Note to admin- I couldn't decide it this went here or under Treatment and Recovery- feel free to move it...

My pug Maggie has mast cell cancer.  She had her left rear leg amputated in September of 2006, and incredibly is still here. For those of you who don't know Maggie's history you can read it in her blog at: http://maggiesj.....ies-story/

We were at the vet today because I found two more bumps on Mag, one of which we are pretty sure is a new cutaneous mast cell tumor (MCT). The thing about cutaneous MCTs is that they may each be an independent primary tumor, and NOT an indication of mets.  This seems to be the case for Maggie.

Some background:

The tumor in her leg which led to the amp was actually her second MCT. When first presented with the diagnosis of the tumor in her leg and the potential options I decided right away that I would not do radiation therapy on her.  It was a personal choice knowing  that pugs, and particularly Maggie, do not do well being anesthetized.  The radiation treatment would require her to be anesthetized frequently, and I felt that there was a good chance she wouldn't survive multiple treatments. As it turns out radiation was not an option for the tumor in her leg, it was just too big.  It could have been used on subsequent cutaneous tumors but I do not consider it an option for Maggie. 

After Mag's amp she went through 6 months of chemo.  While she did fine, she was often tired and lethargic.   I have also decided at this point that I won't do such a rigorous chemo treatment again.  Maggie is almost 11, I'm not sure how long she has, but I don't want her to spend 6 months tired all the time.  Don't get me wrong-  I don't regret the decision to do chemo at the time-I think it has saved her life. But now there are different factors to consider when deciding on treatment.

Last March I found what turned out to be two cutaneous MCTs, one on her chest, and one on her back. She was due for an oncology check up so we met with the oncologist to decide the course of treatment.  Usually for cutaneous MCTs the tumor and a huge amount of surrounding tissue is removed to be sure to get all of the the tumor.  MCTs show as a bump, but there is usually more of it than you can see.  Picture an egg cracked into a pan.  The yellow yoke is the tumor you can see, but the surrounding clear (what becomes white) is the rest of the tumor.  Maggie's first MCT (before the one that caused the amp) was cutaneous- she has a 6-7" scar on her side from the surgery- and she is only 21" around at the chest.  When we found the tumors last March Mag was 10. I had decided then that I would not do any more huge tumor removals.  I met with the oncologist and expressed my concerns about aggressive treatment.  She was totally supportive of my decision.  Together we decided to run some tests to make sure her internal systems were still clear of cancer, which they were. Then Mag's oncologist suggested we remove just the tumor under a local anesthetic.  I thought this was a good option since it was minimally invasive, relatively pain free, and Mag didn't need to go under. She ended up with two stitches in each site.  The risk is that you don't get it all and the tumor re-grows. Because we did not get good margins, that is a 'zone' of cancer free tissue around the tumor, the tumors were graded II.  That means that there is a possibility that they would re-grow.  Nine months have gone by and there is no tumor growth in the areas.

So that brings us back to today.   Maggie had a lump on her side and a tiny one on her nose.  My vet and I are pretty sure the one on her side is a MCT- the one on her nose maybe not. While you can't necessicarily tell a MCT by looking at it, given Mag's history and the fact that this one looks like the six other cutaneous MCTs we have dealt with between the two pugs I will be shocked if it is not a MCT. Instead of aspirating each lump to see if they were MCTs we decided just to take them off.  Another thing about MCTs- they can releases histamine-containing granules that lead to inflammation and increased stomach acid secretion. So dogs will usually be put on Pepcid during treatment to help counteract stomach problems.  Since we most likely would have to take the tumors off anyway there seemed to be no point in testing it ahead of time- both tumors will be sent for biopsy to confirm diagnosis.

My next decision will be whether or not do do an full oncology check up in March or April.  Since I am going down the path of minimal treatment it doesn't seem necessary to do a lot of expensive tests.  As many here have decided I may wait until she shows signs of internal cancer before I do the tests. And I'm not sure how many more tumors I will remove either, I guess it depends on the rate they show up, the location and the rate of growth.  A fast growing tumor is an indication that it is aggressive and potentially more dangerous. And at some point you have to stop if they keep coming back. Another MCT thing- dogs that have had more than one MCT are likely to develop more.  This is true in Mag's case but so far all seem to be independent and not signs of mets.  One of my oncologist's Bostons,  a twelve year old, recently died with ten MCTs- but they were not the cause of death.

I read somewhere that after treatment dogs are considered 'cured' of mast cell cancer if no new occurrence happens with in 6 months.  We have made it past 6 months twice, only to find cutaneous MCTs later.  I'm not sure what this means- but Maggie is sure a survivor!

There is not many of us on this site dealing with mast cell cancer and I have not seen much info posted. Hopefully this information will be useful to the next parent dealing with mast cell cancer.

We should get the biopsy report back Monday or Tuesday, and Mag gets the stitches out in 10 days.  Then we will go on,  always on the look out for the next lump. My dad and I are trying to decide if we should call her 'lumpy' or 'stitch'.

Karen