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The Daily Vet by petMD

The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

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Imagine taking your dog for his usual morning walk. Nothing seems out of the ordinary; your companion’s energy level and demeanor is perfectly normal, as it's been for as long as you can remember.

Imagine leaving for work, or to run errands for a few hours, and returning home to find your pet completely lethargic and unable to rise, breathing shallow rapid breaths, with a distended abdomen, pale gums, and an exceedingly rapid heart rate.

Imaging rushing to the nearest open veterinary hospital, and within moments of arriving, hearing the devastating news that your pet is suffering from internal bleeding from a mass associated with its spleen, and will require emergency surgery in order to have any chance of survival.

Now imagine hearing the mass very likely represents a deadly form of cancer called hemangiosarcoma, and that with emergency surgery, this disease is typically fatal within 2-3 months, and even with aggressive chemotherapy after surgery, survival is extended to only about 4-6 months.

While trying to wrap your head around this information, imagine hearing there is a smaller chance the bleeding results from a completely benign tumor that will be cured with surgery alone. And there is no way to know whether your dog has a cancerous or benign tumor before making the decision to go to surgery. What do you do when all you can think is, "My dog was completely normal this morning when we went for a walk"?

Hemangiosarcoma is a fairly common cancer diagnosed in dogs. It arises when mutations occur in the endothelial cells lining blood vessels. The most common primary sites of tumor development include the spleen, the right atrium of the heart, and the skin. The liver is also a common site for a tumor to form, and also a frequent site for metastases from other locations. Hemangiosarcoma occurs more commonly in older dogs, especially larger breeds such as Golden retrievers, German shepherds, pointers, Boxers, and Labrador retrievers.

As hemangiosarcoma tumors grow, rapidly dividing endothelial cells try to form blood vessels and vascular channels, but their growth is erratic and abnormal, and tumors are fragile and prone to bleeding. If bleeding occurs while a tumor is small, or the cancerous vessels can be repaired, dogs will usually be asymptomatic. Once a tumor reaches a critical size, bleeding will typically be more severe and dogs will show signs related to massive internal blood loss.

In most cases, owners have no way of knowing their pet is afflicted with this type of cancer until it is very advanced and they are literally faced with a life or death decision about how to proceed.

The statistics surrounding a diagnosis of hemangiosarcoma are fairly abysmal. It is estimated that over 80 percent of affected pets have microscopic metastases at the time of diagnosis. Therefore, even though the surgery to remove the immediate source of bleeding is life-saving, it is generally not curative. Chemotherapy can prolong survival, but typically only for a short duration. Even when dogs are diagnosed with hemangiosarcoma "incidentally," meaning tumors are discovered before dogs show signs of bleeding, the average survival time with surgery alone is about 6-8 months.

The unluckiest dogs have visible metastases in multiple organs at the time of their diagnosis. Survival times for those dogs may only be on the order of a few short weeks.

What I find most problematic is there is little information to help determine whether a splenic mass is cancerous or not before a tissue biopsy is obtained, so owners are forced to make a decision about pursuing emergency surgery without having all the information they might need to feel completely educated about their choice. Although most splenic tumors are ultimately diagnosed as hemangiosarcoma, other types of cancers can occur within this organ, many of which carry a more favorable prognosis than the odds I’ve listed above.

I’ve also seen dogs "diagnosed" with hemangiosarcoma within their spleen, with spread to the liver, based on images obtained with an ultrasound. Yet biopsy showed the masses in both organs were completely benign.

Hemangiosarcoma is uniquely challenging for this exact reason: Owners are forced to make major decisions with limited evidence-based data to feel comfortable they are truly making the "right" choice for their dog.

I’ve treated many dogs with hemangiosarcoma and happily continue to monitor a small number of patients who are alive a year or more after their diagnosis. I’ve talked with their owners about the spectrum of emotions they experienced when deciding whether or not to proceed with the initial emergency surgery. The most common answer I hear is they just knew they had to give their dog a chance. They felt that should something happen during or after surgery, they would be content knowing they made their decision with their pet’s best interests in mind. And they knew that even though the odds for long-term survival were not in their favor, the odds for a chance to have a few more usual morning walks were great enough to warrant the risk of a diagnosis of cancer.

Of course, there was always the hope the tumor would be benign, but even when hemangiosarcoma was confirmed, they were comfortable knowing it wasn’t the duration of time that mattered for them, but the time itself.

Whether dealing with cancer or with any other of life’s infinite challenges, I think we could all stand to benefit from approaching things from a "quality over quantity" standpoint. And really figure out what it means to enjoy the moment while it lasts.

Dr. Joanne Intile

Image: Petar Paunchev / via Shutterstock

Comments  17

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  • 01/23/2013 03:33am

    Sadly, don't have to do much imagining ... hubby's brother's dog fell very ill before Christmas. Repeatedly diagnosed and treated as UTI, the dog kept getting worse. Finally they listen to us and went for a second opinion. At the time of surgery the tumor was already bleeding and there were "tiny nodules" all over the place...

  • The 'C' Word
    01/23/2013 06:29pm

    The 'C' word is frightening in any sentence even if the doctor just said that there's only a 10% chance something is cancer.

    I'd have to make the decision to take a chance that the problem is benign and move forward with the surgery, but perhaps make the sad decision to tell the doctor/surgeon to not let the patient wake up if they're full of cancer. I can't imagine letting the last few weeks be spent recovering from emergency surgery.

    " I think we could all stand to benefit from approaching things from a "quality over quantity" standpoint."

    So true. So true.

  • Cancer, my dog and me
    01/25/2013 09:41pm

    My beloved dog was dx with liver cancer 15 months ago. The mass was discovered by accident in May, while doing an ultrasound due to his IBD. Surgery was performed with success. Chemo can not be done on his liver cancer. He gets blood panels and ultrasound every 3 months. This past week, his blood panel looks good, but two new nodules are seen on his liver ultrasound. Sadly, a Doug's liver cannot regenerate itself as human liver can. Is it cancer returning or is benign? This time surgery can't be done. One lobe has already been removed. Even if it isn't cancer, if the nodules grow, they can impede on other organs. That is the hard facts. Now for the raw, emotional side of this. I am dying inside. He is my best friend. I started a money market for him, so if he ever got sick, I would be able to give him the best care possible. Best decision I ever made. He sees a board certified Internost, cardiologist, oncologist, and surgeon, as well as his PCP located at another practice. They have blessed me with additional time with him. I am not sure what the future holds. Right now, he is doing fine. My neighbors are amazed at his energy. He is 14 and has other health issues. He and I are joined at the hip. He is by shadow. I spare no exspense concerning him. Yet, I know the day will come and if I could, I would stop time. He is a rescue. I got him when he was 6 months old. I really don't know why I am sharing all off this.... Probably because it hurts so bad.

  • dog liver
    01/26/2013 10:49pm

    macrjobn,
    congratulations on having the foresight to prepare financially for the inevitable veterinary bills.
    if he has survived 15 months with liver cancer, you are doing something right.
    however, your statement that "...a Doug's liver cannot regenerate itself as human liver can" is incorrect. if you do a search for "dog liver regenerate" you will see many returns from credible sources attesting to this fact.
    i wish you the best with your boy. he is lucky to have someone as loving and devoted as you.

  • Dog liver
    01/27/2013 12:04am

    Thank you for the info! It gives me more hope!

  • 02/13/2013 02:03am

    Hello,
    Our Black lab / rottie, Boston,is 9.5 yrs old,& has been diagnosed with hemangiosarcoma with mets to liver. We are giving him Chinese herbs in capsule form, K9 immunity plus,home cooked food & lotsa love. We didn't get surgery as I thought the odds were he would not live long afterwards, and his quality days like he has now would be gone post surgery.

    Now I am wondering if he should have surgery? He is doing well, considering the surgeon at Canada West figured he would not even make 2 wks and it is 2 wks 2 days and he is eating,drinking, swimming, walking, playing with toys. We gave him yunnan baiyao and it stopped the bleeding,no more hot swollen tummy. Was giving it daily even when his tummy is no longer hot and swollen and his gums are pink. Not sure whether he should have yunnan baiyao daily as I was reading that it should be given on alternating days. I read it can bring the liver count up.

    Our regular vet retired so we used the vet that took his place. We took Boston in to see her due to a decreased appetitie, only eating half his food, and lethargic. I told the doctor he ate a whole bag of greenies so I thought that was why he was not well. She xrayed and did blood tests. She said she saw undigested food ( presumably greenies) She then said she saw some fluid which concerned her, so my husband and I were worried it might be cancer. The vet then informed us the blood test was good news, just white blood cell count up, which as we know indicates infection or the body trying to fight something. She put him on antibiotics and said he had developed pancreatitis from the greenies. He improved but then a couple of months later he had the same symptoms back and I thought he had pancreatitis again. Back to the vet who x-rayed him and then told us over the phone that he has terminal cancer, that he has malignant tumours. Took him for a second opinion at Canada West and we were planning to have the spleen removed that day tll we got the horrible news from the surgeon that their ultra sounds revealed tumours on both the liver and spleen. I was crying and said we would not do surgery because I had read that the dog only lives weeks to a few mths after surgery. Since then with further research I have read of dogs outliving the predictions after surgery and a good diet and supplements.

    I asked the surgeon if there was a possibility that the tumours on the liver might be what dogs get sometimes in old age (forget the name), but a benign thing, and maybe the spleen has a non malignant hematoma or hemangioma. She said "no, we know the difference". I have read statements on the net from vets who said a dog should never be euthanized presuming it is hemangiosarcoma with mets, without a histopathology. Sometimes autopsies have been done after the dogs were euthanized only to find out with autopsy that the spleen had a hematoma or hemangioma and the liver had the nodules from old age.Apparently they look similar on ultrasound. I understand that benign tumours can also bleed.

    My husband and I are angry that the vet misdiagnosed. Alarm bells should have gone off and she should have delved further, not presuming the greenies were the problem. ( I found out greenies have killed dogs but did not know this of course, till researching when Boston got sick) The alarm bells are : Boston's size and breed - big lab/rottie, his age - 9.5 yrs,his sex - more males get Hemangiosarcoma, his symptoms - downed appetite and lack of energy, the FLUID she saw, AND the pancreatitis diagnosis, which I learned happens a lot with dogs that turn out to have hemangiosarcoma and NOT pancreatitis.

    We were told by the surgeon where we got a 2nd opinion that Boston is stable and would survive surgery, but she was concerned what might happen to his other organs such as the brain etc post surgery. She did not mention TCM (Traditional Chinese Medicine - mushroom therapy that has given extra time to both humans and dogs with cancer). I found out about it through research on the net and we are using it and it is helping Boston. The surgeon did not give us any hope that we might prolong Boston's life with more quality days ahead. She said he would not even make 2 wks and it is 2 wks and 2 days today since we saw her and Boston is doing well, considering. He eats and drinks, walks, swims, and plays with his toys, and his coat looks better than it has ever looked, shiny with way less shedding. I did tons of research and lost a lot of sleep but worth it for our boy. Found out so much.

    We have him on K9 Immunity Plus wafers (they have Chinese mushrooms in them). I give him 2 doses a day of IP6 with inositol, Capsules of Turmeric (curcumin), reishi mushroom capsules, salmon oil, coenzyme q 10, homeopathic liver tonic and milk thistle liquid, etc. I have also ordered Apocaps which were designed by a DVM named Dr. Dressler. They are made in Hawaii and have betaglucans, milk thistle plant, curcumin etc in them. They are a natural product and are available in the U.S. via amazon with no perscription. We had to get a perscription for them here in Canada and they are on order from the U.S.

    We are wondering now if we should have got the surgery for Boston, as in splenectomy and maybe partial removal of liver tumours. Besides, the only way to know 100 % if it is hemangiosarcoma and not benign is to do surgery and histopathology.

    We need to find a holistic vet in Vancouver that practices both western and eastern medicine as in TCM (Traditional Chinese Medicine).

    Would appreciate feedback, especially from a holistic vet.
    Thank You
    Marion Lindsay
    Squamish BC
    mariontlindsay@gmail.com

  • 02/20/2013 03:38am

    I do not know anything about holistic or TCM, but I do understand the second guessing you are going through. I wrote about my little boy who has liver cancer a few comments up from yours. I had to rethink the exact date he was dx with it. Eclair has other health issues. In May, 2011, he was being ultrasound for his
    IBD, and his Internist discovered a small mass on the liver. We thought we would just watch it and ultrasound it the following month. We did a needle bx which said it was negative. His Internist said that that test was not really a good measure to determine if it was actually a maligment mass. She wanted to have the surgeon remove it. I was cautioned that he may not be a good canditate for surgery as he might not do well under anesthesia. Besides IBD, he has Cardiomyopathy, hypertension and kidney disease. So I went back and forth in my mind. Do I risk the surgery only to find out that it was beneign, and he didn't make it through it. Or have the surgery and hope for the best. It was such a heavy decision. I didn't want to lose my little boy. I kept talking to the specialist, having monthly ultrasounds done and doing my own research. I had a lot of sleepless nights. What should I do? In Novemeber, 2011, the tumor had grown to the point that I had to make a decision. I decided to let them do the operation. Once I made the decision, a peace came over me. No matter the outcome, I knew that for me, I was doing the best for Eclair. It did turn out to be primary liver cancer. The surgeon removed all of the surrounding tissue, which should that the cancer had not spread to it. He did recover and he now has ultrasounds and blood panels done every three months. This past Jan. 2013, the ultrasound showed two new nodules. I will take him in March for another ultrasound. I am holding my breath and I am very scared. I am writing this to let you know that I do understand what you are going through. Try not to second guess yourself if you can and I know that isn't easy. We each approach the care of our beloved pets differently. Go with your instinct. You know your pet better than anyone. You will reach a point where your decision feels right for you and your pet. It is hard making it, but once made, it gets easier. I am going to have to face this again. I love my little boy so much. On top of everything, he jumped off of my bed and tore his ACL in his knee. Surgery is not an option per the surgeon. He is slowly healing. I am 66 and a widow, yet I pick him up to take him outside or to get on my bed. I have taken my bed apart. My bed frame is out in my sunroom. My box spring is up against the wall and I am sleeping on my mattress on the floor, just in case, he has to get down and drink water or just to change positions and I am asleep. It will heal. Just takes time. He gets laser tx as well as shots for the arthritis. He is allergic to steroids. I know this is long winded. I started out trying to give you encouragement, but I seem to now be trying to give myself it. I feel comfortable writing here. Just seems that there is a lot of compassion and love on this website. Let me close by saying that I will be praying for you. You will find your peace.
    from, macrjobn

  • Beginning our journey
    04/22/2013 08:12pm

    I really empathize with your stories. Our beloved Shepard mix, Max, was diagnosed with hemangiosarcoma on the 17th. Everything the doctor said in her essay has happened and is happening to us. He was bleeding internally but no diagnosis could be made. We agreed to the surgery because we wanted to give him a chance. We agreed to let him go if the doctor found multiple tumors. He looked great internally and we had hope that it was a benign tumor. Only afterwards does the news come that it is cancer. He has recovered very well from the surgery. In fact, he seems upset that we are not walking him or playing ball with him (the stitches are still in and our vet hasn't cleared him for vigorous activity yet). Since the recommended chemo treatments are a fraction of the cost we already spent for the surgery, it seems inhuman to deny him this life-extending treatment. He gets his first chemo treatment on the 24th. We got him as a rescue when he was 4 months old and he is 11 years old now. He has spent every night on his life with us cuddled up to me with his head on my pillow. When he hears my alarm go off in the morning, he comes and snuggles up to me with his head on my chest. I'm never on time for anything because Max keeps me in bed. I just don't want him to go. Thanks for listening. I can't share this with anyone but my husband because people will think I am crazy. He's just a dog. But he's just the best dog ever and I can't imagine being without him.

  • Hanging on by a thread
    04/23/2013 01:54pm

    The thought of losing my best friend, frightens me so much, that sometimes I can hardly breathe. How do you prepare for it? I can't leave the house, unless a member of the family watches him while I run errands. I do not want him to die alone. I have put my life on hold. There will be time for me later. Right now I just want to cherish each walk, each play time, even feeding him is precious to me. There are some who might roll their eyes at me and that is okay. Before my little boy, I probably would have done the same thing. I try to be pragmatic and challenge my thought process, telling myself that I need to conquer my fears and take a deep breath. I try to focus on what his Internist is saying, knowing that I am living by emotions right now while trying to accept things the way they are. My family knows how I feel and my neighbors and friends have picked up on it. I have heard sympathy and I have heard jokes like " when I die, I want to come back as your dog ". Not funny. One day at a time is all I can do right now. He is still doing okay, but his ultrasounds aren't looking so good. Even if surgery was an option, he probably wouldn't survive the anesthesia. I know what you are feeling. I am so glad you have someone to share this with and to help you through it. There is a certain amount of peace in knowing we can share our thoughts on this forum. I wish you the best. I believe one day, we will find our peace.

  • 04/29/2013 06:35pm

    I really empathize with you. I feel the same way. The thought of losing my Max just hurts so much. I don't want my baby to die alone either so I understand how you feel about that too. My husband and I take turns sitting with him. He started throwing up after his first chemo treatment and refused to eat. He's at the vet's right now so they can stabilize him and get him eating again. But it is clear he doesn't feel good. My husband and I are questioning if we are doing all this for him or for us. We don't want to let go but we don't want him to suffer either. This is so hard. Hang in there. I think our compassion will be a credit to us some day.

  • 05/01/2013 11:55pm

    I am so sorry your little boy is going through so much. How many treatments are left? My Eclair couldn't do chemo. I was told chemo doesn't' work on liver cancer. I know it is hard to see him so sick, yet think how he will feel after the chemo. So many decisions to make when cancer is dx and the pain as we both know, is barely tolerable. I hope you will let us know how Max is doing. I know you are fortunate to be able to share your feelings with your husband, but we also care for Max. Somehow knowing there are other people walking the same walk is comforting. I am cheering you, your husband, and Max on, and sending good thoughts to both of you. More important, I will be praying for Max.


  • beating the odds
    05/07/2013 11:19am

    Our family has also been dealing with the exact same condition with our dog, Tess. 10 days ago she suddenly went down, exactly as the doctor above described. She required blood transfusions while we waited overnight for the surgery. She was a very sick dog. The veterinarian did not think she would make it thru the splenectomy and warned us that if tumours were found on the liver too she would make the decision to euthanize her on the table. Luckily the liver looked good and she eventually came out of the anesthesia. The trouble did not end there because she required 3 more days and nights of close monitoring for the arrhythmia of her heart. Overall, we had 5 different veterinarians prepare us for her to not make it. They even thought she had brain damage related to the blood loss.

    I am happy to report that Tess has been home for the past 5 days and continues to show improvement. The first day at home she remained on the iv fluids and the lidocaine drip for her heart. Today she is med free and walking, drinking and eating!

    Our family understands that our time with her is limited but at least we have seen her enjoy some extra time and we are more prepared for the inevitable.
    Most people would think we are crazy to opt for the splenectomy in our 12-year old springer spaniel but we are so happy that we did!

    We also feel very thankful for the fantastic care she has received from all of the veterinarians, especially the ones in the emergency clinic. She wouldn't be alive without their expertise.

  • 05/07/2013 08:44pm

    What would we do without our great vets! I am so glad that Eclair's doctors wanted to be a vet! I also love this website! It is my go to website for online help! If you want a great site to shop, go to wearethecure.org. It is the site of the Nat'l Canine Cancer Foundation. I really want people to know that cancer can affect our animals all. I have a t-shirt with a paw print on the front with Eclair's name inside the paw print. I am glad Tess is doing great! I hope Max is doing well also. Eclair sees his Internist next month. Holding my breath.... Hope the ultrasound shows that the nodules haven't grown more. His spirits are up. Yesterday, he got in the play position and we played tug a war, which hasn't happened for a long time. Besides the cancer and other health issues and being 14.5 years old, I was amazed at his energy. He is a poogle. I had his DNA done when he first started having trouble. Since he was a rescue, I thought he would be many breeds. But he is only two, a beagle and a poodle. I found some notecards that say "i rescued a poogle and he returned the favor". How true. We all can relate to that. He has been my heart and soul. He has seen me through so many events. When my husband died, he kept me going. I had to get up everyday to walk and feed him. And that was a blessing also. Anyway, it is so nice to connect with people who love their pets and consider them part of the family. I think we all feel there is nothing we wouldn't do for our pets.

  • My Shiraz
    05/20/2013 11:26pm

    My Shiraz is an 11-year old catahoula mix. Brought her to the vet last week because she was intermittently not eating and getting tired quickly on walks. Today vet did ultrasound and said she had the spleen cancer that had metastasized. He said he' d be willing to try the surgery but had little if any hope of improvement. He said she was basically in hospice mode and it would be less than a month. She's my first dog (I'm 57), a rescue, and just the greatest, sweetest animal you can imagine. She seemed fine until just about a week ago but the vet said she'd probably had this a while. She's always been so healthy; I figured she had at least a few more years. I have no other family members--lost my last brother to prostate cancer just a year ago, a few months after my fiancé walked out and I lost a job. I'm so sad. Thanks for listening, everyone.

  • 05/21/2013 01:48am

    I totally understand being alone, while going through what we are going through. I wish you could get to a practice of board certified vets. They have internists, oncologists, etc. your baby has more of a chance going there. However, if money is a concern, do you have a vet college near you? They might have a cancer trial going on and it is free, if your baby qualifies. Also, go to the cancer canine website. You might get help there. You are not alone. We are here for you. My dog Eclair goes for his ultrasound next week. Fingers crossed. I hate the word cancer. My mother died of breast cancer, my sister was 48 years old when she passed from bladder cancer, my 55 year old sister's breast cancer is in remission and my younger brother's colon cancer is also in remission. My husband passed from lung cancer. I don't know why things happen. I do know my faith plays a big role in my life. I try to keep it together....but there are times when I cry a lot. Please let us know how your baby is doing. I am praying for both of you. But pease don't let anyone talk you into anything you don't want to do. Trust your instincts. You will find your piece.

  • Siberian Husky prone
    08/25/2013 12:34pm

    Hello - [b] I think Siberian Huskies should be at the top of the list for breeds [/b]prone to this. I have owned 5 Siberian huskies and have not seen one live to beyond 8 years old as of yet. I've lost 3 to this awful cancer @ 8 years old and currently have 2 left - one is just 1 year old now and the other 7. None of my huskies were related. I just had my 7 year old husky's abdominal area ultrasounded and they do see a small cyst on his spleen which is under a 6 month watch. It is just unreal.
    Just wanted to share this with you & spread awareness to those with large breeds of 7 years old to have their pups ultrasounded - maybe they can prolong life by years by removing the affected spleen before it bleeds.
    Jill

  • Samson missed
    03/25/2014 05:13pm

    Dr. Intile,

    Your message about hemangiosarcoma hits so close to home with me. This past November, my wife and I made the confusing and painful choice to have our 10 1/2 yr old lab Samson to have surgery. I took it in baby steps hoping that he would even survive the surgery and post opp and deal with the biopsie results later. Sam encountered every complication he was faced with for this type of surgery. On his 3rd day in the hospital we were given encouraging words that his blood count was on the rise and that he was showing an interest in water and food. About 6 hours after that positive news, 4:00 am Thanksgiving morning with the turkey slowy roasting in the oven, I received a phone call to get to the hospital as fast as I could. My boy was gone when I got there. I ran over to him nudging the attendent aside and tried mouth to mouth. My wife pried me away from him sobbing heavily. They say he died from complication due to a clot as a result of the surgery. Several days later we got the pathology report saying he did have a splenic hemangiosarcoma. We paid over $5,000 but I didn't care about the money. I felt that he deserved that chance anyway. We loved him very much. What I wouldn't give for just one more day...just one to at least say good bye to my boy my way.

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