Identifying the Cancer

Gracie's surgery left a long incision on her right shoulder and leg that needed to heal without her licking it. So she is styling the lovely Elizabethan collar; we call “the cone of shame”. The phone call came with the test results.

The biopsy identified that Gracie has mast cell tumors (MCTs); a common cancer in dogs. Tumors are given a grade and stage. The grade identifies as to how likely the tumor is to be malignant. The higher the grade means the more serious the tumor. Gracie was a grade III, the highest. The stage measures how much the tumor has spread in the body. As with the grading, a higher stage is the more serious case. We needed to perform another test in order to determine the stage; however, the prediction was that Gracie was a stage IV, the highest. My poor sweet Gracie!

Now that the diagnosis was confirmed, the next step is to decide on treatment. The veterinarian wanted to do more tests and have us meet with a canine oncologist. There were a number of potential proposed options suggested during that call, such as amputating her leg, radiation, chemotherapy and various medication treatments. I needed a little time to sort this out. I was both angry and devastated. How could this happen to such a lively dog?

I immediately started my quest for more information on canine cancer. Access to my community college’s database and the internet were the immediate choices. I came across a few articles that were quite informative. An article on canine mast cell tumors provided a fast-track education. I learned that mast cell tumors can develop in all ages and all breeds of dogs. They are rare in cats and non-existent in humans. Much like human cancer, the cause is speculative. It may be hard to visually diagnose a mast cell tumor. The tumors contain large amounts of histamine, which triggers an inflammatory response. As with all tumors, early identification and treatment are very important in obtaining the best possible outcome.

Another article by PetPlace.com reviewed the different diagnostic tests; what they are called and why they are done, as well as treatment options, including home care and prevention. The overview indicated that mast cell tumors are also called mastocytomas and are most commonly in the skin. It’s known as canine skin cancer. The skin is the most common site of cancer in the dog and skin cancer is among the most common tumors of dogs. The cause of mast cells is unknown. Typically older dogs (8 or 9 years old) develop mast cell tumors; however, they can occur in dogs of any age. The tests typically performed are:

· A complete medical and physical exam to determine the dog’s general health.

· A urinalysis to evaluate kidney function and check for urinary infection.

· A complete blood cell count to evaluate anemia or signs of inflammation.

· A needle aspiration of the mass and any enlarged lymph nodes.

· A fine needle aspiration of the bone marrow, if speculating wide-spread mast cell disease.

· A buffy coat smear of blood to look for rare circulating mast cells.

· X-rays of the abdomen to evaluate spleen and liver size.

· Abdominal ultrasound, if additional evaluation is needed of the spleen and liver.

· Surgical removal of suspicious skin tumor followed by evaluation by a veterinary pathologist.

An article on the internet indicated that the Boxer, English Bulldog, Boston Terrier, Shar pei, Labrador Retriever, Golden Retriever, Schnauzer, and Cocker Spaniel seem to be at higher risk. Most mast cell tumors arise in the skin, but they can arise anywhere that mast cells are found. The mast cell tumor does not have a characteristic appearance; however, because of the tumor's ability to cause swelling through the release of granules, it is not unusual to notice a sudden change in the size of the growth. The growth is also itchy or bothersome to the dog.

Gracie's lesion on her shoulder looked similar to the lower one in the picture to the left. I had not forgiven myself for not taking Gracie to the veterinarian as soon as we saw the lesion. Then once we did take her in, I found myself wondering why it took a couple visits before we learned the identity of the lesion on her shoulder. How could we have been treating it as an infected sore, when it was really cancer? I probably even blamed the vet for not identifying it in the prior visits. However, after reviewing information about mast cell tumors, I understand that they may be hard to diagnose without a biopsy. Her lesion covered her entire shoulder and upper leg by the time we resorted to surgery. It was not the vet’s fault for us trying other treatments first. Can I also forgive myself for not taking her in sooner?

Reading these articles helped me to better understand all the terminology used by my veterinarian in our conversations. Additionally, I was able to use the information to determine my financial and emotional ability in the treatment of Gracie. Her cancer was identified as aggressive and treatment would need to be aggressive. Dogs with mast cell tumors staged and graded the highest, like Gracie, have an unfavorable prognosis. It is at this juncture; the decision was made to not amputate her leg, or pay for additional tests, or put her on chemotherapy. I did not want her to endure any more surgeries or suffer through side effects of chemotherapy. I want her to enjoy the life she has left and be as comfortable as possible.

So without wasting any time, Gracie was put on prednisone, which is a steroid used in cancer treatment. She was also put on pepcid as the histamine has a tendency to cause stomach ulcers. The pepcid will hopefully help to alleviate that. What is the financial impact of the choices available? How do I know if this is the right decision? What would Gracie want?

Citations

Connick, K. (2002). Canine mast cell tumors. Retrieved October 30, 2009 from the Ebscohost database.

Gracie. (2009, November). Image of Gracie from the Treadwell family digital photo album.

Image of lesions. (n.d.). Retrieved November 7, 2009 from http://www.marvistavet.com/html/body_mast_tumors.html

Philibert, J. (n.d.). Mast cell tumors (matocytoma) in dogs. Retrieved November 2, 2009 from http://www.petplace.com/dogs/mast-cell-tumors-mastocytoma-in-dogs/page1.aspx