Hello and welcome back!  It's wonderful to hear how well Layla has done over the past two plus years.  I went back to the beginning of your post- so now she is between 12 and 13 years old?

I'm so sorry you are dealing with cancer again- stupid cancer!

My pug Maggie survived several years after her amp for mast cell cancer, she developed oral melanoma about 3.5 years after her amp.  Oral melanoma is very aggressive and the suggested treatment was surgery to remove the tumor and part of her upper jaw, followed by radiation and the melanoma vaccine.  Mag was near 11 at the time and also dealing with renal failure.  She had never been a good surgery patient, almost passing due to the anesthetic.  No way could I do radiation for her and I felt she was done with aggressive cancer treatments after the previous 4 year battle with mast cell cancer.  I chose to keep her comfortable for as long as possible, Mag passed 3 months after the oral melanoma diagnosis.

Karen and the Spirit Pug Girls

I was in a weird place with Maggie when the oral melanoma was diagnosed.  She had been diagnosed with renal failure a month or two before so getting her to eat was a real challenge which is common with kidney problems.  I pretty much had to feed her with a syringe for her last 3 months or so- nothing to do with the cancer.  So I could not use appetite to gauge how she was dealing with the oral tumor.

I actually let Maggie go when she needed meds to manage the pain from the tumor.  She was dealing with kidney failure and her liver was suspect because of the original mast cell cancer so strong pain meds could have caused additional problems.  But the biggest issue was that she really did not do well with pain meds.  In fact I had given her some tramadol on what turned out to be her last night and she didn't sleep for 12 hours and acted like ghosts were chasing her!  I discussed with my vet but mixing and matching meds to try and get her comfortable would maybe buy us a few days or a couple weeks, really just postponing the inevitable without being sure we could find something that would work.

As far as dealing with the unknown- when the oral cancer was diagnosed and I decided not to do aggressive treatment I defined for myself what Maggie's minimum life quality was. It helped to do it while I was still kind of clear headed, I knew what I was looking for and I do think it helped me when we reached the end.

I'm so sorry you are dealing with this! For me the second cancer diagnosis was in some ways more devastating than the first.  Seriously- isn't one cancer enough? 

Karen