Caring for a Three Legged Dog or Cat
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Hi Docs, quick question for you that we've all been wondering:
If a Tripawd is diagnosed with osteosarcoma and upon doing a biopsy the pathologist discovers that cancer has metastasized to the lymph nodes, exactly how does this affect the overall prognosis and treatment options?
Thanks for any insight you can provide.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Keep in mind that I am not an oncologist, but I would suspect it doesn't affect the prognosis or treatment much (if at all).
The VAST majority of the time, by the time osteosarcoma is detected in the long bones of dogs, the cancer has already spread. We always do thoracic radiographs to check for pulmonary metastasis, and owners have a sense of relief if no mets are seen, but really a more appropriate diagnostic tool would be a CT scan to look for early mets. A lung x-ray may be totally "clear", but mets may still be present and visible on a CT scan. CT scans are not routinely done due to the associated expense.
If the lungs were already full of mets at the time of diagnosis, then I would definitely question whether it is appropriate to be undergoing chemotherapy, I would be more concerned with maintaining quality of life due to the advanced disease. But a positive lymph node in an otherwise happy and healthy dog? Probably the same prognosis and treatment options as any other dog with long bone OSA.
Right hind limb amputated 7/3/12 for OSA, started on alternating cycles of Carboplatin and Doxorubicin and oral Palladia. Single lung met 9/1. Met in the neck muscle removed 9/30. Large mass in sublumbar lymph node 10/2. Rescue chemo with ifosfamide 10/6. Mets to the rib and axillary lymph node 10/21. Started Leukeran and Pred 10/25. Wookie left this Earth for a far better place on 12/4/12. I miss you, Boo, you were my heart.
I have heard reports that elevated alkphos blood tests or enlarged lymph nodes at the time of surgery lead to shorter survival times but I do not think that is always true! Many times dogs will outlive "average" survival times so I would not change my treatment strategy based on only 1 or 2 variables. Even some dogs with lungs mets visible on rads at the time of amputation have lived over a year.
I am attending a continuing education conference in Seattle next month and one hour of lecture is devoted specifically to OSA so I will post an update here after the lecture.
Pam
Spoke to Jill's onco. Her lymph node was aspirated when we first discovered the OSA diagnosis and showed no sign of spread however when the leg was amputated lymph nods were not sent to pathology. She says she has seen several cases where there was lymph node spread and "long" term survival (take the word long for what it's worth). She does not treat OSA any different whether there is sign of spread to the lymph node or not.
Jill is a 9-year-old tuxedo kitty. She was diagnosed with Osteosarcoma in June 2012 on her toe in her right hind leg. Her leg was amputated on 12/12/12 and she completed four rounds of chemo (2 of Carbo, 2 of Doxy) in April 2013. "Like" Jill's facebook page: https://www.fac.....tty?ref=hl Proud member of the WINTER WARRIORS!!!! Her blog can be read at http://jillsjou.....ipawds.com. xoxo
Ricca, Tazzie Dog and Wookie and Jerry-----Thanks for your help on this question. It gives me a lot of good positive insight and knowledge that only seems to come from this site.
With appreciation, Sally and Happy Hannah
Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!
Wonderful and THANKS! It's what I thought I had heard but wanted a professional to answer that one. Thanks!!
Pam I can't wait to hear about your seminar, and would love to interview you for the blog.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
I asked about lymph node involvement today (3/15/2013) at Jackson's 4th chemo treatment: at this point I think we all know that OSA likes to spread to the lungs rather than travel within the lymph system, so taking a portion of the amputated lymph node is not a common practice. If his amputated lymph node were impacted, she's not be worried about that since it's now gone! I asked, well, if the amputated lymph node were impacted, wouldn't that make it easier for it to impact the other lymph nodes? The answer: no. So, there you have it. It's not common to sample the lymph node(s) with OSA b/c it rarely goes there. If it were in the amputated node…well, now it's gone!
I failed to ask, though: "what if a sample were taken and the amputated node were impacted? Would that impact the prognosis or treatment?" To me, that's a good question. Anyone have an answer?
ACL tear in right hind leg 12/5/12 and scheduled ACL repair surgery 12/21/12. Pre-op xrays revealed osteosarcoma. Amputation 12/28/12. Chemo (carboplatin) started Jan 10, 2013 and ended on April 5, for a total of 5 doses. He handled carbo like a champ! No side effects. We started metronomic therapy at his third chemo and have been also doing some holistic treatments. He's a lively, playful 10 year old huskie-boarder collie and a very proud member of the Winter Warriors! Our love. Our funny little guy!
I did ask my onco that and I see Dr. Sue responded to this question as well on facebook.
Dr Sue:
It has been shown to be a negative prognostic factor. The survival time with lymph node mets is about 2 months vs 11 months without.
Jill's onco just said to me, the treatment would not be different, but she has seen it negatively impact prognosis, but has also seen dogs defy that as well.
Jill is a 9-year-old tuxedo kitty. She was diagnosed with Osteosarcoma in June 2012 on her toe in her right hind leg. Her leg was amputated on 12/12/12 and she completed four rounds of chemo (2 of Carbo, 2 of Doxy) in April 2013. "Like" Jill's facebook page: https://www.fac.....tty?ref=hl Proud member of the WINTER WARRIORS!!!! Her blog can be read at http://jillsjou.....ipawds.com. xoxo
Thanks everyone for continuing to gather info. on the lymph node issue. Don't know if tis belongs where I originally postrd Happy Hannah's challenges --so p,ease move it where ou think best BUT YIKES! YLKES!! I just had Hannah undergo her first treatment YESTERDAY and I Just now saw the prognosis of two months potentially All the posts here on this page prior to this seemed to indicate it wouldn't change the prognosis and the tretment would be the same (prognosis being the one on lung mets probably showing up and the potential time frame associated with that). You may recall sirgeon said lymph node sibmitted---pathologist said not presented----surgeon said yes it was but cancer must have destroyed it----my REGULAR vet called pathol. to have it re-run and she stated again there was othing to re run because no tissue was submitted!! So I decided it didn't matter anyway----there was no roof whatsover if node was involved and the previous feedback up til today seemed a good indicator. I don,t think I would have ever started the chemo (especially as she,s still slower to recover and any side effect could tilt the scales backwards) I searched everywhere I could find and couldn't find median time if lymph involved --just how rare it ws Thanks zgain for your time and best of success to everyone
Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!
The research does show that lymphnode involvement is rare, but when it occurs it does have a poorer prognosis. But remember, numbers are just numbers, and t here are lots of them. There is only one of your dog, and she is an individual--not a statistic <3
One citation for you to look up, should you want to:
J Am Vet Med Assoc. 2005 Apr 15;226(8):1364-7.
Incidence and prognostic importance of lymph node metastases in dogs with appendicular osteosarcoma: 228 cases (1986-2003).
RESULTS:
10 (4.4%) dogs had histologic evidence of regional lymph node metastasis at the time of amputation. Median disease-free interval for dogs without regional lymph node metastasis (238 days; range, 0 to 1,067 days) was significantly longer than median disease-free interval for dogs with regional lymph node metastasis (48 days; range, 2 to 269 days). Median survival time for dogs without lymph node metastasis (318 days; range, 20 to 1,711 days) was significantly longer than median survival time for dogs with lymph node metastasis (59 days; range, 19 to 365 days).
CONCLUSIONS AND CLINICAL RELEVANCE:
Results suggest that regional lymph node metastasis is rare in dogs with appendicular osteosarcoma but that dogs with lymph node metastasis have a poorer prognosis than do dogs without.
"Let us think the unthinkable, let us do the undoable, let us prepare to grapple with the ineffable itself, and see if we may not eff it after all."
-Douglas Adams, Dirk Gently's Holistic Detective Agency
"May I recommend serenity to you? A life that is burdened with expectations is a heavy life. Its fruit is sorrow and disappointment. Learn to be one with the joy of the moment."
-Douglas Adams, The Long Dark Tea-Time of the Soul
Guess this was in Ettinger's book but I didn't see it. Oh yeah, Hannah's onco believes that it was just too destroyed for patho to fine it (she worksmin same place as surgeon) and because she had been limping so long all that probably indicates lymph npde I'm confused beyond salvation. the leg is off----the node is off I don't know how to do facebook so I don't know how to get more info from Ettinger. And please' I don't want to discourage anyone fromchemo as soooooooo many have had wonderful successess, For me had I had this new info., I think I would let her be "chemo and not do anything to compromise whatever immune system she has left--------meant to say "chem free" in previous line above
Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!
Sally,
I wouldn't let this affect you too much as none of your vets/surgeons/pathologists seem to really know if the lymph node was even looked at it seems? Again, you cant let the statistics get to you, especially when you are not 100% positive of what you're dealing with!
Jill is a 9-year-old tuxedo kitty. She was diagnosed with Osteosarcoma in June 2012 on her toe in her right hind leg. Her leg was amputated on 12/12/12 and she completed four rounds of chemo (2 of Carbo, 2 of Doxy) in April 2013. "Like" Jill's facebook page: https://www.fac.....tty?ref=hl Proud member of the WINTER WARRIORS!!!! Her blog can be read at http://jillsjou.....ipawds.com. xoxo
Excellent information that we really needed here gals, thank you. This wasn't in Ettinger's book, I looked through it extensively, so now that we have it this is fabulous.
Sally, please don't focus on that prognosis. MANY dogs make those statistics look so dumb. We have our paws crossed that Hannah will too. Remember that she doesn't care what a prognosis is, she just wants you to be happy.
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
I'll end with this, hard-*&^ statement: Sally, you have no evidence that her lymph node was impacted. None. Get over it. You and her vets came to the EXCITING conclusion that she's well enough for the next step: chemo! She's doing SO MUCH BETTER! She's getting better! She wags her tail more today than she did 2 weeks ago! You two are learning a lot and depending on each other. Forget about the &(%#ing lymph node! I'd have to imagine that if she had lymph node involvement, at this point she'd be showing some very serious, very obvious signs that her vets would have noticed and would NOT advise chemo. The fact that they've moved forward, her WBCs are strong....all indicate Hannah is a fighter and is doing well!
There. I'm done.
~ Katy
ACL tear in right hind leg 12/5/12 and scheduled ACL repair surgery 12/21/12. Pre-op xrays revealed osteosarcoma. Amputation 12/28/12. Chemo (carboplatin) started Jan 10, 2013 and ended on April 5, for a total of 5 doses. He handled carbo like a champ! No side effects. We started metronomic therapy at his third chemo and have been also doing some holistic treatments. He's a lively, playful 10 year old huskie-boarder collie and a very proud member of the Winter Warriors! Our love. Our funny little guy!
I am going to say this as someone who is going through lung mets after 4 chemos. We didn't know if it affected Sassy's lymph nodes or not. Would it have mattered?? NO. Do I regret chemo? NO Do I regret amputation? NO. It so far has given me 4 months plus with Sassy that I may not have had. Katy is right GET OVER THE LYMPH NODE. MOVE ON! That doesn't help Hannah now. What helps her is a positive attitude and your plan of treatment. I am sorry to have yelled but enjoy the time you have. You have only have a day or you may have a million days the only thing that matters to Hannah is that she isn't in pain and you love her. Be More Dog or Cat. Hannah doesn't know if it affected her lymph nodes. Prognosis is just a number. We have to stay positive. Thats all for me anymore, I enjoy every moment of every day with Sassy (even when she decides she isn't going out to go potty or come back inside)
Sassy is a proud member of the Winter Warriors. Live long, & strong Winter Warriors.
sassysugarbear.tripawds.com
07/26/2006 - Sassy earned her wings 08/20/2013
05/04/2006 - Bosch, Sassy's pal, earned his wings 03/29/19 fought cancer for 4 months.
"You aren't doing it TO her, you are doing it FOR her. Give her a chance at life."
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