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A veterinary blog for pet lovers, vet voyeurs and the medically curious...
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It’s perhaps one of the ugliest tumors we see, a knobbly blackish gray multilobulated lump that looks something like the fungal outcroppings your neglected refrigerated foods might suffer. When melanoma masses get to breaking and bleeding they’re even less likely to compete against Miss Venezuela for the coveted sash and crown.
Last week I cut one of these bloody suckers out of a mixed-breed’s mouth down near the base of his tongue. The lump on the underlying mandibular bone led me to discuss the likelihood of a malignant melanoma diagnosis even before the pathologist had her way with the specimen of greedy cells.
A trio of X-rays later (along with a histopathology report in damning black and white) and it seemed fairly plain: A big tumor in the lungs along with a nasty tumor in the mouth tends to signal the spread of this cancer: now add “metastatic” to the diagnosis of malignant melanoma…bad.
After the owners of this unlucky nine year-old endured their grief sessions in the privacy of their home, it was time to get down to brass tacks. What’s next? What can we do…if anything?
One option had included radical surgery of the mouth with a procedure that would essentially remove half of his lower jaw (hemi-mandibulectomy), but the spread of the melanoma to the chest pretty much precluded that option (truth be told, the owners weren’t too upbeat on that approach anyway). And going into the chest to pull out a fist-sized hunk of blackish flesh seemed an even more unsavory (not to mention extremely temporary) way to curb this cancer’s relentless drive to consume my patient.
A phone consult with two internists and one oncologist later, we’d finally decided to take on the tumors with the much-touted melanoma vaccine.
Though the melanoma vaccine is only approved for use in dogs who suffer malignant melanomas of the as yet non-metastatic variety (i.e., the solitary, black toe mass), it has been used to halt the rapid spread of late-stage manifestations of this cancer.
Without the vaccine this little guy likely has less than a month to live. With $3,000 of melanoma vaccine therapy his owners can buy him six to seven months of comfortable “cure,” on average…and, of course, there are no guarantees.
The good news, and there is some, is that the vaccine has no side effects (that we know of). The application of this non-drug is blissfully painless and practically stressless…for the patient, that is. But for the rest of us?
It’s a tough choice, knowing that several paychecks will need to go to your dog’s last few months. The time bomb factor. The worry if you do. The guilt if you don’t. It’s enough to hope for a speedy end so these decisions can be denied their intrinsically agonizing nature.
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Just another option...
Lori and Diesel
This post prompts more interest in: the pathology itself and why it has been written that mitotic<2 indicates non-malignant, yet it "can" be precursor to malignancy. And curiously, did this pet have any abnormal bloodwork: such as high alk phos or other liver enzymes.
And has the use of "piroxicam" ever been suggested and/or tried with this particular cancer? I noted a recent DVM360 article that had piroxicam listed for use with mammary tumors and I'm going to ask to try it with my older Scot diagnosed with adenocarcinoma recently.
Have to say, "piroxicam" has been hugely successful with abating symptoms and slowing progression of Transitional Cell Carcinoma, if the dog can tolerate it.
http://www.holvet.net/neoplasene.html
Lori and Diesel
what are the signs/symptoms of malignant melanoma? since it was in the back of the dog's throat, i don't think it's visible. did owners just observe him not eating for several days and figured something was wrong with him? i want to be observant so if it's something that can be caught, removed and treated, it will keep my dog with me as long as possible.
thanks, leslie
One way to look at this conundrum is to accept that the animal has a life-threatening disease. So, anything that is done to prolong its life is just that: the prolonging of its life. If the disease were to run its normal course -- say, out in the wild -- the animal would die. The actions we humans take may give an animal extra time. If I let the animal die on nature's schedule instead of trying to squeeze out extra time, I feel sad for the loss, but not guilty.
I know this is not a popular way of looking at things, but I’m sure I’m not the only one who feels this way. (And, yes, I feel the same about my own life/death.)
Just thinking this all through as I read your post and the comments. Although it's never clear until it's one's own pet and money involved. And heartbreak.
leslie, according to the above link, you would want to be vigilant checking your dog for any type of melanoma. It is thought that eye, toe, and oral cavity are the worst areas, but have discovered that melanomas arising from "haired areas" can be malignant also. Also, to answer "my" question, mitotic rate or histology is not a guarantee of non-malignancy.
I was so curious of this topic, because both my dear Pocket (linked to my name) and her dam , both sprouted an eye rim melanoma (same eye, same location) & surgically removed w/ margins, two years prior to their death(s). In addition, one of Pocket's littermates had a toe melanoma (digit removed--but never healed) one year prior to death.Coincidence-maybe? Scotties & mini-schnauzers are known to have this come up. And curiously, there was a rise in alk phos to a peak well beyond 1000, followed by decline.
Marcella: I echo your sentiments, I would be less likely to treat terminal illness agressively in an elderly animal (or myself, or loved-human) and opt for comfort and supportive measures.
When my guy developed (atypical) Cushings, I did quite a bit of research on alkaline phosphatase, but never came up with any info on the melanoma connection. Most of the info said when alk phos increases in an adult dog (w/out other liver enzyme increases and no evidence of liver disease) to look at Cushings, hepatic nodular hyperplasia (benign), and bile duct obstruction. I've heard of some Cush dogs having an alk phos at 15,000.
It is curious. Does anyone know of the reason of the increase and then the sudden decline in alk phos in cancer/melanoma cases? Does the ALT also increase in cancer cases where the alk phos increases?
I have read a few times, that cancer cells are "water-loving" cells. Everything I've read on true Cushing's indicate 2-21/2 times normal water consumption--
I find atypical Cushing's a fascinating subject and wish their was more published about it. Wonderful that U of Tenn. has the panel for diagnosis!
Do I feel the need to know the source or metastasis of my 11 yr. 5mo. half-sister to Pocket's adenomacarcinoma? Nope! Nor did I need to know Dottie Sealyham's, who's groin lymphnodes swelled to rock hard limes.
I agree--Thank goodness for the U of T! And especially Jack Oliver! What a wonderful gentleman and doctor he is.