It’s once again Friday and time for another cool case. Today we talk about cancer again. Cancer is never great, but what if it is benign? Sometimes a seemingly terrible diagnosis turns out to be not as bad as we originally think.
Today we meet Copper. He was another great dog. His owners were clients of mine for many years, so I was able to see Copper on many occasions. He was a very handsome Golden Retriever; one of the darker colored ones. On this particular visit, his owners mentioned that he seemed to be swollen in his abdominal region. This change had occurred over the last couple months prior to his examination that day.
Before starting his physical examination, I started with a lot of questions for the owners. Was he still eating? How was his activity level? Was he still defecating? Had they noticed any vomiting? If they looked in his mouth, were his gums ever pale? Had he lost a significant amount of weight? The owners reported that he continued to eat very well, no vomiting was noted, and he was still able to defecate. He was an older golden, about 12 at that time, so he had slowed down and it was difficult for them to say if his activity level had changed or not.
I next moved on to his complete physical examination. I had a number of ideas in mind, and wanted to check some specific things out. He was quiet and alert, had developed some age-related clouding in his eyes, and his ears were not inflamed and had no debris. When I looked in his mouth, he had an expected amount of dental tartar for his age, but his gums were a little pale. His heart rate was a little increased, but that could be explained in part due to nervousness during his exam. On abdominal palpation I definitely felt something concerning - a large mass effect in his mid abdominal region. Finally, he had arthritis in his knees and hips that was palpable on range of motion exercises with his limbs.
You probably guessed my next question to the owners…..can I take an abdominal x-ray on this young man? They were on the same page and definitely wanted an x-ray to be taken. I’ll post his x-ray three times here. The first is below without anything circled. Can you figure out were his mass is located?
Absolutely. That large white area in the middle of his abdomen is a large tumor. I was concerned immediately about his spleen. While it could have potentially been his liver or a kidney that was diseased, the most likely organ affected in this area was the spleen. The pale gums and increased heart rate would definitely be explained by this type of tumor. The spleen contains a large portion of the body's blood volume, and any loss of blood from this bleeding tumor would cause pale gums and an increased heart rate. Below is a "normal" abdominal x-ray on a dog. Can you see the huge difference? The arrow in the x-ray points to a normal spleen.
I discussed the x-ray with Copper’s owners. Splenic tumors can be either benign (cancerous but not the bad kind) or malignant (cancerous and will quickly spread to other organs). We wouldn’t know what kind this was unless we did surgery to remove his spleen. After surgery, the organ (or parts of it in this case) are sent to a Histopathologist to tell us if the cancer was benign or malignant, if we removed all of it, and what the prognosis was for the future. Their options at his advanced age were to either consider not doing surgery and continue to monitor him and his quality of life, or to proceed with surgery. They thought long and hard, but in the end decided to not proceed with surgery. This is a very personal decision in every case, and I always tell owners that the decision they make will be the right one. I’m there to provide information, discuss the pros and cons of either decision, but ultimately they know their pet the best and will make the best decision for their family.
Before we wrap up this case, I’ll put that x-ray up one more time below this paragraph. Another interesting finding on his x-ray was the amount of arthritis along his spine. This is very common amongst older large breed dogs that are very active in their youth. As the body gets older, it tries to stabilize itself along the spine. These bony “bridges” that you see, are the body’s stabilization attempts. Look how many vertebrae are affected! This can lead to pinching of the intervertebral disc spaces and some discomfort when lying down and getting up.
In Copper’s case, time would tell us that this tumor was most likely benign. With the sheer size of the tumor at the time of diagnosis, I wondered if it might be benign. It must have been growing for at least 3-4 months prior to them bringing him in. With only minimal symptoms, it was acting more benign than a quickly spreading malignant tumor. Copper lived another year and a half after that visit. He was occasionally uncomfortable in his belly due to his large mass, but he continued to eat and was able to defecate. His owners were very appreciative of the extra year and a half they were able to spend with him after his diagnosis.
Today we meet Copper. He was another great dog. His owners were clients of mine for many years, so I was able to see Copper on many occasions. He was a very handsome Golden Retriever; one of the darker colored ones. On this particular visit, his owners mentioned that he seemed to be swollen in his abdominal region. This change had occurred over the last couple months prior to his examination that day.
Before starting his physical examination, I started with a lot of questions for the owners. Was he still eating? How was his activity level? Was he still defecating? Had they noticed any vomiting? If they looked in his mouth, were his gums ever pale? Had he lost a significant amount of weight? The owners reported that he continued to eat very well, no vomiting was noted, and he was still able to defecate. He was an older golden, about 12 at that time, so he had slowed down and it was difficult for them to say if his activity level had changed or not.
I next moved on to his complete physical examination. I had a number of ideas in mind, and wanted to check some specific things out. He was quiet and alert, had developed some age-related clouding in his eyes, and his ears were not inflamed and had no debris. When I looked in his mouth, he had an expected amount of dental tartar for his age, but his gums were a little pale. His heart rate was a little increased, but that could be explained in part due to nervousness during his exam. On abdominal palpation I definitely felt something concerning - a large mass effect in his mid abdominal region. Finally, he had arthritis in his knees and hips that was palpable on range of motion exercises with his limbs.
You probably guessed my next question to the owners…..can I take an abdominal x-ray on this young man? They were on the same page and definitely wanted an x-ray to be taken. I’ll post his x-ray three times here. The first is below without anything circled. Can you figure out were his mass is located?
Absolutely. That large white area in the middle of his abdomen is a large tumor. I was concerned immediately about his spleen. While it could have potentially been his liver or a kidney that was diseased, the most likely organ affected in this area was the spleen. The pale gums and increased heart rate would definitely be explained by this type of tumor. The spleen contains a large portion of the body's blood volume, and any loss of blood from this bleeding tumor would cause pale gums and an increased heart rate. Below is a "normal" abdominal x-ray on a dog. Can you see the huge difference? The arrow in the x-ray points to a normal spleen.
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| Courtesy: Long Beach Animal Hospital |
I confirmed my suspicions with a quick ultrasound of his abdomen before having his owners come back to the x-ray room to discuss my findings. Splenic tumors were very common in the area of the state that I practiced in. Why? I’m not sure, but it was a disturbing trend. Prior to purchasing this practice, I had worked in the southern part of the state, and in my previous six years, had only seen one splenic tumor. There were times during my 7 ½ years at this practice where I diagnosed or surgically removed upwards of 20 cancerous spleens PER YEAR.
I discussed the x-ray with Copper’s owners. Splenic tumors can be either benign (cancerous but not the bad kind) or malignant (cancerous and will quickly spread to other organs). We wouldn’t know what kind this was unless we did surgery to remove his spleen. After surgery, the organ (or parts of it in this case) are sent to a Histopathologist to tell us if the cancer was benign or malignant, if we removed all of it, and what the prognosis was for the future. Their options at his advanced age were to either consider not doing surgery and continue to monitor him and his quality of life, or to proceed with surgery. They thought long and hard, but in the end decided to not proceed with surgery. This is a very personal decision in every case, and I always tell owners that the decision they make will be the right one. I’m there to provide information, discuss the pros and cons of either decision, but ultimately they know their pet the best and will make the best decision for their family.
Before we wrap up this case, I’ll put that x-ray up one more time below this paragraph. Another interesting finding on his x-ray was the amount of arthritis along his spine. This is very common amongst older large breed dogs that are very active in their youth. As the body gets older, it tries to stabilize itself along the spine. These bony “bridges” that you see, are the body’s stabilization attempts. Look how many vertebrae are affected! This can lead to pinching of the intervertebral disc spaces and some discomfort when lying down and getting up.
In Copper’s case, time would tell us that this tumor was most likely benign. With the sheer size of the tumor at the time of diagnosis, I wondered if it might be benign. It must have been growing for at least 3-4 months prior to them bringing him in. With only minimal symptoms, it was acting more benign than a quickly spreading malignant tumor. Copper lived another year and a half after that visit. He was occasionally uncomfortable in his belly due to his large mass, but he continued to eat and was able to defecate. His owners were very appreciative of the extra year and a half they were able to spend with him after his diagnosis.
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