Contrary to what Lisa Weiser has told you, I have gone through a mast cell
tumour with one of my neighbours Boxer - a 7 year old female,a diagnosed
with a Mast Cell Tumour.
Far from being NON malignant, they tend to be HIGHLY malignant, but like
many cancers, some victims survive the cancer with quick identification and
proper treatment from a vet who is highly recognized in the treatments of
cancer.
Please read carefully the article that I attached. It is one of many, many
articles we researched, looking for the proper diagnosis and treatment if
Izzy's Mast Cell Tumour.
Ultimately, hers was surgically removed but sadly, it metastasized and she
lasted only a total of 5 months from the first sighting of the growth, to
identification, treatment and surgery.
THERE IS HOPE as many dogs do survive, so don't be discouraged - just be
AWARE. That is half of the battle.
Good luck!!
Jeanne
*Canine Mast Cell Tumors*
Author: Kate Connick ©2002
*Mast cell tumors (MCT)* *are cancerous proliferations of mast cells.
Although they can and will spread throughout the body, *the bigger danger
from mast cell tumors arises from the secondary damage caused by the
release of chemicals that they produce. These chemicals can cause systemic
problems that include gastric ulcers, internal bleeding, and a range of
allergic manifestations. Clearly, mast cell tumors affect both lifespan and
quality of life. *Sometimes mast cell tumors are referred to as "the great
imposters," as there is no way to definitively identify them without a
biopsy and pathology report.* Mast cell tumors vary widely in their size,
shape, appearance, texture, and location. It can be difficult not only to
recognize mast cell tumors but to predict their course. *They may be
relatively innocent or aggressively malignant. *As mast cell tumors are
very common in dogs, it is important for the regular pet owner to have at
least a basic understanding of what they are and how they work.
*Mast cells* are specialized cells that normally are found distributed
throughout the body and help an animal respond to inflammation and
allergies. Mast cells can release several biologically active chemicals
when stimulated, among them histamine, heparin, seratonin, prostaglandinsand
proteolytic enzymes. Although these chemicals are vital to normal bodily
function, especially immune response, they can be very damaging to the body
when released in chronic excess.
*Other names:* Histiocytic mastocytoma, mast cell sarcoma,
mastocystosis(when there is systemic involvement).
*Frequency/Location:* Mast cell tumors are among the most common tumors in
dogs and are the most common type of skin cancer found in dogs.
Approximately 1/3 of all tumors in dogs are skin tumors, and up to 20% of
those are mast cell tumors. The most common location to find mast cell
tumors is, by far, the skin, followed by the spleen, liver, and bone
marrow. Approximately half of all cutaneous (skin) MCT�s are found on the
body proper, another 40% on the extremities (most frequently the hind
limbs), and the remainder on the head or neck. Approximately 11% occur in
more than one location.
*Causes/Predispositions:* No one fully understands what causes cancer. Mast
cell tumors are very common in dogs, yet they occur far less frequently in
cats and very rarely in human beings. They occur in dogs of all breeds,
ages, and genders and can occur anywhere on the body. There appears to be a
genetic component, as certain breeds are predisposed to developing MCT.
Among the most common victims are beagles, Boston terriers, boxers,
bulldogs, bullmastiffs, bull terriers, dachshunds, English setters, fox
terriers, golden retrievers, Labrador retrievers, schnauzers, American
staffordshire terriers, and weimaraners. Boxers are at the highest risk,
yet mast cell tumors are often not as aggressive in this breed. There is
some suggestion that mast cell tumor development may be associated with
golden/red coat color and with chronic immune over-stimulation that occurs
in dogs with allergies or other inflammatory conditions. There may be
environmental factors, viruses, or other undetermined contributors. Mast
cell tumors, as with all cancers, tend to be associated with age. Older
dogs are more likely to develop cancerous growths, with the average age of
a dog with MCT being 8-9 years.
*Prevention:* Because the cause is unknown, there is no known way to
prevent mast cell cancer. Presumably, the best one can do is to maintain
their pet�s overall health and be alert to signs of tumor growth or ill
health.
*Diagnosis* hopefully begins early when the alert pet-owner notices a
growth on his dog. The vet may take a fine-needle aspirate from the growth
to submit a sample for preliminary biopsy. The entire tumor will then need
to be fully removed, if possible, and submitted for biopsy. Blood tests may
include a complete blood count, serum chemistry profile, and buffy coat.
The CBC may reflect low or high white blood cell count, low platelet count,
elevated mast cell counts. The buffy coat is diagnostic (although subject
to false-positives) and reflects mast cells circulating in the bloodstream
where they are ordinarily not found in large numbers. A positive buffy coat
suggests bone marrow involvement. Other tests may include urinalysis, lymph
node aspirate, bone marrow aspirate, x-rays, and ultrasound. The
pathologist assigns a "grade" to the tumor, a somewhat subjective
assessment of *how well differentiated the cells are and therefore how
aggressively malignant the cancer appears to be.* The practicing
veterinarian and/or oncologist assigns a "stage" to the cancer, as well.
The supplemental lab work gives an estimate of how great a foothold the
cancer has, and this is reflected in the staging.
*Histiologic Grade:* The pathologist will apply specialized stains to the
tumor sample and microscopically examine it in order to determine its
grade. AgNOR staining appears to be the most conclusive prognosticator for
mast cell tumors. Tumor grade is associated with the degree of
differentiation of the mast cells. The majority of MCT are Grade 1 tumors
and are well differentiated and appear to have a very good prognosis with
no treatment beyond complete surgical removal. Grade 2 tumors are
moderately differentiated, and the prognosis and treatment options are
perhaps most complicated and difficult to predict. Grade 3 tumors are
poorly differentiated, very aggressive, and most likely to rapidly
metastasize. They carry the poorest prognosis but are fortunately the least
common. Histiologic grade is most predictive of prognosis.
*Stage:* Staging refers to degree to which the cancer has already spread at
the time of diagnosis. Tumors caught early - before they have invaded other
tissues or caused signs of systemic disease - logically carry the most
optimistic prognosis. MCT most commonly metastasizes to lymph nodes, bone
marrow, liver and spleen, so much of the lab work focuses on these areas to
detect and assess abnormalities. It is unusual for MCT to spread to the
lungs, as is so common with many cancers. In simplest terms, Stage 1 refers
to a single tumor with clean margins and no signs of spreading. Stage 2 and
Stage 3 show progressively greater signs of invasion, perhaps to local
lymph nodes, demonstrating dirty margins, or presenting as multiple tumors.
Stage 4 involves systemic metastasis and carries a grave prognosis.
*Local symptoms:* The most obvious sign of mast cell cancer is likely to be
a tumor of some sort. Mast cell tumors can appear singly, in groups, lie on
the surface of the skin or underneath it, crop up anywhere on the body, and
defy easy description. You just don�t know it�s a MCT by looking at it.
Most (at least half of) mast cell tumors are found in or under the skin on
the trunk of the body itself, and the vast majority of the remainder are
found on the extremities, especially the hind limbs. They are less commonly
found on the head and neck, and less commonly still arise from tissues
other than the skin. If they are very swollen or ulcerated, there may be
pain, but most MCT�s are unlikely to be painful. It has been observed that
higher-grade tumors may be more likely to be ulcerated in appearance and
cause local irritation.
One characteristic quirk of mast cell tumors is the tendency for them to
change in size, even on a daily basis. A tumor that gets bigger and
smaller, seemingly on a whim, may be a MCT. Another idiosyncrasy is the
potential of the tumor to produce "Darier�s sign" if poked and prodded.
Handling these tumors - even a routine veterinary palpation or needle
aspirate - can cause a heavy release of histamine that results in swelling,
redness, itchiness, hives (wheal formation).
*Systemic symptoms:* Symptoms are variable, depending on the location of
the tumor and the degree to which is has developed and/or spread. Signs of
systemic involvement may include: loss of appetite, vomiting, bloody vomit,
diarrhea, abdominal pain, dark or black feces, itchiness, lethargy,
anorexia, irregular heart rhythm and blood pressure, coughing, labored
breathing, various bleeding disorders, delayed wound healing, enlarged
lymph nodes.
*Treatment* for mast cell tumors almost always first involves surgically
removing the entire tumor, if that is possible. It is particularly
important to remove a wide margin or large area of healthy tissue (2-3 cm
in each direction) around the perimeter of the tumor. The idea is to
capture any stray cancerous cells that aren�t immediately obvious. In some
areas, such as a leg or paw, it is virtually impossible to remove
sufficient tissue to satisfy this 2-3 cm oncological rule. The tumor is
then submitted to a laboratory for biopsy, and a pathology report is
generated. Very important is the determination of whether or not the
margins of the submitted tissue removal are clean (showing no signs of
cancerous cells) or dirty (showing invasion of cancerous cells). If the
margins are dirty, further surgery or radiation may be indicated to attempt
to remove or kill any remaining cancerous cells. Nonetheless, a significant
proportion of tumors that are incompletely excised (i.e., dirty margins) do
not return.
Beyond complete surgical excision, treatment options depend on factors that
suggest the aggressiveness and status of the cancer. Low-grade tumors are
generally treated locally with surgery, with or without radiation.
High-grade tumors may be treated systemically with prednisone and/or other
chemotherapy. Sometimes the only "treatment" is supportive care intended
not to extend the dog�s life but to make what remains of it as comfortable
as possible.
*Local treatments:* Surgery is used to remove local cancerous tissue when
possible. Sometimes surgical sites for MCTs are resistant to healing.
Radiation may be used afterwards to locally kill off remaining cancerous
cells. Sometimes radiation is used in place of surgery to shrink tumors
that cannot be easily operated on. Radiation is highly effective in
controlling mast cell cancer, yet radiation is not for everyone. Dogs
treated for mast cell tumors may have 3-5 radiation sessions per week for
3-5 weeks and must be anesthetized for each treatment. This may cost
several thousand dollars, may require travel and/or boarding during the
treatment period, and may have short or long-term side effects that owners
find objectionable.
*Systemic treatments:* Prednisone (a corticosteroid) appears to be the drug
of choice in treating mast cell cancer, so much so that many veterinarians
will routinely prescribe several weeks or months of prednisone subsequent
to surgical removal of any mast cell tumor. In the great scheme of things,
prednisone is inexpensive and safe. Side effects include increased
drinking, urination, and appetite and potential gastrointestinal upset. If
a tumor has a reasonably high metastatic potential, or if it has already
metastasized, prednisone is likely to be prescribed.
Sometimes other chemotheraputic drugs are used in combination with
prednisone if the mast cell cancer appears to have metastasized. These may
include: CCNU (lomustine), vinblastine, vincristine, doxorubicin,
mitoxantrone, cyclophosphamide (cytoxan), and L-asparginase. These are all
heavy-duty drugs with potential side-effects that include severe
immunosuppression, vomiting, diarrhea, liver damage. Several studies seem
to demonstrate their limited efficacy in conjunction with surgery, but in
and of itself, chemotherapy is no match for inoperable or metastatic mast
cell cancer. Responses to chemotherapy are minimal in cases of MCT.
*Palliative treatment (supportive care):* Sometimes one cannot do anything
more than offer supportive care to a dog with mast cell cancer. The cancer
may have spread too far. The dog may be old or have other health
impairments. The owners may object to more aggressive treatment. It is the
inability to manage such things as vomiting/diarrhea from gastric
ulceration that typically marks the end of quality of life for the dog with
mast cell cancer. Thus, controlling symptoms may be more important than
battling the cancer, per se.
Various drugs are used to prevent or manage potential problems caused by
the chemicals that mast cells release. In effect, one isn�t addressing the
cancer itself. One is simply trying to maintain quality of life by fighting
the deleterious effects of the chemicals secreted by the mast cells.
Corticosteroids like prednisone, antihistamines like benadryl, and antacids
like tagamet, zantac or pepcid are often used as a matter of course after
surgery and/or radiation and are routinely used to maintain comfort in dogs
where the cancer cannot otherwise be treated or has spread. Sucralfate may
be helpful with dogs that have bleeding ulcers, as it coats the surface of
the ulcer to protect it and allow for healing. Further, there are now
special foods available for dogs with cancer - like Hills Prescription Diet
n/d - which are intended to preferentially nourish the patient but not the
cancer itself, thereby increasing both quality and length of life.
*Recurrence:* Dogs who have had mast cell tumors are more likely to develop
more mast cell tumors. 50% of surgically removed mast cell tumors will
re-grow in the same area.
*Prognosis:* Prognosis is highly variable and dependent on many factors
including tumor location, histiologic grade and clinical stage. One
statistic suggests that approximately half of all MCT�s are curable with
complete surgical removal and prednisone treatment. Dogs that are
tumor-free after 6 months are considered unlikely to have a recurrence.
Primary tumors that originate in areas other than the skin tend to be more
aggressive than cutaneous tumors. MCT in preputial (sheath), perineal(groin),
subungual (nail bed), and oral regions areas are generally the most
malignant. MCT of bone marrow or visceral tissue is particularly grave. The
higher the grade or stage, the worse the prognosis. Boxers are especially
at risk for developing mast cell tumors, yet they tend to have less
aggressive (lower grade) MCT than other breeds. *Dogs showing systemic
signs and dogs whose tumors return after surgical removal have poorer
prognosis. Similarly, the faster the growth of the tumor, the worse the
prognosis. One study found that dogs with tumors that grow more than 1cm
per week have only a 25% chance of surviving 30 weeks. MCT's that exist
locally for several months without showing signs of rapid growth tend to be
benign.*
*Prognosis/Grade-1 MCT:* A grade 1, stage 1 cutaneous MCT is likely to
never return after surgical removal. The estimated long-term survival rate
for dogs with such tumors is over 90%.
*Prognosis/Grade-2 MCT:* It is reported that 50-75% of dogs with Grade
2 MCTsurvive long-term (beyond 35 weeks). Another study concluded that
44% of
dogs with Grade 2 MCT survived long-term (over 4 years) after nothing more
than complete surgical removal of their tumors. Yet another author reports
a 45% mortality rate.
*Prognosis with radiation:* *Radiation may increase survival. *One study
concluded that 86% of its subjects, dogs with Grade 2 MCT, survived
long-term (over 5 years) with a combination of surgery and radiation
(compare that to the 44% mentioned in the previous paragraph). Another
author cited a 48-77% remission rate for treatment plans that included
radiation. Yet another study reported a 94% disease-free rate at one year
in dogs with Grade 2 MCT (dirty margins) after surgery and radiation, and
an 86% disease-free rate after 5 years. And another study still reflects a
75% survival rate two years after radiation and prednisone treatment. As
with anything, any research results need to be taken with a grain of salt
unless the entire research protocol is examined. These are merely
statistics that one can readily discover in various citations online and in
books. Nonetheless, they all appear to suggest that radiation after
complete surgical removal is statistically the most effective way to combat
(primarily Grade 2) MCT.
*Prognosis with prednisone:* Prednisone, with or without other
chemotherapy, is estimated to induce partial or complete remission in
approximately 20% of canine patients with MCT. The reason for prednisone�s
effectiveness is not fully understood, yet its use is pervasive in treating
this condition.
*Prognosis/Grade-3 MCT or metastasis:* Only 15% of dogs with Grade 3
MCTwill be alive 7 months after surgery, and only 6% will be alive
after 2
years. Once mast cell cancer has metastasized, dogs tend to die within 6
months as the symptoms of systemic illness (e.g., gastric ulcers) can no
longer be managed and the animal loses its quality of life.
*Bottom line:* Mast cell tumors occur frequently in dogs. They are well
documented and well understood in some respects, yet they are unpredictable
in appearance and behavior. No one knows what causes mast cell cancer, nor
how to cure it with certainty once it has metastasized. The best one can do
as a pet owner is be attentive to the general health of one�s dog and get
all unusual lumps and bumps examined carefully to rule out MCT or to catch
it in the earliest stages. MCT can be lethal, but it is not necessarily so.
If you�d like to send me the details of your experience with mast cell
cancer in your dog, I�d be fascinated to read it. Perhaps I can compile a
section with this information at some point in the future.
s (opens new window)
- Treatment protcols for
MCT.<http://www.vetmed.ufl.edu/sacs/Oncology/treatmentprotocols.htm>
University
of Florida College of Veterinary Medicine.
- An overview of mast cell disease in dogs and
cats.<http://www.vet.uga.edu/vpp/CLERK/Dahm/index.htm> University
of Georgia College of Veterinary Medicine.
- Mast cell tumors in dogs and
cats.<http://www.cah.com/library/mstcll.html> Columbia
Animal Hospital, Maryland.
- Mast cell tumors. <http://vetinfo.com/dmastcell.html> Vetinfo; Dr.
Michael Richards, Virginia.
- Mast cell tumors.<http://www.peteducation.com/article.cfm?cls=2&cat=1638&articleid=461>
Dr.
Joe Bodewes; Drs. Foster and Smith, Inc., Wisconsin.
- Mast cell tumors in
dogs.<http://www.oncolink.com/templates/types/section.cfm?c=22&s=69>
Oncolink; University of Pennsylvania Cancer Center.
- Canine mast cell
tumor.<http://www.vetcentric.com/reference/encycEntry.cfm?ENTRY=Mast%20Cell%20Tumors%2C%20%20Canine&COLLECTION=1>
Vetcentric; Maryland.
- Mast cell tumors.<http://www.jersey.net/~mountaindog/berner1/mastcell.htm>
Patricia
Long; Bernese mountain dog home page.
- Mast cell tumors <http://clubs.akc.org/fcra/healthmanual/mast.html> -
Flat-coated retriever society of America.
- Mast cell tumors in
dogs<http://rainbowsbridge.com/New_Beginnings/pets_in_need/pets_with_cancer/Mast_Cell_Tumors_Dogs.htm>
-
Dr. Gail Mason, DVM, Bath-Brunswick Veterinary Associates.
- Mast cell tumors in dogs and
cats<http://www.vetsurgerycentral.com/mct.htm> -
Michigan Veterinary Specialists.
-
On Fri, Nov 9, 2012 at 12:00 AM, Yvonne Loppnau <yvonneloppnau@yahoo.ca>wrote:
> **
>
>
> Wow this is great. My boxer has a mast cell tumor on her elbow and I have
> been saving for surgery. Has anyone here used this ? Is Tagamet only avail
> by prescription ? Avail in Canada ? Can you use other anti-ulcer drugs ? I
> wonder if it really works, a few websites claim it does. I would LOVE to
> avoid surgery. I have not found any side effect so far.....
> Thank you Yvonne
>
>
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