or grooming. Remember, early detection is key. If you notice any of these symptoms, it's always best to consult with your veterinarian. They can perform a thorough examination and determine the cause of the changes. Catching skin cancer early can make a huge difference in your cat's treatment and outcome.

Areas Most Affected by Skin Cancer

Knowing where skin cancer is most likely to appear on your cat can help you focus your attention during your regular check-ups. Certain areas of a cat's body are more susceptible to skin cancer due to factors like sun exposure and thinner fur. The ears are a common site for skin cancer, particularly squamous cell carcinoma. The tips of the ears are often exposed to the sun, and in cats with white or light-colored fur, this area is especially vulnerable. Regularly check your cat's ears for any signs of lesions, scabs, or unusual growths. The nose is another high-risk area. Like the ears, the nose is often exposed to the sun, and cats with light-colored noses are more susceptible to sun damage. Look for any changes in color, texture, or the appearance of new bumps or sores. Eyelids are also prone to skin cancer. The skin around the eyes is delicate, and tumors in this area can be particularly problematic. Be vigilant about any changes around your cat's eyes, including swelling, redness, or the presence of growths. The skin around the mouth is another area to watch. Tumors in this area can affect your cat's ability to eat and groom, so early detection is crucial. Check for any unusual lumps, bumps, or sores. In addition to these specific areas, skin cancer can also occur on other parts of the body, especially areas with thin fur or frequent sun exposure. This might include the abdomen, legs, and paws. Regular full-body checks are important to catch any potential issues early. Remember, early detection is key. By knowing the areas most affected by skin cancer, you can be more proactive in monitoring your cat's skin health. Incorporate these checks into your regular routine to give your feline friend the best chance at a long and healthy life.

Diagnosing Skin Cancer in Cats

If you suspect your cat might have skin cancer, the next step is getting a proper diagnosis. This involves a visit to the veterinarian and a series of tests to determine if cancer is present and, if so, what type it is. The diagnostic process typically begins with a thorough physical examination. Your veterinarian will examine your cat's skin, looking for any abnormalities such as lumps, bumps, sores, or changes in pigmentation. They will also check for any signs of pain or discomfort. After the physical examination, your vet may recommend a biopsy. A biopsy involves taking a small sample of the affected tissue and examining it under a microscope. This is the most definitive way to diagnose skin cancer and determine its type. There are several types of biopsies, including fine needle aspiration, incisional biopsy, and excisional biopsy. In a fine needle aspiration, a small needle is used to collect cells from the affected area. An incisional biopsy involves removing a small piece of tissue, while an excisional biopsy involves removing the entire growth along with a margin of surrounding tissue. The choice of biopsy method depends on the size and location of the growth. In addition to a biopsy, your veterinarian may also recommend other diagnostic tests, such as blood tests, X-rays, or ultrasounds. These tests can help determine if the cancer has spread to other parts of the body. Blood tests can provide information about your cat's overall health and organ function, while X-rays and ultrasounds can help visualize internal organs and detect any abnormalities. Once a diagnosis of skin cancer is made, your veterinarian will work with you to develop a treatment plan. The treatment options will depend on the type of cancer, its stage, and your cat's overall health. Early diagnosis and treatment are crucial for a positive outcome, so it's important to consult with your vet as soon as you notice any concerning changes in your cat's skin. Remember, being proactive and seeking veterinary care promptly can make a significant difference in your cat's health and well-being.

Veterinary Examination and Biopsy

Let's break down the key steps your vet will take to diagnose skin cancer in your feline friend. The process typically starts with a comprehensive veterinary examination, followed by a biopsy if necessary. During the veterinary examination, your vet will thoroughly assess your cat's skin, looking for any signs of abnormalities. This includes checking for lumps, bumps, sores, changes in pigmentation, and any other unusual skin conditions. Your vet will also feel for any underlying masses and assess your cat's overall health. This initial examination provides valuable clues and helps the vet determine the next steps. If your vet suspects skin cancer, a biopsy is usually the next step. A biopsy involves taking a small sample of the affected tissue for microscopic examination. This is the most accurate way to diagnose skin cancer and determine its type. There are several different types of biopsies that your vet might recommend, depending on the specifics of your cat's case. One common type is a fine needle aspiration, where a small needle is used to collect cells from the affected area. This is a less invasive procedure and can be helpful for initial assessment. An incisional biopsy involves removing a small piece of tissue from the growth. This provides a larger sample for examination and can offer more detailed information. An excisional biopsy involves removing the entire growth along with a margin of surrounding tissue. This type of biopsy can be both diagnostic and therapeutic, as it removes the tumor while also providing a sample for analysis. The biopsy sample is then sent to a laboratory, where a pathologist examines it under a microscope to identify cancerous cells and determine the type of cancer. This information is crucial for developing an effective treatment plan. Remember, a biopsy is the gold standard for diagnosing skin cancer in cats. If your vet recommends a biopsy, it's important to follow their advice to ensure your cat receives the best possible care. Early and accurate diagnosis is key to successful treatment.

Additional Diagnostic Tests

While a physical examination and biopsy are crucial for diagnosing skin cancer in cats, sometimes additional diagnostic tests are needed to get a complete picture of your cat's health and the extent of the cancer. These tests can help determine if the cancer has spread to other parts of the body and assess your cat's overall health status. One common additional test is blood work. Blood tests can provide valuable information about your cat's organ function, blood cell counts, and overall health. They can help identify any underlying health issues and assess your cat's ability to tolerate treatment. Another useful diagnostic tool is radiography, or X-rays. X-rays can help visualize internal organs and detect any signs of cancer spread, such as tumors in the lungs or bones. This is especially important for more aggressive types of skin cancer, like melanoma, which can spread quickly. Ultrasound is another imaging technique that can be used to evaluate internal organs. Ultrasound uses sound waves to create images and can be particularly helpful for examining the abdomen and detecting tumors in organs like the liver, spleen, or kidneys. In some cases, your vet may recommend a CT scan or MRI. These advanced imaging techniques provide more detailed images of the body and can help identify small tumors or areas of cancer spread that might not be visible on X-rays or ultrasound. A lymph node aspirate or biopsy may also be performed. Lymph nodes are part of the immune system and can be affected by cancer. Taking a sample from the lymph nodes can help determine if the cancer has spread to these areas. These additional diagnostic tests play a crucial role in staging the cancer, which means determining the extent of the cancer's spread. Staging is essential for developing an appropriate treatment plan and predicting your cat's prognosis. Remember, your veterinarian will recommend the most appropriate diagnostic tests based on your cat's individual situation. Don't hesitate to ask questions and discuss any concerns you have about these tests. The goal is to gather as much information as possible to provide the best possible care for your feline friend.

Treatment Options for Feline Skin Cancer

Once skin cancer has been diagnosed in your cat, it's essential to explore the available treatment options. The best course of action will depend on several factors, including the type of cancer, its stage, the tumor's location, and your cat's overall health. There are several effective treatments available, and your veterinarian will work with you to develop a personalized plan. Surgery is often the first-line treatment for skin cancer in cats. If the tumor is localized and hasn't spread, surgical removal can be highly effective. The goal of surgery is to remove the entire tumor along with a margin of healthy tissue to ensure all cancerous cells are eliminated. The type of surgery will depend on the size and location of the tumor. For small tumors, a simple excision may be sufficient. For larger tumors, more extensive surgery may be necessary. In some cases, reconstructive surgery may be needed to repair the surgical site. Radiation therapy is another treatment option that uses high-energy rays to kill cancer cells. It can be used alone or in combination with surgery. Radiation therapy is particularly useful for tumors that are difficult to remove surgically or when cancer cells may have spread to nearby tissues. There are several different types of radiation therapy, and your veterinarian will recommend the most appropriate one for your cat. Chemotherapy involves using drugs to kill cancer cells or slow their growth. It can be administered orally or intravenously. Chemotherapy is often used for cancers that have spread to other parts of the body or for aggressive types of skin cancer. It may be used in combination with surgery and/or radiation therapy. Cryotherapy is a treatment that uses extreme cold to freeze and destroy cancer cells. It's often used for small, superficial tumors. Cryotherapy is a relatively non-invasive procedure and can be a good option for certain types of skin cancer. Immunotherapy is a treatment that helps your cat's immune system fight cancer. It works by stimulating the immune system to recognize and attack cancer cells. Immunotherapy is a newer treatment option and may be used for certain types of skin cancer. In addition to these treatments, supportive care is also important. This includes managing pain, preventing infection, and ensuring your cat is eating and drinking properly. Your veterinarian will provide guidance on how to best support your cat during treatment. Remember, each cat is unique, and the best treatment plan will be tailored to their individual needs. Don't hesitate to ask your veterinarian questions and discuss your concerns. The goal is to provide the most effective treatment while maintaining your cat's quality of life.

Surgical Removal

Let's delve into surgical removal, a primary treatment option for skin cancer in cats. When detected early and localized, surgical removal can be a highly effective way to eliminate cancerous tumors. The key to successful surgical intervention is to remove the entire tumor along with a margin of healthy tissue. This ensures that any stray cancer cells are also removed, reducing the risk of recurrence. The specific surgical approach depends on the size, location, and type of the tumor. For small, superficial tumors, a simple excision might suffice. This involves cutting out the tumor and a small margin of surrounding tissue. The area is then stitched closed. For larger or more deeply rooted tumors, a more extensive surgery may be necessary. This could involve removing a larger section of skin or even underlying tissue. In some cases, reconstructive surgery might be required to repair the surgical site and maintain function and appearance. During the surgical procedure, your veterinarian will take great care to minimize discomfort and ensure your cat's safety. Anesthesia is used to keep your cat comfortable and still during the surgery. Monitoring equipment is used to track vital signs, such as heart rate and breathing. After the surgery, your cat will need time to recover. Pain medication will be provided to manage any discomfort. You'll also need to keep the surgical site clean and dry to prevent infection. Your vet will provide detailed instructions on post-operative care. In some cases, additional treatments, such as radiation therapy or chemotherapy, may be recommended after surgery to eliminate any remaining cancer cells or prevent recurrence. The decision to pursue additional treatments will depend on the specific circumstances of your cat's case. Surgical removal is often the first line of defense against skin cancer in cats. When performed by an experienced veterinarian, it can provide a high chance of success and significantly improve your cat's prognosis. Remember, early detection and prompt treatment are key. If you notice any suspicious lumps or bumps on your cat's skin, don't hesitate to consult with your vet.

Radiation and Chemotherapy

When surgery isn't the sole solution, or when cancer has spread, radiation and chemotherapy can be powerful tools in the fight against feline skin cancer. Let's break down each of these treatment options. Radiation therapy uses high-energy rays to target and kill cancer cells. It's a localized treatment, meaning it focuses on the specific area where the tumor is located. Radiation therapy can be used in several ways: as a primary treatment for tumors that are difficult to remove surgically, as an adjunctive treatment after surgery to eliminate any remaining cancer cells, or to shrink tumors before surgery. The radiation damages the DNA of cancer cells, preventing them from growing and dividing. Healthy cells can also be affected by radiation, but they are generally able to repair themselves better than cancer cells. There are different types of radiation therapy, including external beam radiation and brachytherapy. External beam radiation involves delivering radiation from a machine outside the body. Brachytherapy involves placing radioactive material directly into or near the tumor. Your veterinarian will recommend the most appropriate type of radiation therapy for your cat's specific situation. Chemotherapy involves using drugs to kill cancer cells or slow their growth. It's a systemic treatment, meaning it affects the entire body. Chemotherapy drugs can be administered orally or intravenously. Chemotherapy is often used for cancers that have spread to other parts of the body or for aggressive types of skin cancer. It can also be used in combination with surgery and/or radiation therapy. Chemotherapy drugs work by interfering with the growth and division of cancer cells. Like radiation therapy, chemotherapy can also affect healthy cells, leading to side effects. However, veterinarians use lower doses of chemotherapy in pets compared to humans, which helps minimize side effects. Common side effects of chemotherapy in cats include nausea, vomiting, diarrhea, and decreased appetite. These side effects are usually temporary and can be managed with medication. Radiation and chemotherapy can be effective treatments for feline skin cancer, either alone or in combination. Your veterinarian will carefully evaluate your cat's case and develop a treatment plan that maximizes the chances of success while minimizing side effects. Open communication with your vet is crucial throughout the treatment process.

Prevention of Skin Cancer in Cats

Prevention is always better than cure, and when it comes to skin cancer in cats, there are several steps you can take to reduce your feline friend's risk. Protecting your cat from excessive sun exposure is one of the most important preventive measures. Just like in humans, prolonged exposure to the sun's harmful ultraviolet (UV) rays can damage skin cells and increase the risk of skin cancer. Cats with white or light-colored fur are particularly vulnerable, especially in areas with thin fur like the ears, nose, and eyelids. One simple way to protect your cat is to limit their time outdoors during peak sun hours, typically between 10 a.m. and 4 p.m. If your cat enjoys spending time outdoors, consider providing shaded areas where they can escape the sun's direct rays. This might include covered patios, trees, or even indoor spaces with access to the outdoors. Applying sunscreen to your cat's exposed skin can also be helpful, especially on the ears and nose. Use a sunscreen that is specifically formulated for pets and is free of zinc oxide and other harmful ingredients. Consult with your veterinarian for recommendations on safe and effective sunscreens for cats. Regular skin checks are another crucial part of prevention. Get into the habit of examining your cat's skin regularly for any unusual lumps, bumps, sores, or changes in pigmentation. Early detection is key when it comes to skin cancer, so the sooner you notice a potential problem, the better. Pay particular attention to areas that are prone to sun exposure, such as the ears, nose, and eyelids. Diet and nutrition play a role in overall health and can also impact skin health. Feeding your cat a balanced and nutritious diet can help support a healthy immune system and reduce the risk of various health problems, including cancer. Talk to your veterinarian about the best diet for your cat. Regular veterinary check-ups are essential for preventive care. Your veterinarian can perform a thorough physical examination and identify any potential health issues early on. They can also provide guidance on preventive measures and answer any questions you have about your cat's health. By taking these preventive steps, you can significantly reduce your cat's risk of developing skin cancer and help them live a long and healthy life. Remember, being proactive and vigilant is the best way to protect your furry friend.

Limiting Sun Exposure

Let's talk about one of the most crucial steps you can take to prevent skin cancer in your feline companion: limiting sun exposure. Just as with humans, prolonged exposure to the sun's harmful ultraviolet (UV) rays can significantly increase a cat's risk of developing skin cancer. This is especially true for cats with white or light-colored fur, who have less pigment to protect their skin from the sun's damaging effects. The ears, nose, and eyelids are particularly vulnerable areas, as they often have thinner fur and are more exposed to the sun. One of the simplest ways to limit your cat's sun exposure is to keep them indoors during peak sun hours. The sun's rays are strongest between 10 a.m. and 4 p.m., so try to keep your cat inside during these times. If your cat enjoys spending time outdoors, make sure they have access to shaded areas. This could be a covered patio, a shaded spot under a tree, or even an indoor space with access to the outdoors. Providing shade allows your cat to enjoy the outdoors while minimizing their exposure to direct sunlight. Another way to protect your cat from the sun is to apply sunscreen to exposed areas of skin, such as the ears and nose. However, it's crucial to use a sunscreen that is specifically formulated for pets. Human sunscreens can contain ingredients, such as zinc oxide, that are toxic to cats. Look for a pet-safe sunscreen that is non-toxic and fragrance-free. Consult with your veterinarian for recommendations on the best sunscreens for cats. You can also consider using UV-protective window film on windows that your cat frequently sits by. This film blocks harmful UV rays while allowing visible light to pass through. This can be a particularly useful option for indoor cats who enjoy basking in the sun. Remember, limiting sun exposure is a key preventive measure for skin cancer in cats. By taking these simple steps, you can significantly reduce your cat's risk and help them stay healthy and happy. Make sun protection a part of your regular cat care routine.

Regular Skin Checks and Vet Visits

Regular skin checks and vet visits are essential components of preventive care for your cat, especially when it comes to skin cancer. Early detection is key, and these practices can help you identify any potential problems before they become serious. Make it a habit to regularly check your cat's skin for any unusual lumps, bumps, sores, or changes in pigmentation. This is something you can do at home as part of your regular grooming routine. Gently run your hands over your cat's body, paying attention to any areas that feel different or unusual. Look closely at areas that are prone to sun exposure, such as the ears, nose, and eyelids. Also, check areas with thin fur, such as the abdomen and groin. If you notice anything suspicious, make a note of it and monitor it for changes. It's helpful to take photos so you can track any growth or changes over time. In addition to regular at-home skin checks, annual or bi-annual veterinary check-ups are crucial. Your veterinarian can perform a thorough physical examination and identify any potential health issues that you might have missed. They can also provide advice on preventive care and answer any questions you have about your cat's health. During a veterinary check-up, your vet will examine your cat's skin, looking for any signs of skin cancer or other skin conditions. They may also recommend additional diagnostic tests if they find anything concerning. Regular vet visits are also an opportunity to discuss any changes in your cat's behavior or health. If you've noticed any new lumps or bumps, non-healing sores, or changes in skin color, be sure to bring it to your vet's attention. Early detection of skin cancer can significantly improve your cat's prognosis, so it's important to be proactive. Remember, regular skin checks and vet visits are vital for your cat's overall health and well-being. Make these practices a regular part of your cat care routine to help your feline friend live a long and healthy life. By being vigilant and proactive, you can protect your cat from skin cancer and other health problems.

Conclusion

Recognizing skin cancer in cats is a crucial aspect of pet ownership. Early detection and intervention can significantly improve your cat's prognosis and quality of life. By understanding the different types of skin cancer, being aware of the risk factors, and knowing the symptoms to watch for, you can take proactive steps to protect your feline companion. Regular skin checks, limiting sun exposure, and maintaining a healthy lifestyle for your cat are all important preventive measures. If you notice any unusual changes in your cat's skin, don't hesitate to consult with your veterinarian. Prompt diagnosis and treatment can make a world of difference. Remember, your vigilance and care play a vital role in ensuring your cat's health and well-being. By staying informed and proactive, you can help your cat live a long, happy, and healthy life, free from the burden of skin cancer. Your furry friend depends on you, so keep those purrs coming by staying one step ahead of potential health issues. After all, a healthy cat means a happy cat, and a happy cat makes for a happy home. So, let's continue to be diligent pet owners and give our feline companions the best possible care.