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Hemangiosarcoma – A (Usually) Silent and Deadly Canine Cancer

November is Pet Cancer Awareness Month. Among the deadliest canine cancers is hemangiosarcoma, or cancer of the blood vessels. Hemangiosarcoma can either present as skin cancer, which can be successfully treated if diagnosed early enough, or as cancer of internal organs, particularly the spleen or heart. The prognosis for splenic or cardiac hemangiosarcoma is extremely poor, even with aggressive treatment, as often the first sign of any problem is when the tumor ruptures and causes massive internal bleeding. An additional complication arises from the fact that, since it is a cancer of the blood vessels, the cancer cells have usually spread to other areas of the body by the time of diagnosis. As a result, the median survival time of internal tumors after diagnosis is measured in weeks or months, even with surgery and chemotherapy. Hemangiosarcoma can occur in any breed, but there is a recognized predisposition in German Shepherds, Labrador Retrievers, and Golden Retrievers. Within my own circle of pet parent friends, we’ve lost a Siberian husky, an Australian shepherd, a golden retriever, and my own miniature poodle, Tiny, to hemangiosarcoma in the past year.

What are the signs and symptoms to look out for? For skin-based tumors, any unusual growth on the skin should be evaluated by your veterinarian and biopsied if cancer is suspected. It’s a good idea to check your pet’s skin often, especially as he gets older, for any abnormal lumps or bumps. Many are benign, but only your veterinarian and pathologist can recognize cancerous skin growths.

For cancer of the internal organs, the signs can be much more subtle and sometimes non-existent. In the cardiac form of hemangiosarcoma, you may notice weakness, weight loss, loss of appetite, difficulty breathing, or difficulty recovering from any type of exercise. These can all be signs of simple aging, other heart or lung problems, or tumor growth. Again, a visit to your vet is for possible x-rays, ultrasound, CT or other diagnostic scans to determine the cause of the problem. If left undiagnosed, the heart tumor will eventually rupture and cause massive internal bleeding.

In the splenic form of hemangiosarcoma, unless the tumor is extremely large and palpable on abdominal examination, the first warning sign may be total collapse when the tumor ruptures. In Tiny’s case, he developed more than usual “old man weakness” one night at home and was unable to stand. She was seventeen at the time and had a bulging belly initially due to the loss of muscle tone associated with aging. I rushed him to the emergency vet clinic (he never had an emergency during regular vet clinic hours) where the doctor quickly tapped his abdomen and drained bloody fluid. She told me about her suspicions that a tumor had ruptured in her spleen and recommended an ultrasound to confirm her diagnosis. The ultrasound showed a very large spleen as well as some suspicious spots on the liver. We discussed the two options: surgery to remove the spleen and the suspicious parts of the liver or euthanasia. Given his age and all the possible complications, we made the difficult decision to say goodbye to him.

But, when Tiny was brought into the room for that final procedure, he had miraculously recovered from his collapse, was very excited to see us, and started asking us to play with him. The vet suspected that the internal bleeding had stopped and that he had been transfused again. After more discussion of the other alternatives and based on the fact that he seemed to be telling us he wasn’t ready to go yet, we brought him home and scheduled a specialist visit early the next morning.

Tiny underwent a splenectomy and partial liver lobectomy and came through the surgery in great stride, especially given his age. We opted for a shortened and low dose of chemotherapy and for the rest of his life he was on fairly mild drugs like doxycycline and Deramaxx to keep the cancer at bay. She also received acupuncture and Chinese herbal preparations in addition to Western medicine. Despite the six months or less that most hemangiosarcoma patients survive, Tiny lived another two and a half years before the cancer spread to his brain and mouth. When he started having trouble eating and started having seizures, it was time to help him cross the “Rainbow Bridge.” His outcome and length of survival with a good quality of life were unusually positive, but he was a fighter with a strong will to live.

Survival in hemangiosarcoma is largely a function of how early it is caught and whether it is a superficial/skin lesion rather than an internal tumor. Treatment options can be limited, especially if a tumor breaks, and diagnosis, surgery, and chemotherapy can be expensive. You know your dog better than anyone and are in the best position to make informed decisions (with the help of your vet) as to the best course of action if this deadly cancer strikes your dog.

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