Mast Cell Tumour On Face

[rusty&biscuit]

Hi, thanks for reading. I am in desperate need of advice/opinions as our dear girl Cherry has yet another mast cell, this time on her face, plus one on her leg. The one on her face is located on her lip, just under the nose. She has had it since 2011 because we thought at 10 she was nearing the end (she's our first family dog) and thought it would be cruel to put her through such a deforming surgery, instead opting for quality if life over quantity as due to the local of the tumour half her lip would need to be removed, leaving her with the possibility of a permanent dry mouth, as the vet told us. However she is still in amazing condition at 12, very lean and muscular and coming on hikes with me and still keeping up with the boys. However the lump has been concerning us lately, so we brought her to the vet for a second opinion and were told that both lumps could easily be removed, and despite her not looking too sightly, she'd still be able to eat properly and not have a dry mouth, and because she is so fit and healthy she would be fine to undergo surgery. So there are 3 of us in the family, and because she belongs to all of us it needs to be a joint decision. Mum is opting to go against the surgery, as she has major concerns over her quality of life afterwards if she was to get a dry mouth and have other complications. Dad is opting to go for the surgery. So it's up to me now, but I just don't know what to do. As much as I don't want it done as I have the same concerns as mum, there is strong feeling in my gut that I haven't felt before, saying to do it. It just feels as though she should get the surgery now, while she's fit and healthy enough to have it done, before she becomes too old/ill and the way cancer can take over the body so quick, it may be too late and then I'll regret not having It done earlier. The vet is confident that's it's a slow growing tumour so she thinks she'll be able to get it all out. I am just devasted, I love her to bits, she's my first ever dog and I really want to be sure I make the right decision. Please please share any opinions, advice, or experience, I really appreciate it and thank you in advance! Sorry this is long, but thank you for taking the time to read.

[~Anne~]

Why would she suffer dry mouth? Is it because the thinking is that the amount to be excised would be too large to close or join any skin over?

If it has been there for 2 years it must be low grade or you would think the repercussions would be felt by now. If it is low grade, I believe she is heading into 'no return' territory anyway after 2 years of it being there.

If it were me, I think I would possibly lean toward my original decision. There's no putting shutting the gate if the horse has bolted as they say.

In having said all that, it really is up to you and your family to decide in consultation with your vet.

Edited June 21, 2013 by ~Anne~

[rusty&biscuit]

Why would she suffer dry mouth? Is it because the thinking is that the amount to be excised would be too large to close or join any skin over?

If it has been there for 2 years it must be low grade or you would think the repercussions would be felt by now. If it is low grade, I believe she is heading into 'no return' territory anyway after 2 years of it being there.

If it were me, I think I would possibly lean toward my original decision. There's no putting shutting the gate if the horse has bolted as they say.

In having said all that, it really is up to you and your family to decide in consultation with your vet.

Thank you for your insight Anne. Yes mum suspected dry mouth because the area would be too large for the skin to close over she was talking to someone at her work whose dog had a similar operation, and ended up with the opposite to a dry mouth. Her dog just kept drooling excessively and they regretted having the operation done. I just want to gather as much advice, experiences, and opinions as possible in order to form my own opinion in this difficult situation

[~Anne~]

Has the vet explained all the outcomes? What does he/she say about the life expectancy before and or after, with or without, and what the complications may be?

I am experiencing mast cell tumours with one of my boys. We've had 5 so far, all removed, and graded 1 and 2 but low grade so far. There are two grading systems. The most common still uses 1 - 3 grade.

To put it in perspective and to illustrate why I I think you need to understand the grading is because this will predict life expectancy.

In summary, in an older study I read while researching MCTs it followed 83 dogs diagnosed with various grades of MCT. One of the areas the research looked at was life expectancy. The dogs were selected after the lesions were removed with clear margins. More than 90% of the dogs with grade 1 tumours were still alive more than 1500 days after diagnoses. 47% of dogs with grade 2 were alive at 1500 days and only 6% of grade 3 dogs were still alive. 1500 days is equivalent to more than 4 years.

There is no way of knowing the grade until it is resected and tested and the dogs above all had them removed and tested. However, I'd be inclined to think in your situation it may not be high grade because your dog is still alive and well and not showing symptoms 2 years later. Of course, that is only a guess. You cannot know until it is removed and examined and my thinking could be filled with flaws.

I'd be speaking with your vet. I must have up to 2 or three discussions about each new issue with my boy before we make a decision together about his treatment. Im sure your mum is a very knowledgable woman, but your vet is trained in and educated in the field. He is the expert. Discuss it some more with him.

Many dogs also cope with major surgery at advanced ages, my boy who is 10 is possibly going to have to undergo the removal of his spleen. If we do this, it will be after many discussions as always with my vet.

Good luck with whichever way you go.

Edited June 22, 2013 by ~Anne~

[Bindo]

I would also see if you can find out (small biopsy) what the grade of the tumour is, then you will have more knowledge for decision making. As Anne has said, it is probably low grade, otherwise it would have spread to other locations by now.

When my dog was diagnosed with MCT grade 3, she was given (statistically) 4 months without treatment. She had a radical excision (two toes) and chemotherapy, and is still here 9 months later (see other thread for more details). The oncologist vet at the time did say though that MCT's are very unpredictable, and she has seen some dogs with low grade not do so well, and others with high grade survive for quite a while.

Is the vet a specialist surgical vet? If possible depending on where you are located, it might be advisable to get a specialist oncolcogy vet (surgeon) to review her case. Good luck with the decision. :)

[~Anne~]

........The oncologist vet at the time did say though that MCT's are very unpredictable, and she has seen some dogs with low grade not do so well, and others with high grade survive for quite a while......

I am lead to believe that is the reason for the new grading system. The new system uses other characteristics to determine the potential for the tumour to cause an escalation of concern. All of Boof's have been low grade on the new system, and grade 1 and 2 on the older scale.

[Bindo]

........The oncologist vet at the time did say though that MCT's are very unpredictable, and she has seen some dogs with low grade not do so well, and others with high grade survive for quite a while......

I am lead to believe that is the reason for the new grading system. The new system uses other characteristics to determine the potential for the tumour to cause an escalation of concern. All of Boof's have been low grade on the new system, and grade 1 and 2 on the older scale.

Yes, that's right Anne. Lucy's was graded as Patnaik grade 3 (old system) and Kiupel = high (new one). Neither a good result And they also use the mitotic index, higher being worse (hers was 13). This is the information from the pathology report on the two systems:

This tumour has been graded using both the traditional Patnaik system

and also using the recently published consensus grading system endorsed

by ACVP and WSAVA (Kiupel M et al. Proposal of a 2-tier histologic

grading system for canine cutaneous mast cell tumors to more accurately

predict biological behaviour. Vet Pathol 2011, 48:147-55). This new

grading system appears to be a better predictor of survival than the

Patnaik grading system. According to the novel grading system,

high-grade MCTs were significantly associated with shorter time to

metastasis or new tumour development, and with shorter survival time.

The median survival time was less than 4 months for high-grade MCTs but

more than 2 years for low-grade MCTs.

[rusty&biscuit]

Thank you both do much for your replies! I am still undecided as to what to do...I wish Cherry could just understand and tell me what to do, would certainly make this a lot easier! :p as I'm trying To do what's in her best interests, I'm unsure wether life without half a lip, with the possibility of constantly salivating is a better outcome than just letting her be, and giving her her wings when the time comes before she gets too uncomfortable. Sorry, just thinking aloud here.

On the grading system, the vet agrees Anne, that it is most likely a low grade as it has grown so slowly.

Bindi, the vet we saw was new the practice we go to. I am not sure wether or not there's specialists around here (Cairns) but will have a look into it. There is a vet who's seen Cherry before that I do not like, however he is a very knowledgeable man, perhaps I should see him and discuss the options with him?

[~Anne~]

If it were me, I'd speak to the more knowledgeable vet.

[rusty&biscuit]

Sorry I havent updated! Spoke to mum about seeing this particular vet, but she said she already took Cherry to see him when she first got the lump and he said it needs to be removed or she'd only hav 3 months to live Mums gut feeling was to go against that, so she did, and look where we are now!

We were given cream from the vet recently to apply to the lump, and it has gone riiight down, so it's obviously not aggressive. Unfortunately this is a situation where we're damned if we leave the lump and we're damned if we cut half her lip off. So we've decided to go against the surgery for now. Thank you so much for both your inputs, I have really appreciated it

[dogbesotted]

Just thought I'd pop in to say Hi and let you know this bit of new info:

Wanted: dogs with mast cell tumour or malignant melanoma

We are looking to recruit dogs diagnosed with mast cell tumour or malignant melanoma that are not treatable by standard therapies. Participating dogs will have pre and post treatment blood testing, a single injection of a novel immunostimulant into one tumour, follow up visits every 2–4 weeks and owners will have to complete a questionnaire every 2 weeks. The cost of the experimental treatment, relevant blood work and follow up is covered by the study but owners and dogs must be able to travel to/from the Veterinary Medical Centre, Gatton Campus, for the initial treatment and for the follow up visits. Details: Contact Moira Brennan on ext. 50096 or (07) 5460 1096.

cheers

helen

[Guest Maeby Fünke]

My Pug had 12 Mast Cell Tumours over an 18 month period; 8 were removed with surgery and 4 went away on their own. He has now been cancer-free for six months.

Three of the tumours were on his face (two on his lip; one on his nose roll). His oncologists recommended that his vet remove them with surgery, which she did and they were low grade. They also said it wasn't necessary to remove them with wide margins. Apparently, this is because the need for wide margins, with low grade tumours, is now considered an outdated practice.

I would get a second opinion from an oncologist. I would also ask the oncologist about the cancer drugs Palladia and Mastinib.

Here is part of the oncology report for my vet.

For multiple, small dermal mast cell tumours in breeds prone to lower grade tumours (i.e. pugs), it is acceptable to remove these with less than the dogma of 2-3cm margins. In this case the pinna and nasal fold masses would be difficult to remove with wide margins but could be marginally resected. Any further therapy required could then be determined based on the histopath report.

Edited September 21, 2013 by Maeby Fünke

[Clyde]

How long has the new grading been in place?

[Rappie]

It's been a while Clyde, but not more than a few years. The new classification suggests that low grade mast cell tumours can be considered to have more benign characteristics. This means they can be removed with smaller margins etc. Accurate grading still requires histopathology after removal but the pathologists can often get an impression of the characteristics from cytology.