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When to amputate for a mast cell tumor
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Member Since:
26 September 2011
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26 September 2011 - 5:29 pm
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Hoping to find some guidance and encouragement.  It's actually difficult trying to type this as I can't stop crying.  We have Willy a 9 y.o. Bishon Frise (sp?) who was just diagnosed with a mast cell tumor on his front left paw.  We're not sure of the level (1, 2, 3) yet and the doctor is putting together estimates of what to expect with the costs for complete diagnosis and treatment.

We love Willy and want to do whatever we can, but I also do not have thousands and thousands of dollars for treatment that in the end may not even work.  We also do not want him to be in pain or to suffer if we decide not to treat and opt for the care and comfort route.

At first diagnosis, the vet was recommending us to see an oncologist; this came as quite a blow.  He doesn't even act sick (my groomer is the one who noticed the paw that was irritated).  The thought of putting him down has been devastating to both my daughter and I who love him very much.

I went to the vets to pick up the steroids they prescribed to bring down the swelling and make him more comfortable.  I was pressing the technician for answers as to what I should do.  She couldn't really tell me anything more than I already knew, but did ask the question "What do you think about three legged dogs?"  I said "I don't have a problem with three legged dogs, I have had a number of elderly blind and deaf dogs, I can handle a three legged one."  She told me to wait to speak with the vet to see if he is a "candidate".

It was a very long few days waiting to "hear" from a vet who called on Saturday to say he should be an excellect candidate.  I asked if we could do some testing to make sure it hasn't spread and she said yes stating they would do x-rays and a cytology test.  I scheduled him to go in on Tuesday (tomorrow) for this testing.

Well, I just got a call from another vet at the same location (he owns the hospital) who thought amputation was an extreme treatment (if it's a level 1) and that he recommended removing the tumor instead.  I told him I do not want to do that if there is a high potential of reocurrence or possible infection at the site that could lead to amputation anyway.

He told me he would read through the pathologist report again, to see what if anything additional it says about the findings.  He stated the other types of testing to check for cancer are with the lymph nodes, the blood, the liver and lungs.

He informed us the best case scenario is a level 1 and easily removable; the level 2 could go either way and the worst level 3 not treat-able.  We don't want our dog to suffer, but are also scared of the future for him.  I have read a number of things on your website and while there is much encouragement the unknown is very troubling.

I would appreciate hearing from others who may have gone down this road and what to possibly expect.

Thank you so much for creating this site.  It provides hope to those of us who feel lost.  sad

krun15
2
26 September 2011 - 5:59 pm
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Hello and welcome to Tripawds.

I'm sorry you have had to find us- but this is a very experienced and supportive community.

Most here are dealing with osteosarcoma (OSA), not as many with mast cell cancer, but there are a few of us.

I have been dealing with mast cell cancer for about 5.5 years.  You should hear from Rio's Mom Micki- she has been at it this long too.  And there is Roxy- who has been hopping along for over a year without chemo.

First off- with the approximately 15 MCTs in two dogs I have never known them to cause pain (assuming they don't ulcerate).   That is often a deciding factor for amputation in dogs with OSA, but that was not a factor for me.  My pug Maggie lost her left rear leg to a MCT in her knee.  She never limped, her leg function was just barely compromised.  I chose amputation because the tumor was large and most likely would have ulcerated.  If that happens a wound can form that will not heal- then there is discomfort and pain.  Also the chance that the cancer can metastasize to the lymph system, liver, or spleen.  Maggie had previously had a MCT removed.

In my experience you can not tell the grade of the tumor until it is removed.  So my amputation decision was based on the reasons listed above.

You can read Maggie's story in her blog- the link is in my signature box below.

I know you are feeling overwhelmed right now- but take a moment to breath!  You guys are on the right track- your pup's quality of life is first! 

I have to run right now- but I'll check back later tonight.  You can send me a Private Message (PM) if you want to talk more.

 

Karen and the pugapalooza

p.s. future posts will not require moderation

Member Since:
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26 September 2011 - 6:38 pm
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Our Bo had osteosarcoma, which was quite painful for him (and us to watch). So, our decision was made to eliminate the pain and increase his quality of life. We didn't definitively know the type of cancer until after amputation, but our vet had a pretty good guess from the symptoms/x-rays. 

We also did not have thousands and thousands of dollars to spend on treatment. Amputation gave Bo the most bang for our buck, so to speak. We got rid of the pain and gave him a better quality of life. From reading, I know that MCT is quite different than OSA, so I'm sorry I don't have any other advice.

No matter what happens, Willy is lucky to have you and any decision you make is right because it is made out of love. Keep us posted...you've come to an amazing community with some of the best folks around!

 

Meghan and Angel Bo 

Washington
Member Since:
1 February 2011
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26 September 2011 - 7:02 pm
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First off, Mast Cell cancer is a WAAAAYYY better diagnosis than osteosarcoma. I say this because it is so much less aggressive and it doesn't cause the pain or fractures of OSA. That said, no cancer is good, and it's a scary thing to hear about someone you love.

As Karen said, we've been at the Mast Cell thing for more than four years now. Rio has gone the gamut of treatment, and only underwent the amputation because her most recent tumor grew in her lymph node. If I had to do it all over again, knowing now what I didn't know back then, I'd probably not change anything. It's been traumatic and heartbreaking and scary and frustrating. Rio's never once stopped fighting. She's had days where she didn't feel very well, but she's never stopped smiling through all of this.

Mast Cell cancer can go years without metastasis. In most cases, surgical removal with wide margins are considered "cures." Rio's was atypical in that it was locally aggressive. We removed it, and within weeks it was back in the same area. Another surgery, and it came back even quicker. We did a third surgery followed by radiation, and she was fine for two years. Because her cancer came back after that, we knew that she was on the "bad" side of the statistics for this cancer. So we chose a more aggressive route for her subsequent treatments.

The x-rays seem odd -- typically to check for spread of disease they do an ultrasound, since MCT goes to the liver, spleen and bone marrow. The cytology will likely be for c-KIT mutation, which will better define what sort of treatment options will be appropriate. Some of the drugs work better on non-mutated c-KIT. Since MCT doesn't go to the lungs, it seems that they don't really need to x-ray (just my opinion, but my oncologist said the same when Rio developed a cough). I would definitely ask about that, because it starts to add up quickly, so if you can avoid some of the expenses.....

I would be happy to answer any specific questions that you might have about our experiences. Just send me a PM...

Good luck, and hang in there.

Rio and Micki

the Woo

~ ~ Rio ~ ~
Forever in my heart...

April 2000 – January 20, 2012
Diagnosed with Mast Cell Cancer in June 2007. Left rear leg amputated Feb. 8, 2011.
Mets discovered Aug. 31, 2011. Read more of Rio's story here.

On The Road


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26 September 2011 - 8:15 pm
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Welcome, we're sorry to hear about Willy. Be sure to check the Tripawds Nutrition blog for lots of healthy diet and cost effective homeopathic canine cancer treatment options. Jerry's Required Reading List also has links to many of the most helpful blog posts and forum topics the Tripawds community has to offer.

Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet

Las Vegas, Nevada
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14 August 2009
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26 September 2011 - 10:04 pm
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Welcome Willy and Family,

As you can see others have great experience with Mast Cell.  I don't.  But I just wanted to welcome you and send you good thoughts.

Keep us posted!

Her Retired AvatarComet - 1999 to 2011

She departed us unexpectedly  January 23, 2011 at the age of 12 1/2.

She was born with a deformed front leg and a tripawd all of her life.


Member Since:
22 August 2008
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27 September 2011 - 1:12 am
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I would not amputate yet.  Prednisone often shrinks the tumor so you can get better surgical margins.  After the entire tissue is sent in the pathologist will determine the grade and check for clean margins.  If the tumor comes back with clean margins and is a Grade I or a low-grade II then you are done.  If margins are "dirty" you still have the option of watchful waiting since many of these never recur or grow slowly.  If the tumor is a high-grade II or a Grade III (unlikely in that breed) then you could pursue other diagnostic testing which as Rio's mom said usually involves ultrasound and needle aspirates of liver and spleen and not xrays.  Only after all of those tests should aputation be considered.

Pam

New Jersey
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4 June 2011
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27 September 2011 - 1:02 pm
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Rumbles had one surgery to remove two tumors…the one in his "underarm" tested as MCT, the one on his elbow as hemangiopericytoma. Six months later the hemangio tumor recurred and we amputated.

The mast cell tumor has not shown its ugly little cancer face again. Hopefully it will stay away.

Based on our experience with MCT, I would try tumor removal surgery first as it is much less expensive, much less invasive and much less traumatic than amputation.

Best of luck to you and your pup.

krun15
9
27 September 2011 - 1:28 pm
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I like Pam's advice (she is a Vet).

I missed the part in your post about his paw being irritated- that does mean you probably need to do something for his comfort. Hopefully the prednisone will shrink the bump.

I have taken 5 tumors off my second pug and none of them have come back.  The last two I took off were just the tumor- not a lot of other tissue.  One came back with dirty margins, but I have not done anything else at this point.  Because she has multiple tumors (3 more that I know of) I will probably not take any more tumors off.  She is fine now, in fact her aging issues (she is 11) are more worrisome at this point than her cancer.

I'm curious to see the results of the tests you are doing today.

 

Karen and the pugapalooza

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26 September 2011
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4 October 2011 - 12:32 pm
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Thank you all so much for responding.  Your kind words help.  I'm back with some results on Willy.  Lymph node was too small to aspirate a sample.  Vet said this is good in that the chances of anything being there are slim to none.  X-rays were clear with one exception....found out he has a dozen bladder stones too.

Vet said he may have had them for years and asked a number of questions (i.e. pain when urinating, excessive licking of genital area, etc.).  Similar to MCT he has never shown any pain.  Vet said it's a gamble.  He could live with stones and never have issues or it could create a blockage and have grave consequences.  He said if I wanted we could do the stones at the same time we address the leg.

I'm so torn up about what to do about his leg and this latest diagnosis doesn't help.  From your responses and some of the other discussions it seems like MCTs are not as serious as OSA, but it's still a gamble if the choice to remove the mass doesn't work and it comes back.  I don't want to do repeated surgeries and want to make a decision with the best probable outcome.  Vet did state amputation would do that if I decide that route.

Is it selfish of me to not want to put him through the pain of multiple surgeries, save myself from going into a financial hole and opt to amputate?  It's so hard to make a decision that I am almost paralyzed by it.  confused

krun15
11
4 October 2011 - 2:02 pm
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Making these decisions is never easy.  And they are made more difficult when there are more complications.  And dealing with mast cell cancer is hard- our oncologist calls it the most frustrating cancer she treats because it is so hard to predict what it will do. 

One question I forgot to ask before- is the tumor size reactive?  Is it noticeably growing or shrinking?  I think you just found it so might not know the answer to that yet.  Sometimes a less reactive tumor- one that stays the same size- is less of a problem.  Is Willie actually limping on his paw?  Where exactly is the tumor?

If it was me I would not amputate without an ultrasound of the liver and spleen to see if there are problems there- since that is where mast cell tends to go (besides lymph nodes and bone marrow).  I know that involves more money- I think the last one I did on Maggie was about $325, I live in the San Francisco Bay Area.  I wish finances didn't play a part in our decisions, but the fact is they do.

I still like Dr. Pam's advice of shrinking the tumor with pred and then seeing if it is removable.  Did you get cost estimates from the vet on the different procedures?  From my experience with my pugs, and my own orthopedic experiences, surgeries that involve soft tissue and not bone are not as painful and surgeries involving bone.  No doubt there is some discomfort though.

I'm not sure I am being very helpful here- like I said these are hard decisions to make.  You have to weigh all the factors- where the tumor is, Willie's overall health, his age, your finances, etc.  Based on what you have said I would go with the less aggressive treatment first- removing the tumor and see if it comes back.

What ever you decide to do we will be here to support and help you all we can.

 

Karen and the pugapalooza

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4 October 2011 - 3:15 pm
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Thanks so much for your response and follow-up questions.  The MCT is on the pad of his left foot.  He does not limp on the foot nor does he act like it bothers him.  He will occasionally lick it when alone, which makes it swell.  I didn't even know it was there; our groomer brought it to my attention.  Although it has gotten larger over time, it did shrink when he started taking steroids.  The pad is approximately twice the size it should be.

The vet told me the location where it is; there is ver little tissue there and there is a high potential for the incision to not heal as it should (I also read that in one of the Tripawds discussion threads).  They also said that due to the far reaching effects of the MCT they were not sure as to how good the "margins" would be if we choose to remove the MCT vs. the entire leg.  The estimates I were given were $980 to remove the MCT or $1180 to remove the leg.  If I opt to remove the stones at the same time it's an additional $650.

If removing the leg will alleviate the possibility of additional surgeries (removing the MCT and it growing back) my tendency is to go with the more sure route; I'm not a gambling woman.  The vet also told me they could take a small section of the MCT and have it tested further.  It would be easier to make the decision if he was in pain or having difficulty walking, but then again maybe it wouldn't.

I just don't want to jump the gun.  I also have my 18 y.o. daughter who is pressing me to schedule the surgery, while I am experiencing all this doubt.  I wish I had a crystal ball.  This really sucks.  yell  Pardon the language.

I truly appreciate the feedback from this group.  It is a tremendous help.

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4 October 2011 - 6:15 pm
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The important thing to remember, no matter what you decide, is that you have Willy's best interest at heart. You will make the right decision for him and your family. Your vet sounds really honest and it's great that they already gave you an estimate for the different procedures. Good luck and keep us posted!

Washington
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1 February 2011
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5 October 2011 - 12:41 pm
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With my own experience with Mast Cell, I would still opt for surgical removal of the tumor over amputation. Here's why: Mast Cell cancer has a 50% chance of being completely cured with a simple excision. Granted, if it does come back you are looking at more surgery and additional expense, but there is always the possibility that even with amputation, the Mast Cell will reoccur somewhere else, and so you'd still be looking at additional treatment costs.

You could look at one of the targeted therapies (Palladia or Kinavet) to shrink the tumor, then do the surgical removal, too.

Just my two cents....

I'm still mystified by your vet's use of x-ray vs. ultrasound for the abdomen check. We've been seen by numerous oncology specialists, several different vets, etc., and never have had an x-ray. Did he say why he used x-ray instead?

Micki

the Woo

~ ~ Rio ~ ~
Forever in my heart...

April 2000 – January 20, 2012
Diagnosed with Mast Cell Cancer in June 2007. Left rear leg amputated Feb. 8, 2011.
Mets discovered Aug. 31, 2011. Read more of Rio's story here.


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6 October 2011 - 12:01 am
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Any chance you can post a photo of the pad?  If the entire pad is twice the normal size even after prednisone and Benadryl and we are talking about the large pad that he walks on (not a small digital toe pad) then amputation might indeed be your best option.  Based on the quote of $900 to remove the tumor I am guessing that it is more involved then it first sounded.

I do agree that it is still a good idea to have an abdominal ultrasound done prior to amputation so you know what you are up against.

Pam

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