Featuring Demian Dressler, DVM and Susan Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide.

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How Long to “Watch and Wait”

Last week I told you about two recent cases in which the tumors were too big for surgery by the time they came to me. I also promised to give you some guidelines about how long to wait when your vet says “let’s just monitor this.” Too many lumps and bumps are being monitored for too long … so this post contains some guidelines.

The Vaccine-Associated Feline Sarcoma Task Force of the American Veterinary Medical Association has guidelines based on their work looking at sarcomas occurring at vaccination sites. While these guidelines were created for cats originally, and the first rule refers to vaccine injection sites, in my experience these guidelines apply to dogs, as well.

According to this “1-2-3 Rule,” you should get a lump or bump aspirated right away if any of the following is true for your dog:

  1. The mass is increasing in size one month after injection.
  2. The mass is greater than two centimeters in diameter.
  3. The mass persists for longer than three months

So, if your dog’s lump or bump is increasing in size after a month, bigger than two centimeters (just under an inch), or hasn’t gone away after three months – get it checked!

 Phew: It’s Benign.

Hopefully, the mass will turn out to be benign. If that’s true, it may not need to be removed right away.

A lot depends upon where a benign tumor is located. If it’s causing pain, it might be keeping your dog uncomfortable. On the other hand, if removing it would be a complicated surgery – it’s near a joint, or it is on the lower limb where there just isn’t much tissue to work with – it might not be worth removing.

If it does need to be removed, most benign masses require smaller surgeries. We don’t worry as much about getting wide margins. Also, sometimes the surgery can be combined with another procedure that requires anesthesia. For example, if your dog is getting his teeth cleaned and undergoing anesthesia for that, your vet might offer to remove the benign tumor at the same time. The risks of anesthesia are real, too, after all.

Oh, no. It’s malignant.

If the aspirate comes back indicating the mass is malignant, remember that it is often better to get a small surgical biopsy to determine the type of malignant tumor and the grade before going for a curative surgery.  I may also recommend staging diagnostics first, before the curative surgery. This is a complicated subject, I’ve written about in several posts, including this one on mast cell tumors.

 Surgery Might Be All You Need

Surgery is often all we need to treat many cancers, so please, do not wait too long to get a lump or bump checked out. Remember Tiger and Tulip? Both could have had great prognoses, if the tumors were removed with clean margins the first time, when the tumor was small enough to get out. Now, surgery would harm more than help, and they are stuck with radiation, which is less effective for measurable sarcomas, or chemotherapy, which is much less effective for primary tumors than it is for metastasis.

As your dog’s guardian, make sure you read biopsy reports. Tiger’s mom was unaware of the dirty margins that were reported on the biopsy from his first surgery a year ago. If she’d known then about the incomplete margins, and that it meant his tumor was more likely to recur, she would have had more time to address the situation.

What About Recurrence?

That said, even with a clean margin reported on the biopsy, tumors can still regrow from microscopic cancer cells we don’t see in the biopsy. So we must all monitor for regrowth. Some tumors, like Tiger’s, are in a location that you can see. Others, like those inside the mouth or inside body cavities, you might need to check with imaging tests or sedated exams.

If your dog’s tumor is malignant and you have it removed, recheck it every two to three months after the surgery. Early detection of recurrence is key to addressing it with the highest possible chances of success.

The Bottom Line

Please, don’t watch and wait as a mass grows, because there is a point at which it will be too big to address. Have your vet measure and document the size of the tumor, so you can compare growth. Aspirate or biopsy that mass, if needed. And make sure you find out about the margins after surgery. Were they wide enough for that tumor type? If not find out if there can be a scar revision (second surgery), or if radiation can prevent regrowth, or chemotherapy can slow recurrence. Be proactive. Check with an oncologist, and please, don’t monitor for too long.

Remember the “1-2-3” Rule and get that lump or bump aspirated right away if any of the following is true for your dog:

  1. The mass is increasing in size one month after injection.
  2. The mass is greater than two centimeters in diameter.
  3. The mass persists for longer than three months

All the Best,

Dr. Sue

About the Author: Susan Ettinger, DVM, Dip. ACVIM (Oncology)


Susan Ettinger, DVM. Dip. ACVIM (Oncology) is a veterinarian oncologist at Animal Specialty Center in New York and the co-author of Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity. She blogs about dog cancer at http://www.DogCancerBlog.com.

  • Robin

    Hi, Just read this article and it’s a great resource to have. Would you mind if I re-posted your 1-2-3 rule on my blog and in our Newfie club newsletter?
    thanks!

    • Dr. Susan Ettinger

      Robin,

      Not at all, just please make sure to point out this is my recommendation. You can also please provide a link to the blogs. Thanks for sharing!!

      All my best, Dr Sue

  • https://twitter.com/ocdgirl2000 Lynne G. Siegel R.N.

    If it’s infected, then the biopsy results can be interpreted as a false positive. If you treat the infection, and it can’t clear up, because it becomes increasingly resistant to antibiotics, then piercing it puts the dog at even more risk of getting cellulitis and spreading the infection systemically. so then what? you keep treating the infection over and over with continuous culturing, until you reach a point of ordering the strongest antibiotics available, until you think your dog has MRSA or some other fatal flesh eating bacteria, only to find out later on, that it was a cancerous lesion that made your dog immune suppressed. So, then you have 2 issues to deal with, and in the end, neither can really be treated effectively with anything that exists on the market.

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  • Cheryl

    My dog was diagnosed with lymphoma last June and given max 4 weeks. I decided to let him have his time without treatment (which I was told wouldn’t really benefit him as he was so ill) and wonderfully and thankfully he is still with me and doing well (eating, enjoying his walks etc). I am now in a state of limbo because I have no idea how long I will have him. Is this length of time usual for a dog given that prognosis? He has some lumps but they don’t seem to hurt when I touch them. Just not sure what the future holds and would be grateful for any advice. Thank you

    • Dr. Susan Ettinger

      Cheryl,
      Most dogs with lymphoma that are not treated live about a month, but as you proved, statistics will never predict every dog. I wish I could predict things for you now, but the best I can say is enjoy each day – each day is a gift – and keep him happy and comfortable.
      All my best, Dr Sue

  • http://riverthebeagle.blogspot.com stephanie lilley

    One of my friends used a Sharpie to draw around the lump to keep track of the size. My vet says after dealing with my dog with MCT that she will never trust any lump again. I know now that what we used to think was normal for old dogs–all old dogs get lumpy–could mean cancer and we could possibly extend their lives if it is removed.

    • Dr. Susan Ettinger

      Stephanie
      Good advice, I recommend that too. Hard to do on some breeds without shaving the area. Thanks for sharing!
      All my best, Dr Sue

  • BARBARA

    my vet told me to wait, i waited and thank god it was afatty tumor.i decided to leave it alone because he is 8yrs old and it dosnt appear to be bothering him..did i do the wrong thing? i just hate to have him go for surgery….

    • Dr. Susan Ettinger

      Barbara,
      As long as its a lipoma, I am okay to leave it. If its getting bigger or bothering your dog, reconsider.
      All my best, Dr Sue

  • Deb

    As I can’t get Tagamet or Pepcid otc in Australia can I subtitute Zantac? My girl weighs 25kg so what is a safe dose?

    • Dr. Demian Dressler

      Deb, you need to discuss this with your veterinarian to see whether there are any problems giving Zantac to your dog. But Zantac has been used in the dog to decrease stomach acid, yes. Discuss with your vet please…
      Dr D

  • Ron Sholar

    i had a three year old great dane that died of lymphomas at the jaw line on both sides. The breeder was from Missouri and i believe a puppy farm.
    Our current danes are from a well know long time breeder from the Chicago area. The younger of the great danes is 3 1/2 years and has a small lump (1/2 inch) on the right side of the jaw line. I am nervous about it because of of the past (i guess you will say have it checked). The other dane is 6 years old and she is fine except she has a few bump on the top of the neck and on top of the rib cage. i have thought this is because of them playing hard. (same breeder but not the same blood line).

    • Dr. Susan Ettinger

      Hi Ron,
      Sorry about your Dane with lymphoma. Never easy to lose a pet!
      You are correct, I recommend you go get the mass checked out – probably start with an aspirate. See what your vet says.
      All my best, Dr Sue

  • Ron Sholar

    I design and built veterinary hospitals throughout the U.S., which does not make us experts as veterinarians. i know that vets. kind of look at danes as cash flow for them, because they are so large and grow quickly that they have many issues.
    Thank you for for your thoughts…

  • Holly

    My 10 year old Australian Shepard was diagnosed with anal sac adenocarcinoma in both anal sacs on July 2, 2012. After surgery to remove both anal glands and a lymph node (metasticized) he received 6 treatments of chemotherapy. His recheck on November 15, 2012 showed no evidence of cancer. On December 26, 2012 blood tests and x-rays showed that the cancer had returned. His calcium levels were scary high and there was sign of another tumor growth in his tummy. I love my dog so much, but decided not to put him through another surgery only to have the cancer return so quickly. Did I make the right decision? His Oncologist has him on another 6 chemo treatments, along with palladia given at home. In less than a month we have spent over $2,000 (total over $13,000) and I am still not sure the outcome to expect from this new treatment. I was so disappointed that the cancer returned 6 months later when I was told one year or more. I just don’t know what to believe anymore and if I am doing the right thing for me and my boy.

  • http://www.facebook.com/Gemma.Furbank Gem

    Hi Sue, thank you for all your online info and advice.

    My rescue Rottie bitch, roughly 8/9yrs old was Xrayed Early December, and although we didn’t Biopsy, we believed due to the various factors, she has an Osteosarcoma in her from right. Amputation was
    never an option, due to her having been suffering from Arthritis in her hind
    right for as long as we have had her. Chemo and Radiation therapy, having
    treated dog’s in the past with Chemo – i didn’t feel it fair to her.
    choosing quality of life over quantity..as much as i don’t want her to leave us.

    I have been treating Bonz since early December with Artemisinin and Super
    Artemisinin although not Artemix. Sadly NSAID’s were tried but didn’t manage her
    pain. She is currently on PLT’s and Tramadol as needed. Since switching to the PLT’s we have only had to use Tramadol once after exercise.

    She is on the lowest does possible for her weight with the Steroids to give us
    room to adjust if needed. The last few weeks, it’s as if Bonnie doesn’t even
    have a tumour – knowing that basically her bone is erupting/exploding, and guessing how painful
    that is, it’s amazing to see her. People have commented on just how healthy and
    shiny she looks.

    I have researched on here and other sites, and been using Curcumin, Quercitin and Omega 3
    Fish Oils along with giving her all the vitamin’s that are recommended for use.
    I honestly today, was looking at her tumour and without Xray’s obviously, to the
    touch and naked eye, i do believe that there has been a slight change in size.
    After the initial growth, i do believe today it look’s smaller and feels
    smaller.

    Sadly, Bonnie today was rushed into the vets with a distended abdomen and
    abdominal pain, anorexia and vomiting. A very sudden onset, as yesterday we were
    playing in the Snow and she was as bright as a button and her usual hungry self.

    After Xrays, bloods showing one Liver enzyme was raised, and scans, it looks
    like she has acute Pancreatitis. Have you ever experienced Pancreatitis as
    a possible side-effect from any of these supplemental treatments? I am aware that Steroids
    increase the risk, but she’s on low dose so i just need to know that if she survives, i wont put her in that position again through the use of any supplement i am using. Curious as i know there can be stomach upsets sometimes with Artemisinin.

    I have everything crossed that she makes it, and never thought it wouldn’t be
    the Bone tumour and metastisis that claimed her and after the gloom of knowing
    she has a tumour, we actually have felt hopeful she’d be here a bit longer with
    us yet.

    Thank you x

  • Mike Croley

    We have a 7 yr old Lhasa Apso who has severe Rr knee lameness. He was diagnosed, and underwent an ACL repair at recommendation of local orthopedic specialist. Lameness continued, and we were advised by ortho to do PT, so we took him to Univ TN. Initial results were mixed, he continued to show no improvement. After numerous radiographs showed nothing definitive, my wife insisted on an MRI. They identified a soft tissue mass invading the back of fibia bone above the joint. It did not show on Xrays. They did took a bone and tissue biopsy and it wasn’t conclusive due to possible error in taking sample, and Xrays show his lungs clear. They want him to come back for more tests on his internals now. They say are pretty sure it’s cancer and want to see if it’s spread, but hesitate saying it’s osteosarcoma, and hold out possibility it’s something rare as he doesn’t fit the usual symptoms. They mentioned a possible fungus. We are at wits end, and want to move quickly with some type of treatment. Does it sound like they are on right track? Do you have any experience with a case like this?

    • Dr. Demian Dressler

      Dear MIke
      have them do titers for fungal infections…they might be considering amputation or surgery after this which seems like a road you could end up on, so be prepared. Just be sure it is not a complication from the surgery creating some kind of inflammation related to the implant for the ACL repair (if one was used).
      Best,
      Dr D

    • Dr. Susan Ettinger

      Mike,
      I know it is frustrating but some cases can be so hard to get a diagnosis. Lhasas are not breed at high risk for osteosarcoma, and that location is not classic. You are at a teaching hospital, and centers like that are good places to be especially in tough cases. Good luck!
      All my best, Dr Sue

  • shelley paterson

    My dog had a large tumor (hepatocellular carcinoma) removed 4 years ago. Ultrasound revealed another large tunor that was excised this week, however the vet found another suspicious area that is inoperabledue to its location. I am looking for a diet that will help him as much as we can and am reading alot of mixed opinions. His creatinine was also elevated 1.8 prior to surgery. Any suggestions?

    • Dr. Demian Dressler

      Dear Shelley,
      If you dog were my patient I would have you download the dog cancer diet at the top of this blog and recheck the kidney markers now and again in 2-3 weeks after you start the diet. Please discuss this with your vet.
      Best,
      Dr D

  • shelley paterson

    Unfortunately, the tumor turned out to be hemangiosarcoma not the hepatocellular carcinoma that had previously been removed four years ago. So I think we are going with with an organic diet that he will enjoy since his days are numbered. We are going to try I’m-Yunity – based on a small study the University of Pennsylvania did. It seems that chemo results are not great when measuring quality versus longetivity. Any thoughts?

    • Dr. Susan Ettinger

      Shelly,
      Thanks for the update, sorry to hear about the diagnosis. I like the mushrooms, maybe add Apocaps too. I often use them together. Talk to your vet.
      All my best, Dr Sue

  • Julie B

    My pug just had a mass removed from her intestines that show a “transmural adenocarcinoma” that was completely excised 2cm & 6 cm margins; both the omental mass & liver show metastatic adenocarcinoma associated with areas of necrosis & secondary inflammation. Any idea of prognosis of our love pug? your thoughts are much appreciated. Thank you!

    • Dr. Susan Ettinger

      Julie,
      Sorry to hear about your Pug! (I love pugs!) Unfortunately the prognosis is worse with metastasis. Were all the mets removed, or are there multiple mets to the liver? I would consider post-op chemo. Good luck!
      All my best, Dr Sue

  • Julie B

    There are multiple mets to the liver. We have been going back and forth as to whether or not we want to put Lexi the Pug (7.5 yrs old) through chemo or not after reading all the side effects in your book. My husband is calling today to find out the quantities of the various supplements in Apocaps and hoping with supplements vs. chemo it would give our gal more quality of life. So you would recommend chemo at this point? Our oncologist gives her 3 mos without and 10 with but we do not want to subject her to feeling miserable for those 10 months. Which chemo do you feel would have the best results (I know it is difficult without seeing her history). She is also prone to chronic UTIs. Thank you so much!

  • Kikka

    My almost 12 year old dog diagnosed bigtumor in chest that push heart and lungs. Diagnosed mady by X-ray. My dog put in medicine that remove fluids in lungs. My question is, because we dont know what kind of tumor it is and dont know if is Mast Cell Tumor, can we use Palladia or Masivet medication? I know these are for Mast Cell Tumor medications but can these help in my case?

  • K Nelson

    Wish I would have read this a long time ago. Even if a mass doesn’t change it should be checked? Just lost my dog and didn’t do full Necropsy. Signs point towards cancer now that he’s gone, sadly. Presenting symptoms fooled my Vet.