13 1/2 year old dog, mammary cancer but not sure she can cope with surgery

[moosemama]

She developed a fairly significant lump sometime between the beginning of December and mid January. It's about 4 cm long by 2.4 wide.

Vet did bloods first and said they came back with no indication of anything sinister, although she is apparently mildly anaemic. She then had a fine needle biopsy done last week and we've just got the results.

"Insufficient sample, no clear indication of malignancy, but spindle cells present."

Vet says she wants to just go straight ahead and remove it, but my poor old girl is almost deaf, doesn't have good sight and has developed late onset separation anxiety as a result. She has never coped well with inpatient procedures at the vets anyway and I'm really worried about how she would handle an op.

Complicating things are my own hang-ups arising from a monumental mishandling of my beloved boy's cancer years ago. They fluffed the biopsy - came back 'contaminated cells' so no clear cancer type identified. I had asked them to aspirate the regional lymph-node and they contaminated that as well. They insisted it was 'mast cell' - I was conversing with a vet online that said it sounded scarily like fibrosarcoma to him and that if it was, they shouldn't excise but amputate, as excision was likely to lead to accelerated growth (they couldn't get wide enough clean margins, as it was located on his hock).

Vet (actually a retired vet locum drafted in to cover small animal practice during the foot and mouth crisis) insisted I was making a fuss about nothing, removed the tumour and within months it was back, twice the size and growing rapidly, ultimately rupturing. In the meantime our dog went went from a nearly 9 stone hulk of gorgeous boy to skin and bone in just a couple of weeks. At that point the head vet of the practice got involved and finally admitted that the original vet should have listened to me in the first place. They wanted to get him straight in to amputate - sedated him for xrays to check for metastases, but it was too late. Every organ in his body had been invaded and we had to take the decision not to wake him. We lost him when my first dc was just 10 days old. It was fibrosarcoma, they had failed to remove it all and caused the rapid development in growth, end result, we lost him much sooner than we should have.

So, as you can imagine, I was more than a little to find yet another biopsy cock-up ten years later and several hundred miles away from the previous vets.

I have just tried to google, but don't have enough info to go on. From what I've read though, there is a chance, albeit small, that this tumour could also be fibrosarcoma and although they could get wider margins, I don't want to put my girl through the same torture that my lovely boy went through all those years ago, only to lose her in a few months anyway. I would rather keep her comfy and happy for as long as we can, iyswim.

Am I letting my heart rule my head here? I can't seem to make logical sense of it all and I desperately want to do the right thing by her.

Any thoughts, advice would be really appreciated.

[RedwingWinter]

I'm really sorry that you are going through this and that you lost your boy like that. It must make it harder to deal with things, but you have to save your energies for your girl now. I think it's very difficult to make this kind of decision, especially with an old dog. You can always have another chat with your vet about the likely outcomes of each approach.

Hopefully a vet will be able to explain about the spindle cells. If it's any consolation I have the impression that those fine needle aspirations don't always yield enough (I'm not a vet - I only say this because one of my dogs has had a lot of them for various reasons).

I think you know your dog best and are the only one who can decide what is right for her. It's an awful situation to be in and I send you lots of unmumsnetty hugs and sympathy.

[RedwingWinter]

P.S. Did the vet say how long it would take her to recover if she has the op? One of mine has had several and usually bounces back quickly, although he is a young dog so the decision has always been easy. Because of the general anaesthetic, he doesn't know what's going on at the time, and he still loves going to the vet. I think it's a balance between how much time it would buy her and whether it's affecting her quality of life, or when it will begin to.

[ggirl]

If it was me I would be inclined to leave the tumour and let nature take it's course . Is the only symptom mild anaemia?

[moosemama]

Thank you Redwing.

Unfortunately, it was dh that spoke to the vet today, as I had to take ds1 to a hospital appointment. He basically said that she wasn't very forthcoming and just wants to remove the tumor regardless.

I can't help wondering why they bothered doing the biopsy at all if they were just going to recommend removal anyway. One blood test and biopsy so far and it's already cost over £250 - I suppose that's my answer.

As for coping with the actual op. I know from previous experience that she would most likely be scheduled for the end of the day, after morning clinic, but they insist they have to be in first thing - so she'd be caged for half a day before they even think about operating.

I also know, from the position of the tumour and the fact they would need to take wide margins to be sure they've got it all, that she is most likely going to need to be crated and moving will be painful.

We lost our Wheaten two years ago to oral cancer. They tried twice to remove it, but ended up only being able to debulk. She was a little younger than this dog when she had her last op and it really hit her hard, she was really upset by the whole experience and she didn't have the deafness and blindness to deal with, let alone the separation anxiety. I felt awful afterwards, as it didn't prolong her life and was just a horrible distressing experience for her. They wanted to have another go not long before she died, but we said enough was enough - we couldn't put her through it again and in the end she was happy and comfortable at home for a good few months before a very sudden decline, when we made the decision to pts.

Dh is thinking we should perhaps get a second opinion. There's an excellent and very well respected 'super-vet' type centre locally, but we really can't afford it. She was insured for years and never needed to claim, but her premiums went up and up to ridiculous prices and when she it 10 years old, the excess was a huge percentage of the cost of the procedure, almost cancelling out the point in having insurance, iyswim.

[moosemama]

Ggirl, she's noticeably slowed over the past couple of months and has gone from thinking she was a 13 year old puppy to being very obviously an old dog. The separation anxiety is new too, making me wonder if she is in pain.

That said, she still has good days, although they are few and far between. I'm hoping part of that was to do with the cold weather though. She was out in the sunshine chasing her kong on a rope yesterday and spent ages trying to persuade me outside to throw it for her. It was lovely to see her back to her old self, but then today she has slept all day.

If I'm honest though, the weather has never bothered her at all in the past. She is a border collie x belgian shepherd and until recently, would happily spend all day outside in the rain or snow, only coming in if we made her. Recently we have had to actually force her to go outside for a wee - mostly last thing at night - which is just not like her at all.

She is eating well and although, she'd dropped weight in January, has now regained it.

Anaemia was the only thing that showed up in her bloods.

[ggirl]

aww , i would be inclined to go down the tlc route and control her symptoms.

[moosemama]

Thank you ggirl, it helps to get different peoples' perspectives.

[RedwingWinter]

Moosemama, whatever decision you make it's very clear that it will be made with love for her - and therefore it will be the right decision. You can always call the vet and ask to speak to her over the phone, if it would help to hear it direct from her. I am the kind of person who always likes to ask 'what happens if we don't operate' and see what they say to that. Depending on her answer, I might well opt for tlc.

[Stonefield]

Really really sorry for you it's heartbreaking situation. My father had a very similar situation a few years back. He's a shepherd and the dog hes always thought of as the best dog he's ever had in his life who he loved to bits, sadly became ill very quickly, she wasn't even that old, but when taken to the Vets it was discovered she had very advanced cancer. Dad made the very difficult decision to quietly put her to sleep, he couldn't stand for her to be in pain. It broke his heart.
I'm not saying that this is what you should do, but I do believe that it is an option that you should consider and may be the kindest thing to do for your dog.
You have my sympathy.

[moosemama]

Thank you Redwing and Stonefield.

I think perhaps I do need to speak to the vet myself, I'm never satisfied when dh speaks to someone without me there - I like to have all the facts and consider things from every angle.

You're right, asking the direct question "What will happen if we don't operate?" is probably the best way to go. Dh said she didn't seem to want to discuss that, she just wanted to operate, probably because she doesn't know without accurate biopsy results.

He told her he wanted to talk to me and get back to her.

[Lonecatwithkitten]

I'm sorry you are going through all of this. Fine needle aspirates are great when they work, but quite regularly they don't as the mass doesn't exfoliate (give up cells) well. It happens in human medicine to I had an FNA on my breast only a few weeks ago that didn't exfoliate.
Spindle cells can be a suggestion of a nasty cancer, but not necessarily diagnostic. Fibrosarcoma would be uncommon in the mammary line adenomas, adenocarcinomas and carcinomas would be more common as would mammary hyperplasia. I would always advise doing chest x-rays to met check in a bitch as old as your girl before removal though this can be done on the same day. Of mets were present I would advise against proceeding with surgery. Hope this answers some of your questions.

[ToeCap]

Aaaaw sorry to read this. If I were in your shoes, I would be tlc and checking with vet that she is in no pain at all. I wouldn't put her through the op, unless she had years ahead with successful surgery. Not sure what breed she is, maybe I missed that, but 13 is quite an age for many breeds.
Hope you are ok x

[moosemama]

Thank you Lonecat, that makes sense. I asked dh and he said the vet did mention a possible xray the first time they spoke, but this time said she wanted to go ahead and operate.

I would be happier with the xray first, having gone through the experience with our old boy, where they could have ended up amputating a hind leg when it was already too late to save him. He was a big lad who didn't like the vets at all, so they sedated him on admission - I wonder if these vets would do similar for my girl this time to avoid her getting overly stressed by it all?

[moosemama]

ToeCap, she is a border collie x belgian shepherd.

My longest lived dog was my first, a big old long-coated GSD rescue who lived till she was 14 and I think that's at the back of my mind too. I haven't heard of too many dogs of her size that lived much beyond 14 and I don't want to put her through all the trauma of surgery for the sake of a few months, if we can keep her pain free and comfortable instead, iyswim.

I do have a friend who lives for her dogs and has had a couple of border collies make it to 16, but I do know that's not commonplace.

[SaggyOldClothCatpuss]

My dog went through this. She developed several small lumps in her teats, and after investigation I was told she had cancer, she was 11 ish. The vet wanted to operate.
I went home and did the research, and then told the vet I would not be putting her through the surgery. My reasons were:
1, Mammary tumours often recur.
2, Removal consists of stripping the entire row of teats, she had tumours on both sides.
3, Speying is also recommended with tumour removal. When I had looked into her being speyed a year or two earlier, I was told it was too big a surgery for an older dog, and wasnt recommended.
4, She was devoted to me, and hated to be seperated from me. Leaving her in the surgery would cause her considerable distress.
5, She hated being confined. After surgery she would need cage rest and a lamp shade. This would have caused her considerable distress.
6, anecdotally, a couple of people I spoke to said that given the chance again, they wouldnt have put their dogs through that kind of surgery at that age.
The vet was not happy, but I was resolute. I took the old girl home and we had about 18 months together. In the end, I had her PTS. Her quality of life wasnt bad in the end, but she could be quite confused at times, her eyesight was failing, and the lumps were large. The vet was amazed that she was still going!
I held her in my arms as she passed, and whispered her favourite words in her ear. It was peceful and I dont regret for one minute not putting her through that trauma.
There is a lot to be said for treating a young, or healthy animal, but I have severe reservations about putting any animal through long, painful or invasive treatment.

[moosemama]

Thank you for sharing your story with me Saggy.

[ToeCap]

How is your dog Moose? Been thinking about you. x

[moosemama]

Thank you for asking.

She's been ok this week, had a couple of lively days when the sun shone earlier in the week and she wanted to be outside and play. Yesterday and today I've had to drag her outside for a wee though, she really objects to the rain these days.

Dh and I are 99.99% sure we are going to go for palliative care. We're going to see the vet again at the beginning of next week to talk it through properly and make a decision once and for all, as I keep wibbling and we need to be 100% sure what we want to do.

[poachedeggs]

The decision for surgical treatment in an old dog has to be taken in context, by which I mean it's vital to consider how the animal is in itself.

If, as you describe, she has slowed a lot and is losing her quality of life, then surgery ishhard to justify. In a very active, youthful individual then it makes much more sense. Your vet will be anxious because there's no diagnosis at the moment. Sometimes malignant mammary tumours can eventually ulcerate or rupture, which is disastrous and forces a decision to excise or euthanase. You need to discuss this again so all of the potential outcomes are clear to you. Only then can you decide.

Good luck :)

[moosemama]

Thank you poached eggs. We really do need to talk it all through properly with the vet again, precisely for the reasons you mention in your post. Obviously I don't want my girl to suffer either way, be it due to surgery or pain/rupture/other problems caused by the tumour itself.

Ideally I would have like to have seen the vet again this week, but it's just been one hell of a bad week all round and there was no way we could fit in another appointment. I want us both to be there this time as I never quite get the full picture when I hear it second hand from dh and we need to make the decision together.

[ToeCap]

Sorry not been on here for a while. Hope this are as ok as they can be x

[moosemama]

I am resurrecting this thread because things have moved on and are now very different.

We decided that we didn't want to put her through the trauma of an op at her age after considering everything, advice on here, reading up and speaking to the vet etc.

Then she started limping intermittently and a couple of weeks later stopped using one of her hind legs. Vet thought she may have injured herself slipping on ice, so gave a week of anti-inflammatories and said if no improvement within a week, they wanted her in for xrays.

She was definitely more comfortable on the anti-inflammatories, but still not using her leg. Still happy enough, playing with toys, eating well, being cheeky and enjoying hugs etc.

Dh took her for her follow up appointment this morning, different vet said there was significant swelling on her shin bone reaching from the back, around the front and almost meeting again at the back, so they raced her in there and then for xrays, sedating her on arrival. They said as they had to put her under anyway, they may do the mammary excision at the same time, but it would depend on how things went.

We were expecting to call them between 5 and 6 to discuss what they'd found, but they called us about an hour and a half after we left her, to say she had a significant osteosarcoma-type lesion in her leg, with a lot of bone damage. They said they would referto specialists if we wanted her treated, but it would be up to the specialists if they would be willing to treat and if they did it would definitely mean she would lose her leg.

They offered to do more xrays to look for mets and to fine needle aspirate if we wanted them to, but that they felt even if no mets showed up it would probably only be because they are small at the moment, rather than not present.

They explained that the prognosis even in a younger healthy dog for this type of cancer is only a few months and that as hers is so bad we would be looking at less and asked if we wanted to take the decision to not wake her.

Dh wanted to let her go, but I couldn't do it. We lost my beautiful boxer gsd cross to fibrosarcoma in almost an identical site, under near identical circumstances when ds1 was a few weeks old. He went in for limb removal, had xrays, found multiple secondaries and didn't wake him up. I have never really come to terms with it and he was definitely ready, whereas my girlie is still eating, being cheeky, chasing her toys and enjoying hugs - she's just not ready ... I'm not ready.

So, we're bringing her home in an hour's time and the vets are going to give her palliative care. I don't want her to be in pain, so she's going to be on tramadol and anti inflammatories, but apparently if she falls on her leg she could fracture it and that would be that. I'm guessing we have a couple of weeks at best. Vet said prognosis with this type of cancer is usually a few months max, but that given the advanced stage it would be much less for her.

I am worried that she will just be zonked out on the tramadol and if she is, we will have to think again about whether or not it's fair to keep her going.

I'm still not 100% sure we're doing the right thing, I don't want her to be in pain or suffer in any way, but I just wasn't able to make that decision in the short time we had because she was still under anaesthetic.

I have just been out and bought her a lovely soft memory foam base for her bed, hoping to make sure she's as comfy as possible.

I am so worried I have done the wrong thing by her for not just letting her go while she was under anaesthetic, but it just didn't feel right at all. All I can do now is hope it was the right thing and be honest with myself about how things progress.

I think I must have been in denial, because I am in shock, actually shaking and so many tears.

Anyway, just wanted to thank you all again for your advice and support on this thread a few weeks ago and update you to the current situation.

[littlejo67]

Hugs to you. It sounds like you need some time to say goodbye and there
Is nothing wrong with that as long as your dog is not suffering. You will know when the time comes. Its a blessing to have time to do this. Even if its just a few days. X

[needastrongone]

Oh my, I am so sorry you have to deal with this, it must be very difficult for you. I am just giving you my sympathy. You are doing what you think is right so you are doing the right thing, simple as that.

Big hugs.

[moosemama]

Thank you.

Yes I think you're right.

She's home now. Still zonked from the anaesthetic but has has both pain relieving and anti-inflammatory injections so is comfortable.

Apparently her temp was up and there was a small amount of protein in her urine, so she's been put on antibiotics as well. Poor thing has three tablets to take twice a day, fortunately she has always just taken pills out of our hands, so at least it won't be difficult to get her to take them.

She took a little while to settle, but I sat under the kitchen table with her and stroked her head till she fell asleep. She's sleeping soundly on her new bed at the moment.

Not sure how our other dog will cope when she's gone. He's never been an only dog, as he was fostered with several other dogs before he came to us and we had two already when he arrived here. He spent much of today doing full on 'haunted howls', in between whining and pacing.