Looking for honest opinions please - subcutaneous haemangiosarcoma

[Haemangiosarcoma]

Our 10.5 year old greyhound has subcutaneous haemangiosarcoma. He had a small (maybe an inch across) lump on his side in mid Jan, which grew to a large maybe 9cm lump by the time it was surgically removed in mid Feb. The vet who removed it said it was a very nasty op as the mass ruptured, and it was not possible to get good margins as it went behind his ribs a little. They had to remove some muscle. He didn't have chemo as that vet said there wasn't a good protocol for it.

He recovered fairly well from the first one. He was almost normal after 2 or 3 weeks then normal after about 1 month.

His lump has returned in the same place as of mid April (2 months after removal). The original vet said she wouldn't be comfortable removing it again and referred us to an oncologist specialist to discuss options.

Spoke to oncologist and he reckons he can remove the lump, but would have to remove two ribs and reposition his diaphragm, and would need to remove a lot of muscle so would have to take a flap of it from nearby. With chemo after, the vet is fairly optimistic, cautiously saying numbers even up to a year of health after (obviously not guaranteed), but ultimately it's a disease dogs tend to die from eventually. Another factor is the surgery is at least 1.5 hour drive away, so we worry about getting him back safely after.

Now, of my husband and I, one of us thinks we should go ahead and the other thinks we shouldn't. Both have his best interests at heart, but just differ on what we think is the right choice.

Can I ask if anyone has had any experience of similar, or what you would do in our position? We are both so upset and it's hard to think rationally. Thank you

Personally I wouldn’t. Haemangiosarcomas almost always spread. He will have another one growing elsewhere that you don’t know about. I wouldn’t put an old dog through that kind of drastic surgery when you’re looking at buying yourself 6 months at best. It wouldn’t be in his best interests. FYI I am a veterinary professional

Personally I wouldn’t, a year (optimistic) wouldn’t be enough to put him through it for me.

Ive come across this thread in active and I’ll say upfront I’ve never owned a dog. I have however had a similar experience with an “injection site sarcoma” in a cat.

10 year old cat developed a small pea sized lump at the scruff/between the shoulders. It grew fairly quickly and the vet diagnosed a sarcoma. We got the lump removed, fairly good margins but due to position and type very likely to come back.

We chose (with vet help) not to do radiotherapy for a couple of reasons. The main two being that outcomes weren’t likely to be massively different and that his quality of life in between sessions would be quite poor - car travel to the specialist, treatment itself, then 1-2 days of feeling poorly afterwards, then back to “normal” only to have to repeat this every week or two depending on type of treatment.

His sarcoma came back after 12 months, we didn’t want to put him through further surgery and he lived a further 10 with virtually no symptoms other than the lump itself. It then grew rapidly, affecting his movement and we had him put to sleep before it got any worse.

My advice would be to discuss with the vets the likely outcome, any side effects etc before coming to your decision. It’s so hard, my sympathies are with you 🩵

It's a nasty sounding surgery, past the age 10 or so I don't like to treat cancer surgically unless it's straight forward and impeding vision or movement and just raw feed and supplement with turkey tail until they get too unwell then PTS. Dogs don't understand why they hurt and can't get around well even if we're doing the best for them. For curable diseases it's worth the dog not knowing why it's in pain and going to the vet and feeling under the weather, but considering his cancer has come back after an op I don't think the suffering is worth it.

Imo sometimes we go too far in treating dogs to the point where it verges on cruelty - if you're looking at a year with him if he has this surgery and chemo he'll spend alot of that time healing from it and repeated trips to the vets for chemo. I've heard of people saying their dog seemed fine on chemo, but dogs are notorious for hiding pain and sickness. It seems a better life to treat him like a king and let him eat what he wants, spend alot of time cuddling him and sitting out in the sun. Dogs don't think about dying, they just think of how their life is in the moment.

10 and a half is a good age for a dog, it's easy to think otherwise when you hear of dogs living to 14+ but unfortunately it's not meant to be for all of them. I empathise with you, I have an 11yo bitch with some mammary lumps (she's a lurcher, so not too different to your friend) but she still loves running and playing with her flirt pole and chasing a ball and a mammary strip would stop her from enjoying her favourite things so I'm choosing to leave her be as a dental two years ago knocked the wind out of her and she's had enough surgeries. Growing up my dad always treated cancer in dogs and in all but one of our dogs who only had an eyelid growth I don't think they would have thanked us for it if they could have.

I wouldn't. It sounds like a complicated op with I guess a long-ish recovery time and I wouldn't want whatever time he has left to include that stress and pain. I'm sorry you and your dog are having to go through this.

Thank you all for your opinions and experiences. Sorry for the loss of your cat, @babblingbumblingbandofbaboons

I would leave it and give him a lovely time for what time you have left , sorry 💐

I’m so sorry you’re all going through this. I agree with pp that I would just give him the best life and call it when he starts to suffer. Animals don’t understand that surgery and chemo etc are part of a long term plan because they live in the moment. It must be really hard for you; it’s horrible living with someone you’re worried about and fretting about the decision. I hope you and your DH can reach an agreement.

An injection site sarcoma (soft tissue sarcoma) is an entirely different beast to a haemangiosarcoma. They do not behave in the same way despite both being sarcomas. Haemangiosarcomas have a much poorer outcome

Thanks, not an expert at all here, just sharing experience. The OP had already given the timeline their boy had experienced (lump reappeared in two months) so I gave my story (lump reappeared in 12) with no other treatment and that we had chosen not to do further surgery second time around. Looking at those timelines alone I’d be even less likely to do anything further, before even taking into account the first op being quite nasty and the type of sarcoma - that admittedly I wouldn’t have known was likely to have poorer outcomes. That’s why I advised speaking to the vet plainly about what was likely to happen. Apologies if it felt like I was saying something different.

Thanks @Gymmum82 and @babblingbumblingbandofbaboons , I appreciate you both looking out for us. Unfortunately I know the poor prognosis for haemangiosarcoma. Dogs will almost inevitably die from it sadly.

Just feel so conflicted as we had already made a decision to move into palliative care based on the previous vet's thoughts and now the oncologist feels he can prolong his life by maybe a year, assuming they are successful.

Vets will offer options, but that doesn't mean that all of them are good ones. I have been lucky to have a vet who would answer very honestly when I asked him what he would do if it was his dog. With the dog that I had with hemageosarcoma, he advised pretty straightforwardly against surgery and chemo.

Oh it’s so so hard @Haemangiosarcoma, I’d honestly be considering whether the extra year with him that potential treatment would give will be of any quality - big operation, already some complications in terms of ribs/diaphragm, recovery time etc. As a few others have said beautifully, he doesn’t know he’s ill and doesn’t think about dying, it would potentially be kinder to give him the best of days for however long he has. All of the cuddles, all of the treats, the things he shouldn’t have but won’t make a difference now. He’ll live out his days delighted and you’ll have those memories. Just my opinion of course, but it’s what I’d do.

Prolonging life doesn't mean quality of life though.

That's major surgery the vet has proposed, with what will surely be life changing consequences.

Greyhounds have very deep chests, so how would the loss of ribs affect his breathing, ability to run and move etc? Plus muscle loss, and moving the entire diaphragm? That's absolutely huge and complex stuff.

What's the recovery time for this? What effect will such massive bodily changes have on your dogs ability to enjoy himself at his age? Are to able to be with him at home for the weeks post op where he'll need you while he recovers? What about after that - will it change his needs on a daily basis?

Honestly, I wouldn't do this. And I wouldn't put a young dog through that surgery either. Time to enjoy however long he has left with you all and plan a good, painless end for a much loved dog.

I think your instinct to move to palliative care is absolutely spot on Op.

The oncologist may well be able to do as he says, but your vet knows you & your dog.

Gentle hugs yo your lovely boy 💐

No absolutely I just didn’t want the OP to have false hope that with better margins she would get 12 months like you did with your cat. Because it’s really unlikely despite having a similar sounding name the behaviour of each tumour is so different

I think palliative care is the right option OP. Our boy had lymphoma at 10, we went down the chemo route and I so regret it. Within weeks he caught an infection, was miserably ill, spent several nights in the veterinary hospital and never recovered and we took the sad decision to PTS. It was the most awful thing and I vowed I’d never do it to another dog. I wish we’d chosen to give him the best of what we had left with him.

I had a 3 year old old Sheltie diagnosed with lymphatic cancer. The vet said surgery and chemo could give him 9 to 12 months. We decided against surgery and chemo and he lived 7 months happily and then went down hill quickly and we had him put to sleep.

It was so bloody tough, but I am still happy we made the best decision for him.

I am so sorry @Haemangiosarcoma

I would not put him through another op. Hemangiosarcomas metastasise so quickly that sadly it is likely already elsewhere. The type of surgery he would need would require extended rehabilitation, potentially a long hospital stay. Just because something can be done, it doesn't mean it should.

I am sorry.
x

Oh gosh, it is your decision of course OP, but I am a vet and in your position I would not do this surgery. It sounds very invasive and recovery may not be straightforward.

The specialists will always offer every option, as they should - some owners will feel strongly one way or another, and as such it's wrong to 'withhold' choices from an owner. But doing the most invasive, 'biggest' thing isn't always the best for quality of life, and QOL matters far more than longevity IMO.

Big hugs for you and your dog, OP.

Thanks everyone. I really appreciate your thoughts and kind words. I have asked our normal vet if we can discuss things on Tuesday as I trust their opinion and they know the case and our dog well.

We are still unable to reach a decision between us, which makes it all that much harder. We have agreed to make a final decision on Tuesday after speaking to our vet.

Thanks, will give our dog lots of hugs from you all x

I work in a vets and i feel so sorry for an animal when its owner chooses the major surgery/chemo route with no promise of a good outcome, most of my colleagues have a similar opinion too, but we have to give the owner all the options available.
There is absolutely no way that i would put my dog through this.
Your precious dog is not worrying about the decision that needs to be made, if he were mine i would be letting him live out whatever time he has left in his usual happy way then let him go peacefully surrounded with love.

Little update: we spoke to our vet and he was quite shocked with the scale of the surgery too. He said he can obviously see both sides but would not put his own dog through the surgery. He also reassured us we have done the right thing so far. I am so glad that my husband now agrees with me that we shouldn't do the surgery.

Spoke to the oncologist again today to discuss palliative medicine. Next decision is whether to try a stronger chemo to try to reduce the lump or a milder one which will maybe slow things but also have fewer possible side effects.

The lump is already about the size of a large egg, so maybe about double what it was last week. It's following the same trajectory as the first one in terms of rapid growth.

The oncologist said the stronger chemo should reduce the lump but basically as soon as you stop it in a couple of months, the growth will restart. We will discuss this with our normal vet again.

I guess the question is do we want to try and stave off the inevitable with expensive high dose chemo or let him go more quickly. I'm still considering but I suppose leaning towards milder medicine, although I'm already utterly heartbroken so God knows how I'll cope when the time comes.

I’m so sorry. It’s so very hard. I’m glad your DH and you are fundamentally in agreement. I would agree with the milder dose because I always believe quality of life is paramount but I do appreciate that that is so much easier for a stranger to say when I am not in your position. Your dog is blessed to have people who care so much but I am sorry that that is so torturous for you.

I just wanted to add that, in my experience this is actually the hardest part. Heartbreaking as it is when the time actually comes, there is some peace in it. It’s the decision making when you can’t ask or explain to them that is so difficult. Whatever happens, you have all done your best.