Hemangiosarcoma in Dogs in Annapolis, Columbia & Towson

Hemangiosarcoma of the spleen, or spleen cancer in dogs, is a cancer that is diagnosed in many canines every year. It is a cancer made up of the cells that line blood vessels, and therefore can be found in any part of the body. However, the most common sites include the spleen, liver and right auricle of the heart. Approximately 2/3rds of masses in the spleen are malignant and of those, 2/3rds are diagnosed as hemangiosarcomas. Splenic hemangiosarcoma is most often diagnosed in older dogs, with German Shepherds, Labrador Retrievers and Golden Retrievers being the most commonly affected breeds.

Splenic hemangiosarcoma in dogs is very dangerous because there are very few signs of the cancer until the spleen either ruptures or the cancer happens to be spotted on a routine abdominal radiograph or ultrasound. This is largely due to the fact that the spleen is deeply seated in the body. In fact, many dogs that are diagnosed with splenic hemangiosarcoma present to their veterinarian on an emergent basis with a history of lethargy, decreased appetite, weight loss, acute collapse, pale to white mucous membranes and/or swelling in their abdomen. Vomiting and diarrhea can also be seen in a small percentage of patients.

Splenic masses can sometimes be seen with abdominal radiographs but are most often diagnosed with an abdominal ultrasound. In either case, once a splenic mass has been detected, it is in the patient’s best interest to undergo further diagnostics (i.e. staging tests) to evaluate for any evidence of metastasis (spread of the cancer to other areas of the body). These tests include an abdominal ultrasound (if not already performed) to evaluate for possible disease in any of the other abdominal organs, chest radiographs determine if there is any evidence of disease in the lungs, blood work that includes a CBC (which checks the red and white blood cells and platelets), a chemistry panel, clotting times and a urinalysis. An echocardiogram of the heart may also be warranted. Studies have shown that a small percentage of patients with splenic hemangiosarcoma can have a mass in the right auricle of the heart at the time of diagnosis.

Surgery is the primary treatment for a splenic mass and we need to keep in mind that not all splenic masses are malignant. The only way to obtain a definitive diagnosis is with removal of the spleen and submitting the sample for biopsy.  The hope is to pursue surgery before the mass or masses rupture, but most patients present in a crisis secondary to rupture of the mass leading to emergency surgery. With surgery alone, the median survival time is approximately 1-2 months with patients succumbing to metastatic disease.

Hemangiosarcoma has a high metastatic potential even if the spleen has been removed. Due to the aggressive nature of hemangiosarcomas, chemotherapy may be recommended to try and slow the progression of the cancer.  The primary chemotherapy drug used to treat hemangiosarcoma is doxorubicin (also known as adriamycin). Fortunately, most patients tolerate chemotherapy well with minimal side effects. These side effects can include stomach upset (decrease in appetite, nausea, vomiting, diarrhea and lethargy), decrease in white blood cell count and thinning of the fur coat. In addition, doxorubicin has also been shown to have a cumulative toxicity on the heart and because of this, doxorubicin has a lifetime dose in dogs that we do not exceed. In some cases, an echocardiogram may be recommended prior to the first treatment to obtain a baseline of their heart function and then again prior to the 5th or 6th treatment. Doxorubicin is administered intravenously once every 3 weeks for 4-6 treatments. Patients treated with surgery and chemotherapy experience a median survival time of 4-6 months.

In addition to traditional therapy, there are a couple of other treatment options that have shown some promise, but there is limited information regarding their true efficacy. These include I’m Yunity and Yunnan Baiyao. I’m Yunity is an extract of polysaccharopeptide from Coriolus versicolor mushroom (commonly known as the Yunzhi mushroom) that showed some promise in a small study out of the University of Pennsylvania. This study was very small, so it is unknown whether the information gathered in this study is representative of the larger population.

Many oncologists are prescribing the Chinese supplement Yunnan Baiyao. This supplement is thought to help slow down or stop bleeding from some of the cancerous lesions. There is also some data that shows it may also promote healing and possibly has some anti-tumor benefit against hemangiosarcoma. To better understand the benefit of this supplement, clinical studies are needed.

There may be some ongoing clinical trials available to your pet. Clinical trials are most often trying to find a new and possibly better treatment to improve the outcome for dogs with hemangiosarcomas.

Splenic hemangiosarcoma is a very aggressive cancer and, unfortunately, long-term control/survival is difficult to achieve.  Our main goal when treating your pet is to provide good quality time for all of you.

Symptoms of Cancer in Dogs & Cats in Annapolis, Columbia & Towson, MD

Common Signs of Cancer in Pets

Common Signs of Cancer in Pets: A Great Dane Looks Outside Through a Window

Treating cancer in pets is a large part of what we do here at AVIM&O. An estimated 4 million dogs and cats will develop cancer each year. As dogs get older, their risk of cancer increases. Almost half of dogs over the age of 10 will develop cancer, while there is less information regarding the cancer rate in cats. Still, we do know that cancer is the leading cause of death in 47% of dogs and 32% of cats.

A Morris Animal Foundation study found that 41% of animal owners feel that cancer is the biggest health concern for their pet. It is very difficult to detect cancer early in pets, and unfortunately in most cases, cancer cannot be detected with routine blood work.

However, according to the American Veterinary Medical Association, there are 10 things you can look for. These signs are not definitive for a cancer diagnosis, but they may be able to detect another medical condition early that might require additional veterinary attention and/or treatment. Early detection is key when dealing with cancer, so learn to spot the signs discussed here:

  • Abdominal swelling. This can be a slow or quick onset and it is important to see your veterinarian to try and determine a cause. The work up for this usually starts with blood work, a urine sample, and an abdominal ultrasound.
  • Bleeding from the mouth, nose, or other parts of the body. Melanoma is the most common oral tumor in dogs, and squamous cell carcinoma is the most common oral tumor in cats. Seeing your local veterinarian twice a year for routine examinations can help to identify these tumors sooner. Early detection of these tumors has shown to result in an improved outcome. So if you notice your pet has blood-tinged saliva, is eating slower, has colored discharge from the nose or bleeding from any other areas of the body, the best thing is to have them evaluated by your veterinarian. In most cases some additional testing will be recommended to try and determine a cause and diagnosis.
  • Difficulty breathing. Any time there is a concern that your pet is having difficulty breathing, they should be evaluated immediately either at your local veterinarian or the closest emergency clinic. Evaluation with blood work and radiographs of the chest will likely be recommended as a starting point to try and determine a cause.
  • Difficulty eating or swallowing. This could be a sign of dental disease or something more serious and warrants a visit to your local veterinarian for further evaluation.
  • Lumps, bumps or discolored skin. Any new mass found on your pet should be aspirated by your local veterinarian to determine whether additional steps should be pursued. After the aspirate, a next step may include taking a small biopsy sample (called an incisional biopsy) to gain a better understanding of the mass vs. complete excision if the aspiration reveals that the mass is a concern. As dogs get older they can develop new masses like lipomas (fatty masses), which are benign. Any new masses should be evaluated so your local veterinarian can help guide you towards the best treatment options available. In some cases, monitoring may be the best treatment option, but only after you determine what the condition is.
  • Non-healing wounds. Most cuts and scrapes will heal on their own. Unfortunately, if your pet has a sore that is not improving after a few days to a week, they should be seen by your local veterinarian. Cancer is able to do a lot of things, but it cannot heal and usually continues to grow. Getting to a malignant tumor sooner allows the doctor to provide more treatment options and improve the outcome for most pets.
  • Persistent diarrhea or vomiting. Dehydration can occur quickly, even if your pet is still drinking. If they have had more than 3-4 vomiting episodes in a day or more than 36 hours of diarrhea, then they should be seen by your local veterinarian. The sooner they are seen the lower the chances are that they will require hospitalization. Tests that will be recommended usually include: blood work, analysis of urine, X-rays, and possible ultrasound. There are many benign causes of vomiting and/or diarrhea, but cancer is always a concern and should be ruled out as a possible cause.
  • Sudden or chronic changes in weight. If you notice that your pet has had an unexplained drop in their weight, they should see their veterinarian immediately. Weight loss is sometimes one of the first indicators of a cancer diagnosis. The first steps are very similar to what has already been stated and usually include blood work, a urine sample, radiographs and/or an abdominal ultrasound.
  • Unexplained swelling, heat, pain or lameness. There are a lot of different causes for these signs in dogs and cats. Any persistent swelling, pain or lameness that does not improve with supportive care should be investigated further. In dogs, a bone tumor called osteosarcoma can cause a firm swelling in either their front or back legs, but rarely in other bones in the body. Most of these dogs will improve initially with pain medications and anti-inflammatories, but it never completely resolves and the swelling remains. If this is the case, then along with initial diagnostics (i.e. blood work and a urine sample), radiographs of the affected limb are recommended. If there are changes noted in the bone, the next steps usually include chest radiographs and either an aspirate and/or biopsy with culture of the concerning area in the bone to try and arrive at a diagnosis.
  • Visible mass/tumor. As stated above under lumps, bumps or discolored skin, any new mass should be evaluated with aspiration. Based on the aspirate results, further recommendations can be made.

If your pet is diagnosed with cancer, the next step is being referred to an oncologist where they will discuss your pet’s prognosis and treatment options with you. Fortunately, dogs and cats tolerate most cancer treatments very well. The goal with any cancer treatment is to ensure that your pet maintains a good quality of life before, during, and after treatment. However, in many instances a cure is not possible. In these cases, our goal is to achieve a good quality of life for your pet for as long as possible. We believe quantity of life is meaningless without quality. It is also important to realize that you know your pet best, and the criteria for determining one animal’s quality of life may not suit another. Being armed with the correct information allows you to be the best advocate for your pet.

Feline Mammary Gland Adenocarcinoma

Feline mammary gland tumors are the 3rd most common feline tumor and are most commonly diagnosed in middle-aged to older cats.  Incidence of mammary tumors is dependent on when cats are spayed. Cats who are spayed prior to 6 months of age have a 91% reduced risk of developing mammary cancer. Spaying after 2 years does not decrease the risk of developing mammary tumors.

Unfortunately, the majority (80-90%) of mammary gland tumors in cats are malignant, and 80-90% will metastasize (spread to other areas of the body) during the course of disease. The most common sites of metastasis include the regional lymph nodes and lungs. Due to the risk for metastasis associated with mammary tumors, thorough staging is recommended prior to any definitive treatment. This would include bloodwork (complete blood count and chemistry panel), urinalysis, aspiration of the regional lymph nodes, chest radiographs and an abdominal ultrasound. Prognosis for patients is dependent on the stage of disease. Stage is based on the size of the tumor (tumors less than 2cm have a better prognosis) and evidence of metastasis (patients that have metastasis typically experience a shorter survival time than those without). Another important factor is whether there is any evidence of invasion into the blood vessels or lymphatics which is determined from the biopsy (cats that do not have any invasion have a better prognosis than those that do).

STAGE T
Size of Tumor
N
Lymph Node
Metastasis
M
Distant
Metastasis
Stage I <2cm No No
Stage II 2-3cm No No
Stage III >3cm Yes No
Stage IV Any size Yes Yes

Treatment options include surgery, chemotherapy and supportive care. When possible, surgery is the recommended first step. Local tumor recurrence is common if the tumor is incomplete or narrowly excised, so wide surgical margins (2-3cms and one tissue plane deep) are recommended. This may mean that several mammary glands are removed at one time (known as a chain mastectomy).

Since most of these tumors will metastasize, chemotherapy may be discussed to address the risk of the tumor spreading. The most commonly used chemotherapy agents include doxorubicin (Adriamycin) and carboplatin. Both of these chemotherapy agents are administered intravenously once every three weeks for a total of four to six treatments when combined with surgery. In some situations, chemotherapy may be used without surgery, but the long term prognosis is not as good when surgery is not performed. Side effects of chemotherapy are typically mild and resolve on their own within 1-2 days. Chemotherapy side effects may include lethargy, poor appetite/anorexia, nausea, vomiting, diarrhea, and a decreased white blood cell count. Doxorubicin can also cause dose cumulative damage to the kidneys, so bloodwork is performed at each visit to ensure that it is safe to continue with chemotherapy.

Supportive care may include pain medications, anti-inflammatories and antibiotics as needed. This can be used with or without other treatment options.

Mammary gland cancer is not usually a cancer that is curable, but with treatment, can be controlled while maintaining your pet’s good quality of life. Your oncologist will be able to discuss the treatment options, prognosis and help guide you as to the most appropriate plan for your beloved family member.