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Hemangiosarcoma, Hemangiopericytomas and Hemangiomas
Hemangiopericytoma
Hemangiosarcoma
Hemangiosarcoma tumors on skin
Hemangioma
Cutanious Hemangiosarcoma
Hemangiosarcoma
Hemangioma and pathology report
Hemangiomas
Hemangiomas and hemangiosarcomas
Hemangiopericytomias
Hemangiosarcoma and Chemotherapy
Hemangiosarcoma
also see Dog cancer
HemangiopericytomaQuestion: Dr. Richards,
I have a question about my 11 year old female German Shepherd. Katie
recently had a mass removed from her right front leg, near the elbow. It was the size
of an egg. It was not visible due to the fact that it was on the inside part
of her leg.
I felt it when I was checking for ticks. We don't know how long it was
there. The biopsy came back as a Hemangiopericytoma. What do you know about this
type of tumor?The biopsy report said this never metastasizes, but has a high recurrence
rate. Our vet checked into radiation for Katie. Given her age, the high cost of
treatment($6000) and the fact she would have to live at the hospital for 4 weeks, we
decided against radiation. Would you recommend any kind of further treatment? We have
decided to keep a very close watch on the area, and would opt for surgery again if
the tumor returns.I really would like to learn more about the tumor and any thoughts you
have would be greatly appreciated.I look forward to your reply, and I enjoy reading your comments. Would
it be possible for you to send me an e-mail message letting me know you have answered my
question?Thank you, Lucille
Answer: Lucille-
At the present time the feeling is that hemangiopericytomas and peripheral nerve sheath tumors (PNSTs) are the same thing, or so closely related that it isn't too important to differentiate between them. I think that many veterinary pathologists would agree with the second statement and somewhat fewer with the first statement, although I have never seen anything approaching a formal vote on that. These are among the tumors considered to be in the soft tissue sarcoma class of cancers and are also sometimes referred to as spindle cell origin tumors.
PNSTs and/or hemangiopericytomas thought to be Grade 1 or Grade 2 by the pathologist have about a 10 to 20% rate of metastasis to distant tissues, according to the chapter on these tumors in "Small Animal Oncology, 3rd. ed." by Withrow and MacEwen (2001). If the tumors are judged to be Grade 3, then the metastatic rate is supposed to be about 50%. However, there seems to be a lot of disagreement with this assessment among veterinary pathologists, with many feeling that these tumors rarely metastasize. Our experience is more in line with this opinion but truthfully, since post mortem examinations are rare among veterinary patients, it may happen more than we realize.
These tumors are very likely to recur in the area in which they were removed, especially on a limb, because it is extremely difficult to remove all of the tumor without amputation of the limb. They are reported to be sensitive to radiation therapy and the recurrence rate is supposed to be markedly reduced through the use of radiation. The problem, as you note, is that radiation therapy is expensive and has other drawbacks, such as the time spent transporting pets to available facilities, radiation side effects, hospitalization, etc.
If radiation therapy is not done, there are really only three available courses of action if and when a recurrence takes place.
The first option is to repeat the surgical removal of the tumor and to keep repeating this process until it becomes obvious that further surgery is going to be too detrimental to make it worthwhile. We have followed this course of therapy with several patients and have done surgery five times on one patient over the course of about four years, before it became impossible to even consider attempting surgery again. One consideration in this plan is the age of the pet and overall health. An older pet may be a good candidate for this plan simply because the time provided by debulking surgeries may provide a reasonable quality of life for the remainder of the pet's natural life span.
The second option is to amputate the affected leg. This is a reasonable option in some cases, such as a small or medium weight dog who is not suffering from arthritis in the other limbs, not excessively obese or having some other problem that would make it hard to tolerate removal of one limb. It can work well even in large breed dogs but a careful assessment of the overall health status and of the ability of the other legs to bear more weight is best prior to considering this option.
The last option is to do nothing unless the tumor causes problems when it returns and then to consider euthanasia at that point. This can be a reasonable option in some patients, especially those with additional health problems in which the tumor is just one concern among many.
I hope that this helps some in your decision making.
Mike Richards, DVM
9/22/2001
Question: Dr. Richards.....
My 9 1/2 year old field trial Lab was diagnosed on 4/23 with
hemangiosarcoma from biopsy results......the tumor appeared on his left side
suddenly on 4/9.....test results also showed low white, red, and platelet
counts.....he was on a declining dosage of prednisone from 3/20 until 4/20
for a lesion between his 6th/7th vertebrae that was causing uncoordination in
back legs....on 4/19 he had a lot of blood pooled in his underbelly and left
leg and was very bruised in those areas........I started giving dosages of
vitamin C & E....and all those problems have subsided.......will add vitamin
A to that beginning today....also just started a high protein natural diet
and am considering the Science Diet N/D food.....trying to see an oncologist
also........is there any hope??......experimental treatments?.....new
treatments??.......do you agree with some of the things I am doing and do you
have other recommendations????Thank you, Bruce
Answer: Bruce-
There are two prognostic factors that seem to matter a lot when it comes to hemangiosarcoma
tumors of the skin. The first is the exact location of the tumor. The prognosis for hemangiosarcomas
confined to the skin itself (intradermal) is good with surgical removal alone and may be improved
some by either doxrubricin chemotherapy (Ogilvie, et al. 1996) or radiation therapy (anecdotal). If
the tumor is located in the subcutaneous tissues the prognosis is worse and it there is more reason to
consider being more aggressive about chemotherapy or radiation therapy. However, the other
prognostic factor that seems to matter is the age of the dog at the time the tumor occurs and an older
age onset is better than younger age onset. Hopefully, this tumor was confined entirely to the skin
and had not invaded the deeper tissues but you should check with your vet about this.It would definitely be best to take your Lab to the oncologist if that is an option. There is a lot of
information shared among specialists long before it makes it into print where general practitioners
can find it.There is no dietary therapy that I am aware of that has any proven value in treatment of
hemangiosarcoma, including n/d (tm) diet, but I don't see any reason not to try these things as they
are not likely to cause harm.Good luck with this.
Mike Richards, DVM
5/18/2001
Hemangiosarcoma tumors on skin
Question: thank you very much for your answer. My little
dog Chelsea had a tumor on her neck, it was removed very quickly after I
saw it and the biopsy reported that was hemangiosarcoma. The surgery
occurred on october, 21 and she is doing very well, happy, eating ,
joking, etc. I can not believe she will die soon. Is it possible an
error ? It was a solitary tumor and she feels good , until now. My best
regards, Maria
Answer: Maria-
Hemangiosarcoma tumors that arise in the skin are different than other
types of hemangiosarcoma. For these tumors the prognosis is good if the
tumor is located entirely in the skin (no penetration at all into the
subcutaneous tissues). In this case, surgical excision of the tumor has a
very good chance of removing it entirely and curing the problem
permanently. If the tumor has spread into the subcutaneous tissues at the
time of surgery and a wide margin of tissue is removed around the tumor in
all directions, including underneath it, there is still a reasonable hope
for a good outcome.I hope that this tumor was located completely in the skin and that Chelsea
will do well. The pathology report might tell you if the tumor had spread
into the subcutaneous tissues if your vet was unsure at the time of
surgery. In this case, I did not take into account the possible locations
for the tumor when answering your question. These is the possibility of a
much better prognosis for a cutaneous hemangiosarcoma than for other
internal sites.Mike Richards, DVM
12/4/2000
Question: Thanks.
What is a hemangioma?
Answer: Ray-
Hemangiomas are a benign lump formed by blood vessel tissues that occur in the skin. There is some
argument about whether these are even a cancer, although they are usually classified that way. They
are more common in dogs but do occur in cats, as well. Hemangiomas can vary in color from bluish
to purple to reddish-black or purplish-black. Most hemangiomas appear to be raised lumps but we
have seen some that just looked like skin discoloration. They can vary in size from very small to as
large as several centimeters in diameter. Sometimes they look like a small chain of colored lumps.
We have seen several patients with hemangiomas that would intermittently bleed, probably from
self-trauma because this seems more common when they are on the side of the face or around the
ears. If these are present, the good thing is that surgical removal should provide a complete cure if it
is possible to get the whole tumor. In sites where this is hard, radiation therapy can be helpful. It is a
good idea to send biopsy samples from these lumps in for examination by a pathologist as they can
be a hard to distinguish from more serious cancers based on appearance alone.From your description I am not highly suspicious of this problem but I couldn't think of much else it
could be.One other thing I did think about is the possibility that another dog is licking her head. Saliva can
cause a reddish discoloration of the hair coat. This is more common in dogs that lick themselves,
especially ones that lick their feet a lot, turning the hair red in this area. But I have a couple of patients
who have discoloration of their hair because they have a companion that licks them. This usually
occurs around the ears.Mike Richards, DVM
11/29/2000
Cutaneous Hemangiosarcoma Staffordshire Terrier
Question: Dear Dr. Richards:
I have a staffordshire terrier, 9 years old and full of spunk. She has been diagnosed with
Cutanious HSA in the skin and capilaries. She is going in tommorow to have surgury on her neck
under her lower jaw. They have mentioned that she will possibly have to have skin grafts in that
area also. She is kind of wild so they will be taking a chest x-ray to see if the cancer has spread to
any of her other organs. She is showing little like blood blisters on her neck with some
discoloration of her skin.Do you believe this radical surgury is necessary at this time or would she be better off without the
surgury. Just how much time would I be buying her. She does not appear to be sick at this time.
Could this surgury cause this to progress at a faster rate with all the irritation surgury will cause. I
wish I could have wrote sooner as I need an immediate answer.
Thank you, Janice
Answer: Janice-
The answer to your question has to do with the impression that your vet's have of how deeply into
the skin, or tissues below the skin, this tumor has penetrated. Hemangiosarcomas located completely
in the skin can usually be successfully removed by excision of the tumor and skin around it.
Hemangiosarcomas that have penetrated into the subcutaneous tissues below the skin or even deeper
into the underlying muscles have to be removed by radical excision -- at least a 2cm margin in every
direction around anything that could be tumor, for the patient to have the best chance for a good
outcome.A recent article (Rassnick, May/June 2000 Journal of Veterinary Internal Medicine) evaluated the
use of ifosfamide as a chemotherapeutic agent for metastatic cancers, including hemangiosarcoma,
and concluded that it was useful for these tumors. Other than that report, I haven't seen much
encouraging information for the use of chemotherapy or radiation therapy for cutaneous
hemangiosarcomas that have penetrated the skin.I know this is too late for the decision making but I hope that it is somewhat reassuring that your vets
were on the right track.Mike Richards, DVM
11/6/2000
Hemangiosarcomas are a form of cancer which originates in the endothelium, which is the lining of blood vessels and spleen. As might be expected of a tumor arising in the blood system they are highly malignant and can be found almost anywhere in the body since blood vessels are necessary in almost all body tissues. There is a strong predilection for the spleen, pericardium and heart. These tumors are most common in middle aged or older dogs which are medium sized or larger but can occur in any breed. German shepherds are reported to be more susceptible to this tumor than most dog breeds. In our practice golden retrievers also seem to have a higher than normal incidence.
Because these tumors arise in internal organs there is often little warning that they are present prior to time they cause severe clinical signs of disease. A common estimate of the average time from discovery of the tumor until death occurs in affected dogs is six to eight weeks but death occurs more rapidly than this in a number of cases.
Visible bleeding, usually in the form of nosebleeds, and signs associated with blood loss, such as tiring easily, episodes of unexplained weakness, pale color to the mucous membranes of the mouth and eyes, increased respiratory rates, abdominal swelling and depression are the most common presenting signs for patients with hemangiosarcoma. A few dogs just suddenly die with no clinical signs having been noted by their families prior to death. Bleeding disorders associated with hemangiosarcoma are sometimes confused with immune mediated hemolytic anemia (IMHA) because the type of anemia caused by the two conditions is very similar and early clinical signs are often very similar, as well. Hemangiosarcomas can cause very large tumors, sometimes as large as ten or more pounds, when they affect the spleen.
In most instances tumors of this size in this location are found on physical exam. In other cases the tumor affects the heart and is hard to find on a physical exam and even easy to miss or X-rays. Sometimes there are hundreds of small tumors spread throughout the body and surgical exploration or an autopsy are the only ways to identify the problem.
The blood disorder that most commonly accompanies the presence of hemangiosarcoma tumors is disseminated intravascular coagulation (DIC). This is blood clotting that is occurring inappropriately inside the blood vessels. It uses up all of the blood clotting elements rapidly and dogs with this condition usually have platelet deficiencies, increased blood clotting times, decrease in fibrin content in the blood and an increase in fibrin degradation products (FDPs). This is probably the cause of death in most dogs affected with hemangiosarcoma.
Diagnosis of hemangiosarcoma can be accomplished in a number of ways. Identification of a tumor in the spleen or heart raises a high degree of suspicion for this tumor. Abdominal swelling is also highly suggestive in an older large breed dog. If fluid is aspirated from the abdomen and it looks like blood it is even more suggestive of hemangiosarcoma. If blood is drawn and will not clot when left in the syringe it is another sign that a dog may have this tumor. In some cases careful evaluation of the type of bleeding disorder present is necessary to raise the suspicion of hemangiosarcoma.
If a tumor is identified when it is small it may be possible to remove the spleen if the tumor is there or even to remove tumors found near the heart and prolong the pet's life. Most of the time this will not make much difference, though. These are highly malignant tumors and most have spread by the time they can be identified. To the best of my knowledge there is not a very successful hemotherapeutic or radiation protocol for this cancer at this time but dogs treated with chemotherapeutic agents do live a little longer than dogs that do not receive this treatment.
Treatment for the bleeding disorders and aggressive supportive care also prolong the life of patients with hemangiosarcoma. If treatment for IMHA or immune mediated thrombocytopenia (ITP) are instituted due to confusion over the underlying cause of clinical signs early in the diagnostic process there is not likely to be any harm to the dog.
Due to the tendency to look for an inciting agent in IMHA and ITP it is a good idea to consider an autopsy exam if a dog dies before a definite diagnosis of any of these conditions can be made. Finding hemangiosarcoma saves a lot of agonizing over possible causes of the death of a friend. There are no known predisposing factors other than size and breed that I am aware of for hemangiosarcoma.
Mike Richards, DVM
Hemangioma and pathology reportQuestion: Dear Dr. Richards:
I have a couple more for questions for you. It is about
Dandi's Pathololgy report. It says in the microscopic description
(in the pathology report) that the vet did not request one.
Is that common? I rather thought that was why you sent
something to pathology so that they could look at it under a microscope.
Under diagnosis (in the pathology report) it just says hemangioma, how do
they know whether it is cancerous or not if it is not looked at under a
microscope?My other question is I had my vet fax Dandi's last CBC to me when he had his
teeth cleaned in 1/99, and there is a remark on the report that says:
Platelet count reflects minimum value. Clumps or large platelets present on
blood smear WBC and RBC morphology appears normal. Can you explain? Thank
you for you info.Tina
Answer: Tina-I am not sure exactly what the lack of a microscopic description means,
because our pathologist always provides one. However, this might be an
optional report at some pathology labs.The microscopic description is usually something like this: hemotoxylin
and eosin-stained sections of the mass and adjacent tissue contained
irregular lobules of fine mineralized material cuffed by macrophages and
multinucleated giant cells.......... etc. (from the Journal of Veterinary
Clinical Pathology, 1999, Sharkey, et. al.)Most veterinarians don't really care about the microscopic description
since most veterinarians don't want to try to make a diagnosis based on the
microscopic description. They want the pathologist to do that.So the important part of the pathology report, to most vets, is the
diagnosis section. Since my lab doesn't charge me extra for the
microscopic description and includes it as a standard part of the report, I
have never had to think about how important I would consider it to be if I
had to pay extra for it, which might be the case with your vet's lab.Platelets are counted, or estimated, by machines that have a lot of
trouble counting them if they are forming clumps. Since forming clumps is
how platelets do their job, this isn't an unusual finding. Fortunately,
blood smears are usually examined under a microscope, too. So if platelets
are clumped on the smear and the numbers are low on the counts, it may
explain why. In this case, if there is concern about a platelet deficiency
or bleeding disorder it may be a good idea to repeat the test. However, if
there isn't much reason to worry about this, it may be sufficient to allow
the vet to make up his or her mind that the situation is normal.Hope this helps. I think that you can be reasonably certain that the
diagnosis of hemangioma was made after a microscopic examination of the
tissues that were removed from your dog.Mike Richards, DVM
8/4/2000
Question: Dear Dr Richards:
I am a subscriber to VetInfo, and I have a question. Recently, on my dog Dandi, I found a
discolored lump on his left shoulder area and the vet removed it and sent it to pathology. He told
me it was hemangioma.(i dont know if I spelled it correctly). I then asked Dr.P if I should check
around for any other lumps, and he said it was never a bad idea. I did not think I would find any
others because I massage my dogs pretty regularly and keep an eye out for lumps and things, but I
did find a lump on his left front leg and right rear leg. I dont usually massage down to the paws so
that might be why I missed these, so obviously I do not know how long they have been there.
Anyway my question to you is: Dr P. said that this was a benign tumor, but when I try to find
something on just hemagioma I can't find a thing. All I find is hemangiosarcoma, and that sounds
very scary to me, are they one in the same?? This is my first dog I ever got as an adult (i have
others but he is my first) and he is medium sized, mixed breed and 11 yrs old and my best buddy.
I don't want to take any chances with him I want to make sure I know everything I need to know
to get him anything he needs. I have had other dogs who have been sick, and I know how
important it is to be informed youself. He has always been very healthy. Please advise at your
earliest convenience. Thank YouTina
Answer: Tina-
It is sort of hard to find information on hemangiomas. These are a benign lump formed by blood
vessel tissues that occur in the skin. They are most common in dogs but do occur in cats, as well.
There is some argument about whether these are even a cancer. Some sources identify these as
blood vessel abnormalities and others as benign cancers. These can get large and they have a really
irritating habit of intermittently bleeding from ulcerations of the surface and the bleeding can be severe
enough to be a problem, based on a couple of cases we have seen in our practice. These can also
grow to be quite large at times. The good thing is that surgical removal should provide a complete
cure if it is possible to get the whole tumor. In sites where this is hard, radiation therapy can be
helpful. It is a good idea to send these tumors for histopath exam because they often resemble other
tumors that are malignant.This was a good outcome. Much better than a diagnosis of hemangiosarcoma, as you have
discovered in your research.Mike Richards, DVM
7/29/2000
Question : Dear Dr. Richards:
I took my dog, Tiffani Rose, female, age 9, to my vet, Dr. P for a teeth cleaning
and to remove a small tumor on her back.
While she was there I asked that Doc P take a look at a small pea-size lump
I noticed in December in her right rear thigh. Doc P removed the thigh
tumor and said she had never seen anything like it. It was small and black.
She sent it off to pathology, and yesterday, Monday February 28, 2000, she
received the result back that it was a hemangiosarcoma. She is scheduled at
Iowa State University Veterinary Hospital for an ultrasound on March 8th to
see if there is any other cancer in her body. We have consulted with Dr.
G., an oncologist. Dr. G. is recommending removal
of her leg as aggressive therapy. She says that 2 - 3 cm of tissue needs to
be removed but that would invade a major nerve in her leg.Doc P has told me that dogs adjust very well to amputations as they do not
have the stigma attached as humans do. Dr. G. has agreedMy question to is this. We caught the tumor very early, before most people
would have noticed it in their dogs. Could an aggressive chemotherapy
treatment extent her life at least as long as leg removal? All of the case
studies I have read on hemangiosarcomas have been involving dogs where the
disease has been very advanced.The amputation would have to be done at the hip. I am saying no. My
husband is saying yes, anything to prolong her life. Any additional
thoughts on this situation would be greatly appreciated.I have lost several dogs and cats in my life but I truely believe that
losing Tiffani Rose will be losing a part of my soul. But I must do what is
best for her. Do we let her die or do we remove her leg. Please advise.
Ms. JayAnswer: Ms Jay-
You have presented a very difficult question to answer. Hemangiosarcomas
located in the skin behave differently depending primarily on the depth of
the tumor in the skin and whether it is occurring as a primary skin tumor
or whether it is a metastasis of a tumor in another location.The first step to take in determining what to do is to try to get a really
good idea of whether this was a solitary skin tumor. X-rays and possibly
ultrasound exam of the heart, liver and spleen looking for evidence of
hemangiosarcoma tumors in these organs should be an early step in
determining how to deal with the tumor you already know about, so it is
good you have an appointment for this. If you find evidence of
hemangiosarcoma in other organs then the answer is clear -- this is a
metastatic cancer and further surgery may not be beneficial. It is also a
good idea to do a general blood screening, especially checking for anemia
that sometimes accompanies hemangiosarcoma tumors. If anemia is present it
would make it even more important to look very carefully for signs of the
tumor having spread or coming from another organ in the first place.Another step to take right away is to determine, with Dr. P's help,
whether the tumor was completely contained in the skin or if it had gotten
into the subcutaneous structures at all. Her impression from the surgery is
probably sufficient to answer this question. If there is any question about
total removal of the tumor it may be a good idea to go back and remove
additional tissue from the site and have it examined for microscopic
evidence of hemangiosarcoma. Dr. P and the vets at ISU can help you
determine if this would be a good idea.The pathologist may have been able to give an impression as to whether the
tumor had invaded beyond the margins of the area that was removed. That
would be helpful information, if it is included in the pathology report.
Particularly if the report states whether or not there was involvement of
the muscle underlying the skin. Sometimes the pathologist is also able to
give an opinion about how aggressive a tumor appears to be, but I am not
sure how accurate those impressions are in the case of hemangiosarcomas.In a report that you can find at the PubMed web site, by Heidi Ward and
others (search on "Ward H hemangiosarcoma" to find it) tumors that were
solitary and located entirely in the skin had a good prognosis from
surgical excision alone. If there is invasion deeper than the skin, I have
been under the impression that chemotherapy using doxorubicin (Adriamycin
Rx) was considered to be pretty effective for cutaneous hemangiosarcoma
that had not yet spread to other organs (from the Compendium on Continuing
Education, July 99). Tumors that are located entirely in the skin tend to
be less than 3cm in diameter and smooth in appearance, rather than
ulcerated. This sounds like it fits the description of the tumor that was
removed.If Tiffany Rose is a whippet, there seems to be an increased likelihood of
dermal hemangiosarcomas but they respond well to surgical excision in this
breed so there may be less need to worry over the tumor in a whippet than
in other breeds even though they may be encountered more frequently.If there was involvement of the muscular layer, then perhaps amputation
does make sense, as long as there is no evidence that this tumor has
already spread to other organs. Your vet and Dr. G. are correct that
most dogs adapt very well to amputation of a limb and have a good quality
of life. However, it is a major surgery and it does have major consequences
even if dogs do adapt well. I think that this would be a good time to get a
second opinion from another oncologist since you are hesitant. You might
ask your vet to at least call another oncologist for an opinion or to check
out the opinions on one of the online networks, such as the Veterinary
Information Network (www.vin.com) or NOAH (www.avma.org). The Veterinary
Information Network is exclusively for veterinarians but it is a very good
source of information that Dr. P. would probably find very
useful. Even if there isn't an oncologist on the staff at ISU at the
present time, the internal medicine specialists there should be able to
help with information on prognosis and treatments, as well.Good luck with this. I am hoping that your vigilance will pay off and that
there won't be any evidence of hemangiosarcoma anywhere else and that Dr.
P. feels that the tumor was confined to the skin and the pathologist
agrees. That would make the prognosis much less grave.Mike Richards, DVM
3/2/2000
Hemangiopericytomas in Springer Spaniel
Question: Dear Dr. Richards,
My 12-1/2 year old English Springer Spaniel has recently had 2 surgeries to
remove hemangiopericytomas from her right hindquarters and lower back. The
information I've read about these tumors conflicts somewhat. The Merck
Veterinary Manual describes these tumors as "intermediate malignancies";
another book by a veterinary dermatologist describes them as benign --
although both references recommend surgical removal of the tumors. My
questions: Are they malignant or benign -- which is it? Is it always
necessary to remove these tumors?I understand that it is not uncommon for these tumors to recur. Although I
don't mind spending the money, given the age and other health problems of my
dog (she has had chronic active hepatitis for at least 2 years, but is
responding well to medication and other treatment), I wonder whether it is
riskier to put the dog through anesthesia and the pain associated with
removing them than simply leaving them be. I'd appreciate your thoughts on
the subject. C.
Answer: C.-
A tumor like an hemangiopericytoma is a dilemma in an older dog with
multiple medical problems.These tumors fall in a general category called soft tissue sarcomas. They
have a very strong tendency to recur when removed but a pretty low tendency
to metastasize (spread to distant places like the lungs), even though that
can happen. The faster these tumors are removed the less likely they are to
recur but quick removal does not guarantee they won't recur. Aggressive
surgery with wide surgical margins is the best hope for preventing recurrence.So in an older dog with other health concerns it is hard to decide what to
do. Wide surgical excision usually required general anesthesia and can be
debilitating for some time in an older dog. A local anesthesia might be
safer from an overall standpoint but makes it harder to do a good surgical
excision. The tumors are slow to invade the area they occur in but when
they have invaded enough to cause problems they are hard to remove.We try to evaluate the whole situation. We have a lot of patients who have
lived for a long time after diagnosis of chronic active hepatitis. We think
that it is safe to use isoflurane to induce and maintain anesthesia in
these patients, based on a number of successful surgical procedures. If the
tumors are located in a area where they are likely to lead to problems, we
remove them. If we think that they will probably not cause problems where
they are at we sometimes just wait to see what happens. That does mean
taking on a very small risk of metastasis to other locations but it is
unusual with these tumors. The other factor we try to consider is the
probable recovery period. That varies by tumor location, too. It sounds
like that isn't a big concern where these have occurred.Hope this helps rather than confuses you. I guess I'd lean towards taking
these off in my own dog but would still think through all these issues, first.Mike Richards, DVM
11/3/99
Hemangiosarcoma and chemotherapy
Q: my toy poodle just had a hemangiosarcoma removed (spleenectomy) but the
surgeon found spots indicating likely spread to her pancreas. i have seen
human friends suffer so with chemotherapy; and other articles i''ve found
indicate a limited life expectancy, no matter what treatment, if any,
follows her surgery . my dog has never seemed to feel bad, and is even recovering
well from surgery. what is a likely survival time for my pet and would chemo tend to make
her as sick as it does humans?
A: R-
The average survival time after diagnosis of hemangiosarcoma, without
chemotherapy, is estimated to be 6 to 8 weeks. It is my impression from
attendance at a meeting where chemotherapy for this cancer was discussed
that the survival time with chemotherapy is probably six to twelve months
but I think those figures were for dogs in which there was no obvious
metastasis (spread) of the cancer at the time of Splenectomy.Chemotherapy does not seem to make dogs as sick as it does humans. In many
instances it can provide a reasonable quality of life and some extension of
lifespan. It does not usually provide a cure and is only a method of
delaying the spread of cancer and death. The importance of this has to be
decided on a case by case basis, considering the client's needs, the pet's
needs and the expected benefits of the chemotherapy. The best way to make
this decision when it is troublesome (difficult) is to consult with an
oncologist, if that is possible in your area.Mike Richards, DVM
Hemangiomas and Hemangiosarcomas
Q: Hello Dr Mike, I recently had my Shepard/Lab operated on to remove a couple of lumps, one on his hind quarters and another on his ribs/chest area. One (the one on or near his ribs) I was told was a liponoma which was not anything to worry about but felt it best to remove before it became too large. The other was thought suspect and was identified as "hemangionoma". Could you please tell me everything I need to know about this and if it poses a major concern. He is 7 years old. My Vet seemed to not know a lot about it and left me with some questions as though he was afraid address the issue. I just want to know more about that type of tumor and if there is a history of dogs surviving the affliction. I'm told it was a benign growth. I just wanted to get a second opinion on this. This dog is very special to us. Thanks Joe
A: Joe- I can't find much information on hemangiomas, except that they are a tumor of blood vessels (as implied by the name) and that that are always benign and rarely recur if removed surgically. I suspect that is why there isn't much information -- there isn't much more to the story than that. In general it is good when their isn't a lot of controversy about how to treat a problem or whether or not it is a more serious problem than some people think.
It is possible to confuse hemangiomas and hemangiosarcomas, which are generally malignant. Usually if an hemangiosarcoma is present in the skin there is another site internally affected by the tumor as well. Apparently a lot of eyelid tumors are diagnosed as hemangiosarcomas when that is not actually the tumor type. Just thought I'd mention that in case this was an eyelid tumor.
Mike Richards, DVM
Last edited 12/05/02
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