Spindle
cell carcinomas in German Shepherd
Question: I am writing to you regarding our beloved family member
Nikki. She is a
purebred all black German Shepard. She was recently diagnosed with
"Spindle Cell" carcinoma or sarcoma (as soon as I heard the "C" word
I
mentally blanked out).
To give you a little background information, we acquired Nikki a little
over a 1 1/2 years ago after a loss of our Codybear (another GSD).
She is
originally from Egypt. Her owner was in the USA for cancer treatment
and
passed away. She will be seven in October. She is a great dog
and real
good with our two little girls. Loves people. She really helped
with
losing Codybear to a heart attack after surgery.
About 2 weeks ago I found a tumor about the size of 3 grapes on the
inside
left front leg just down from the elbow. I brought her right in to
our
veterinarian (she had a bath 2 weeks prior to this and I didn't feel
anything). He was real concerned and scheduled the surgery 2 days
later. We also had a biopsy done. The tumor was removed
completely and
the Vet said it was not attached to anything (muscle, bone etc.). Our
vet
said he had never seen "spindle Cell" in dogs before.
She also has a small spot over her right eye (pencil eraser size) that
was
frozen and should fall off in a few weeks.
She seems a lot better than right after the surgery, no limping, eating
well (real well!!) and she protected me from the vacumn cleaner a few
days
later.
My question to you is that when I bring Nikki in for the staple removal
on
Thursday, what should I ask about follow up care (ie Chemo, radiation)
so
that I am more informed to ask the right questions.
We live about an hour from Cornell in Upstate NY, so if we had to we
could
go there. I love our Veternarian, we have been going to him for
over 15
years. But sometimes, you need to know more info and need to
ask the
right questions. I have tried researching on the Internet regarding
Spindle Cell and there is not a lot of information regarding it.
I just
want to know what our options are. Any help that you could provide
would
be a great help!!
Answer: Carol-
Spindle cell carcinomas are tumors that usually develop in connective
tissues. They are malignant tumors and it is very important to carefully
evaluate Nikki's current status due to this.
If the tumor and tissue around it which was removed were examined by
a
pathologist and the pathologist felt that the surgical excision margins
showed no sign of tumor cells, that would be very good. If the margins
of
the excision did contain tumor cells or if no examination of the tissue
margins was attempted, it is probably better to assume that the entire
tumor was not removed and make decisions based on that assumption.
In either case, it is a good idea to have X-rays taken of the chest
looking
for spread of the tumor. It is best to take three views, a view with
the
patient laying on her right side, then left side and a view taken with
the
patient lying on her back or upright on her chest. Taking three views
gives
the best chance of finding a tumor if one is there. Looking carefully
for
any similar tumors on a physical exam would be a good idea, too. It
can be
helpful to remove a lymph node from the armpit region to be as sure
as
possible that there is no spread of the tumor.
If the surgical excision margins were clean and there is no evidence
of
spread of the tumor on X-rays and physical exam (and possibly in the
local
lymph node) then it may be reasonable to do nothing else at this time.
If the surgical margins are not clear of tumor cells then radiation
therapy
would be a good idea. Radiation treatment works well in preventing
recurrence and spread of these tumors, with a long increase in survival
time ( 4 to 5 years) reported for patients receiving radiation treatments
as long as the tumor grade is low (1 or 2).
Finally, what do you do if you find that the tumor has spread?
In this
case, radiation therapy combined with chemotherapy may help but the
prognosis is very guarded.
The important things to know at this point are 1) were the surgical
margins
examined and were they clear of tumor cells? 2) did the
pathologist
attempt to grade the tumor and if he did, what was the reported grade?
3)
has the tumor spread? It will be possible to develop a
treatment plan
based on this information.
It would be helpful to consult with a veterinary oncologist (I'm sure
Cornell has one) if you find that the situation is anything other than
a
low grade tumor with clean surgical margins and no evidence of spread
of
the tumor.
I hope that you get good news on Thursday. In a dog of my own, I would
strongly consider radiation therapy if it could be arranged, even if
the
surgical margins were clean and there was no evidence of spread of
the
tumor but the oncologist can give you a better idea of the necessity
for this.
Mike Richards, DVM
7/26/2000
Transitional
cell carcinoma in German Shorthaired Pointer
Question: My 9 1/2 year old German Shorthaired Pointer
was diagnosed with transitional cell carcinoma of the urethra a couple of months ago. Since then he has gone
through three chemotherapy sessions which did not stop the spread of the cancer. It has spread to his
bladder and some lymph nodes. During the chemo sessions he was on Feldene. Well the Feldene combined
with the sessions caused internal bleeding. His platelate and red cell levels were dangerously low so he was
taken off Feldene to try and build up his blood. His blood is getting better but he is beginning
to show that he is uncomfortable - especially when he walks. We gave him his first Feldene in 2 weeks last
night and he did show a little improvement. I guess my questions are: Does it take multiple doses of
Feldene to show more of an improvement? Can you recommend other pain relievers? The vet did not want
to put him on Rimadyl.
I realize my baby doesn't have much time left but I want it to
be comfortable for him. Please give me any
suggestions you may have.
Answer: L-
Piroxicam (Feldene Rx) is specifically recommended for transitional
cell carcinoma due to
chemotherapeutic actions that have been described for this medication.
I do not know if these
actions have been proven or not, but the studies I can find are pretty
ambivalent. It is not thought
to work very well alone but is often used in combination with chemotherapeutic
agents. It may
take several months to see a lot of benefit when using piroxicam. I
do not know if there would
be a benefit to using misoprostil or one of the other GI protectants,
such as cimetidine (Tagamet
Rx) or famotidine (Pepcid AC) to try to decrease the risk of GI bleeding
but I don't think it
would hurt to try.
If there is pain beyond that which piroxicam is helpful for, it may
be beneficial to use a more
potent pain reliever, such as fentanyl (Duragesic patches, Rx).
It is not a good idea to use
piroxicam and another non-steroidal anti-inflammatory medication, so
your vet is correct not to
use carprofen (Rimadyl Rx) and piroxicam at the same time. Also, there
may be significant pain
relief by using a surgical procedure to relieve pressure, such as a
cystostomy tube. This is a big
decision because it is just a way to buy a little more time but
reports suggest it does improve the
quality of life for dogs with obstruction of the urethra due to transitional
cell carcinoma.
Hope this helps some.
Mike Richards, DVM
7/9/2000
Squamous
cell carcinoma affecting the tonsils
Question: My second Westie (BooBoo, 11 year old spayed female)
has been diagnosed
with metastic squamous cell carcinoma of tonsillar origin.We took her
to
the doctor when she quit eating and her lymph node was swollen and
her
tonsils red. After sending the tonsil off and taking a biopsy of the
lymph
node, the problem was confirmed. We will be seeing an oncologist this
coming week, but the other vet wasn't very optimistic. He said even
with
chemo, since it was in the lymph nodes, she might have only 2 to 6
months.
He did say however, it didn't appear to be in her lungs, and that miracles
can happen. We are heartbroken. Please tell us what we can do to try
to
put this in remission, or if there are any new techniques to treat
cancer
out there. We will do anything for her.
This come on the heels of the diagnosis of Pulmonary Fibrosis in our
first
Westie Molly. By the way, your information on that was very helpful
and it
helped put us in touch with people that are studying the problem and
she
doesn't seem to be uncomfortable - 2 years is much better than the
prognosis in BooBoo.
Thank you for this service. We really appreciate it.
Answer: V-
Squamous cell carcinoma affecting the tonsils is a very aggressive
cancer. It is good that it was not obvious in the lungs but this
is still
considered to be one of the cancers that is most likely to have spread
by
the time it is diagnosed. Carboplatin seems to be the favored
chemotherapeutic agent at the present time. Mitoxantrone and piroxicam
are
also mentioned. Radiation therapy in combination with chemotherapy
was the
most successful treatment in a 1988 study (Brooks, et al) but that
is now
pretty old data in the world of chemotherapy. Based on that study,
there is
probably about a 10% chance of long term (over one year) success for
chemotherapy combined with radiation therapy. It has been
my impression
that radiation therapy alone does not provide much more than six months
or
so of palliative treatment when used alone, based on a couple of cases
we
have discussed with the oncologists at North Carolina State University.
It is really important to find a veterinary oncologist to discuss BooBoo's
case with. Cancer treatment changes faster than almost any other
area of
veterinary medicine and it is possible that there have been major
improvements in radiation or chemotherapy that I am not even aware
of. Your
vet can help you find the closest oncologist. If going to see the
oncologist is not possible your vet can at least get information on
the
latest treatment and survival estimates for you if he or she talks
to an
oncologist.
Whatever you decide to do for BooBoo, make sure that you spoil her on
all
the days that you can. Dogs live from day to day and don't worry much
about
the future, so you can lift her spirits from day to day much more easily
than a person with similar problems.
Mike Richards, DVM
2/23/2000
Transitional
Cell Carcinomas and Piroxicam
Q: Dear Dr. Mike, I am looking for information
on transitional cell carsylonoma, unsure of spelling. My dog Chrissy had
been urinating alot so I took a urine sample down to Dr. Jack, our vet,
and there was blood in it. So he took an x-ray and nothing, so he went
a step further and did the balloon and dye x-ray and that showed up a tumor.
Two days later he removed the tumor. It was on her bladder near her utera.
When he removed it, there were kidney stones lodged into the tumor so he
removed those also. My results came back yesterday and it was malignant.
He feels that the part he did not get was to the lining of the bladder
which was where the utera meets the bladder. He said it is localized and
he has put her on prixocam, unsure of spelling, to help stop the spread
of it. Do you have anymore information on this? He had some and I have
that, but I found this website and just thought I would write to you about
this. Chrissy means the world to me and I don't want to see her suffer
at all. Right now she plays with her Mickey Mouse, eats, and drinks and
I don't see signs of pain and suffering right now. I trust Dr. Jack and
I am very confident that he will do anything to make Chrissy not suffer.
Thank you for listening. A Concerned Parent with her only child. Kim
A: Kim-Piroxicam (Feldene Rx) is a non-steroidal anti-inflammatory medication
that has a direct toxic effect on some cancers, including transitional
cell carcinomas. I think the exact mechanism of this action is unknown.
Other than the usual NSAID side effects (occasional kidney damage, gastro-intestinal
irritation) it seems to be a pretty safe medication. Many vets use a medications
to protect the stomach while administering this medication but some do
not.
To the best of my knowledge there is not an alternative chemotherapeutic
regimen with a better record against this condition.
I hope that things are going well.
Mike Richards, DVM
Basal cell carcinomas
Q: I'm looking for info on Multi-cystic invasive
scirrhous carcenoma, as my Golden Retriever has just been diagnosed with
this form of cancer. Any leads on treatment or general information would
be greatly appreciated. Thanks in advance for your response. T.
A: I do not recognize the description of
the cancer you have given. Where is it located and is there another name
your vet can supply for this? There are cystic adenocarcinomas that occur
in the prostate and liver, is it possible that this is what you are describing?
Mike Richards, DVM
Continued
It is located in her leg, and originates from her sweat glands. The
only other name I have heard it reffered to is "basil cell carcinoma".
The main concern right now is that there is adema in the leg. The swelling
is so bad that the skin is beginning to split. Any suggestions would be
greatly appreciated. Thanks in advance for your response. T.
A: Basal cell carcinomas are reported to be responsive
to surgical removal in Dr. Morgan's book Small Animal Practice,
so that seems like a reasonable alternative to me. Control of edema can
be difficult in some cases and all I can suggest is the use of diuretics
such as furosemide (Lasix Rx) and/or corticosteroids such as prednisone.
I am pretty sure your vets have already considered these options.
I wish I could help more. Hope that there has been improvement since
you wrote.
Mike Richards, DVM
Last edited 01/30/05
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