Neuse River Golden Retiever Rescue
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Neuse River Golden Retiever Rescue

Sebastian stomps out Soft Tissue Sarcoma

by User Not Found | May 16, 2014

I know it’s a nice day, why are we talking about this again??  Cancer is so prominent these days that it is something I hope to keep talking about so we can learn as much as we can.  This week, I’d like to talk about Soft Tissue Sarcoma (STS) and my friend Sebastian is here to help! 

Isn’t he adorable?  Sebastian came to NRGRR with lumps and bumps, so naturally we investigated them as soon as he arrived at our vet offices.  They were “poked” (fine needle aspirates) by our vets, but we couldn’t say for certain what they were, so on to the punch biopsy to get more information.  Legs/knees are a tough place to safely make large incisions, to get margins, and still be able to get them closed again, so it was really imperative that we knew what the lumps were before going in for surgery.  Also remember that the first surgery is the best shot at removing all of whatever is there.  A huge problem we face with rescue dogs is that most of them have no good history.  How long had the lump been there?  Did it grow quickly or has it been there for a long time?  Has he had surgery before?  This kind of information is really helpful to make sure we are exploring all our options.  If we know the lump has been there for a while but hasn’t grown or changed, then it’s more likely that even if it is cancer, it’s slow growing, for example.  If we know that it has been there for a while, then we also know that it might be more involved to remove, etc.  We knew something was not right, when the foster noticed that the incision from the punch biopsy on his hip wasn’t healing as well as the one on his knee. 

The good news was that when we sent these samples out, the pathologist was able to tell us what kind of tumors these were.  The bad news, the one on his hip was a Soft Tissue Sarcoma (STS).  Don’t worry, Sebastian is fine and he’s likely going to live a long and happy life, so just keep reading….

Let’s visit what an STS is for a minute.  It’s a huge category of tumor types, for example fibrosarcoma, nerve-sheath tumor, hematopericytoma, histiocytomas, and on and on.  They originate in the soft tissues of the body, the tissues that connect, support and surround other body structures.  Soft tissues can be muscle, fat, blood vessels, nerves, tendons and even the lining of joints.  Although knowing what type can give you good added information, the general characteristics and symptoms are treated the same for all types.  In the vet world, they don't know a lot about STS....they are really hard to diagnose even for a pathologist because many different cell types can be involved in just one tumor.  Diagnosis is made when pathologists are able to identify the cell type by sight and by using special stains.  They can look at the cells and tell which kind of cancer it is, but with STS, there are so many different types of cells involved that they don't always look the same.  

 These tumors are really unlikely to metastasize (move and grow somewhere else) but they are very locally invasive.  Because of these characteristics, they do commonly reoccur. Recurrence ups the ante on their ability to move around and grow someplace else and also the speed at which they come back.  The goal is to remove them in surgery and get the "margins" on all sides of the tumor for the best chance at staying cancer free long-term.  Picture an Octopus, where the body is the tumor and its tentacles extend out.  STS have the ability to grown tentacles and the longer the tumor is there, the deeper those tentacles grow and reach out.  Since we didn’t have Sebastian’s history, we didn’t know how long this tumor had been growing, which equates to us not knowing how deep or outreaching the tentacles were.  Obviously, the sooner you remove the tumor, the higher your chances for success of completely removing the tumor because it’s probably more superficial and well-organized.  Since these types of tumors are likely to recur, leaving behind any piece or part of the tumor (not getting clean margins) is like leaving a seedling in your garden.  It’s already got a head start to grow back quicker and sooner.  In these cases, vets may recommend high doses of radiation which can help delay the tumor coming back, but just remember when you are weighing your options that any further therapy is seldom curative.  When cancer comes back, it comes back with a bad attitude.  It’s more aggressive and harder to treat.  I can remember two other dogs with STS before Sebastian.  One who had a hemangiopericytoma on his back leg.  We removed it but didn't get great margins because of the location, however they are probably the least likely of all the STS to metastasize and extremely slow growing tumors.  Since this guy was already 10 years old, we had no reason to believe that this tumor, even if it did come back, would affect his quality of life or shorten his life span, so we didn't do anything more than remove the initial tumor...he was subsequently adopted and is doing fine.  We also had a dog with fibrosarcoma which is the layer of tissue that keeps the skin on the muscle.  Because these tumors are in sheets, rather than clusters, it’s nearly impossible to remove them, so we did the best we could to get as much of the tumor removed.  And because this particular tumor was extremely aggressive (mitotic index of 15) even chemotherapy or radiation wouldn't have given this guy a lot more time, so we gave him the best life we could until it came back.  The type of tumor will make a difference, so make sure you get some more information on that before making any decisions about what to do next.

We have the facts about STS and we have the pathologist report from punch biopsies with great information.  It told us that 1) this was indeed an STS, which means it needs to be removed right away 2) the mitotic index was 4.  Remember this tells us how aggressive or fast-growing the tumor is and this is really important for Sebastian because we had no medical history, no report from his old owner about how long it had been there.  A mitotic index of 4 (considered low grade) meant that this tumor was VERY slow growing so this is great news.  Sebastian’s STS was located on his hip, a good place to get margins around the tumor but right on top of his big hip/leg muscle maybe not such a good place to have to go digging deep to remove everything. 

Remember that removing it with surgery, the first time, is the best, if not only opportunity to completely remove these kinds of tumors.  If the surgeon got nice wide margins, it's possible that you won't need to do anything else!  If the tumor comes back, it will be worse and has a higher chance of metastasis.  We, and our vets, felt a specialty surgeon was the best option for Sebastian in case his muscle was involved and the tumor was difficult to remove.  I accompanied Sebastian to his appointment with the specialist.  Unfortunately they made us schedule a “consult” visit first which consisted of a meeting with an Oncologist to discuss our “options”.  This Oncologist wanted to do an MRI, a lymph node biopsy, chest x-rays and about $3,000 worth of other medical tests.  She even recommended amputation as an option!  Although this is sometimes a way to remove a tumor that is extremely aggressive and in a tricky location that may be impossible to get margins, for Sebastian this was an extremely radical and invasive option. 

Let me get on my soapbox for a minute.  You know your dog ok?  Don’t for one second let someone who speaks big, fancy words intimidate you and make you feel like you don’t.  The amount of money that you spend on your dog does not translate to how good you are as a pet owner.  The facts are that Sebastian is an 8 or 9 year old dog with a slow growing, unlikely to metastasize, if you’re going to get cancer this is the one you want to get, tumor.  We know this because we have done our job obtaining that information accurately.  His blood work is beautiful, he’s happy, eating well and acting just fine…..this guy just wants to get on with his life. Even if we don’t get the entire tumor during surgery, given its slow growth and the fact that Sebastian is already 8 or 9 years old, do you really think that if/when this tumor reoccurs it is really going to affect his life-span?  Probably not.  That bill would have easily turned in to a reason that an owner could not afford to even do the surgery, which is far more likely to affect his life expectancy.  Vets will always recommend the best medicine possible and available, that’s their job.  But if they aren’t willing to speak to you about other options, then find another vet, get a second opinion or even third!  If a vet wants to run a test, especially if it is invasive, ask why and what kind of information will it give us to better provide treatment and care for my dog?  This is not an example of every dog with an STS, there are many variables to consider when it comes to cancer.  Learn about it, ask many, many questions and then make your decision, don’t let someone guilt you in to it. End rant.

Sebastian did great during his surgery.  His chest x-rays were clear and his blood work looked great making him a great candidate for the procedure.  The wonderful specialty surgeon was able to remove the entire tumor and send it to the lab for another pathology report.  The pathologist confirmed that the tumor had clean margins and had been completely excised.  Sebastian healed wonderfully and is adopted and enjoying his forever home.  I love happy endings.

I hope this information will help you step thru the diagnosis of this type of cancer.  There is one thing for certain about this disease, it’s always changing and it’s never black and white.  It’s a shock to your system, but take your time, educate yourself and most importantly, ask questions!



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