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

Lymphoma – what you need to know BEFORE you see the oncologist

Updated: October 3rd, 2018

In my last blog post on lymphoma, I shared that I would personally treat my dog with a multi-agent chemotherapy protocol if she was diagnosed with lymphoma.  You will learn a lot about diagnostics and treatment options once you meet an oncologist, so in this blog post, I will share some of the things you need to know before you get to the oncologist –the things I wish you knew before you actually see me.

First

If lymphoma is suspected, make an appointment a.s.a.p, like tomorrow or in the following days. Do not wait, especially if your dog is not feeling well. Symptoms are typically non-specific and include decreased appetite, decreased energy, weight loss, vomiting, diarrhea, increased urination, and increased drinking.

For most other cancers, it is not as urgent that you get into see the specialist – a week or two is typically fine (You may want to see the oncologist with your dog sooner, but from a medical standpoint, it is not as critical to get there in the coming days).

But lymphoma is different, because it is one of the more rapidly moving systemic cancers. Without treatment, the median survival time is one month from the time of diagnosis. So get to the oncologist quickly. I personally will double-book myself in order to get a patient in the following day if lymphoma is suspected.

Second

Do not start prednisone, a steroid, before you see the oncologist. While prednisone is often used for its anti-inflammatory effects, it also has anti-cancer properties and can kill lymphoma cells.  So dogs treated with steroids will respond and often feel better. This sounds great, right?

Unfortunately, prednisone started first can interfere with chemotherapy and can trigger a mechanism called Multi Drug Resistance. In fact, pre-treatment prednisone has been demonstrated to be a strong negative predictor for dogs with lymphoma.

In addition, steroids will start to kill the cancer cells making any diagnostics performed after the steroids less accurate. This can also be a problem if the aspirates were not confirmatory for a diagnosis, and/or if aspirates or biopsies need to be repeated. If prednisone has been started, getting an accurate diagnosis may be challenging and cause a delay in treatment.

Third

Be prepared to do diagnostics and start treatment the day of your first oncology consultation. With other cancers, I typically tell guardians to think about the options over the weekend, and we can often safely wait a few days to do staging diagnostics, like chest X-rays and abdominal ultrasound, and to start treatment. In fact, if surgery was performed, I will typically wait 10 to 14 days post-operatively to start chemotherapy. In non-lymphoma dogs, there is more time to make decisions.

But due to the rapidly progressive nature of lymphoma, I encourage Guardians to make a decision during the consultation appointment. I mention this because if you are not expecting to start treatment right away, you may feel pressured and rushed. Even though you may not have all the information until the appointment, I think it helps to know you should be ready to decide about treatment at the appointment or within a day or two.

You will learn a lot more about lymphoma from your specialist, but these are things I want you to know before you get there. And don’t forget that there is an entire, lengthy chapter on lymphoma, in the Dog Cancer Survival Guide.

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  1. Patty on October 3, 2019 at 7:33 pm

    My Lab is 13 I’m not putting her through Chemo.Prednisone is what she’s getting to give her a little time

    • Dog Cancer Vet Team on October 4, 2019 at 8:37 am

      Hey Patty,

      Thanks for writing and for sharing your thoughts! 🙂 When deciding on a treatment plan for our dogs, there are a number of factors that we have to take into consideration– age, cancer type, your dog’s personality, your personality, and so many others.

      That’s why there is no “one-right-fit” when it comes to cancer treatment as each dog and their health situation is unique 🙂 It’s also why we suggest knowing your personality type and how that plays a role when making treatment plan decisions for your dog 🙂

      You may find these articles on Life Quality to be super helpful 🙂

  2. diane vulcan on March 5, 2019 at 4:43 am

    ok so my dog had a biopsy on her lymph node in her neck – vet had to remove the node as it was pressing on the carotid and was quite large (4.5″ x 1.5″ round). Came back as lymphoma. She also experienced facial swelling post-op and seromas which made breathing laborious. antibiotics and a round of prednisone and things improved dramatically.
    now my question is – we started chemo when she was on prednisone for the seromas — we had to. the swelling was unbelievable and interfered with breathing. we finished the prednisone about 4 days after her first chemo treatment. She is 6 weeks post op from the biopsy – 3wks from the first chemo and just had her 2nd round of chemo and still has a seroma that requires draining – she was on prednisone for a couple of days prior to the 2nd round of chemo to continue shrinking this seroma (size of a golfball presently). So being on prednisone has decreased her chances of successful remission?? We were between a rock and hard place.. now what??
    what is the best way to precede? take her off the prednisone now (1 day post 2nd round of chemo) ignore the seroma and keep her off the prednisone? I am so confused and just want to do the right thing with the highest possible chance of a positive outcome. thank you for any light you can shed on this.

    • Molly Jacobson on March 5, 2019 at 11:43 am

      Hello Diane, thanks for writing. I’m not a veterinarian (I’m the book editor), so I can’t offer medical advice. BUT as a fellow dog lover with a dog with cancer, I can definitely relate to that rock-and-a-hard-place. Your pup was obviously in a real crisis, and prednisone is like a miracle in terms of reducing swelling. It sounds like using it right away as your veterinarian prescribed was the right thing to do. Dr. Ettinger is advising against something a lot of general practitioners do, putting a dog on prednisone immediately after diagnosing cancer, as a “something rather than nothing” cancer treatment. It’s general advice. The fact is, we sometimes have to do something in an urgent situation that might not be ideal — but it is the only choice available. Dr. Ettinger (or any other responsible veterinarian) wouldn’t offer you specific veterinary advice online, because the circumstances of every case are so different. For example, in your case, making an exception and using prednisone was probably necessary, even if it technically *might* interfere with later chemo treatments. You will never know if that actually happened, by the way, because we can’t prove a negative. The fast-acting pred likely preserved your girl’s life so that you can attempt chemo, which is wonderful. And using prednisone now might not be a problem at all — the CHOP protocols that are often used to treat lymphoma include prednisone. (That’s what the P stands for in CHOP.) I would definitely not assume that you’ve made a mistake or decreased her chances for sure, I’d just talk to your oncologist about this and get some clarity about your girls specific case. Remember, Dr. Ettinger is writing this from a general perspective, giving GENERAL advice that GENERALLY applies. Not everything applies to every dog’s case. Let your oncologist explain how they think about your dog’s case specifically, it will help set your mind at ease. When you are between a rock and a hard place, you make the best choice you can. You made the best choice.

  3. Dan on April 22, 2016 at 3:20 am

    Lost my 8 year old miniature eskie to stage 3 lymphoma yesterday, nothing in blood, biopsy was positive, was too late for chemo, prednisone was given. Oncologist said he had about 4-6 weeks to live. He lasted 13 days. He didn’t change at all up until 2 days ago with diarrhea. yesterday he wouldn’t come out from under the bed. He couldn’t stand and was covered in vomit and diarrhea, having trouble breathing. Ended up putting him to sleep that morning. The vet said he had a 108 fever too. I miss him already.
    Moral is just spend lot of time with them and make everyday count.

  4. Susan Kazara Harper on February 22, 2015 at 5:05 pm

    Kathy, I know how heartbrokwn you both are… but you’ve got to hang in there, because there is a lot you can do. Steroids alone won’t stop the cancer, but you can make good changes to Sophie’s nutrition and supplementation so she gets the most out of every day. And all of us only really have one day at a time. I know that’s not very comforting. Did your vet tell you what stage/grade the cancer is at? The Dog Cancer Survival Guide is full of information about walking this journey and I can promise you from first-hand experience with two of my dogs who had cancer, there is no expiration date carved in stone for Sophie. Nutriton and her immune system are the foundation of how she’ll handle this Check out the Dog Cancer Diet (it’s in the book, and also at http://www.dogcancerdiet.com). If you have more information about Sophie’s diagnosis, we’ll do what we can to help you through. You can phone our Animal Health Consultant on 808-568-3252 if you need to talk it through. Big hugs to Sophie and you and your daughter. Good luck!

  5. Kathy on February 4, 2015 at 10:03 pm

    I am just heartbroken. My daughters 11 year old rot/mix was diagnosed with lymphoma. The Vet gave her steroids to give Sophie & that was 3 days ago. Her lumps have been getting smaller & My daughter, Jackie, is wondering if steroids could shrink them so she no longer has cancer. The Vet said that Sophie is too far gone for chemo. Sophie is still full of life & eats normally & hasn’t lost a pound so far. The Vet wasn’t very helpful with any info. Can you help me please?

  6. Trish on October 20, 2014 at 1:10 pm

    My beautiful 8 year old greyhound cross has lymphoma and has gone thru the CHOP protocol. It was 6 months and she responded positively with minimal side effects. She was in remission for 4 months. She is now on prednisone but is lethargic, can hardly walk and is wheezing. What next? Not sure what to do. Why des she have to die at 8 years old. I feel angry at the universe. I guess I do not regret having an extra 10 months with her but dang, this is bloody awful. Thanks for listening who ever may be out there.

    • Cooteronascooter on December 4, 2014 at 3:32 pm

      My dog is almost 5. I learned today he is not responding to chemo. Why does he have to be only 4 and not be in the 80% that achieve remission. I feel the same as you, mad at the universe.

  7. Mary on October 1, 2013 at 6:31 am

    We’re at the end of the line now with conventional lymphoma treatments. As far as I can tell, the vets and I have done just about everything right – very early diagnosis before organ involvement, pred AFTER starting the CHOP protocol, then after she relapsed 5 weeks following CHOP we did MOPP, then DTIC … It’s obvious she has developed multiple resistance to chemo agents. Along the way I have also been giving her curcumin + pepper, which didn’t seem to have any effect. So, I’ve elected to stop conventional treatments, and her nodes have just ballooned. Is it worth trying holistic treatments like Apocaps at this point? The only conventional treatment I would still consider is Elspar (she had 1 txt at the start of CHOP), but not if it only buys her another week. Thanks.

  8. Diana Couture on September 12, 2013 at 4:54 am

    I would like to share what I think is an unusual situation. Over 3 months ago my 5 year old Golden was rushed to the vet with a sudden 105 temp and a mass developing on his chest. He was given antibiotics, a shot a pills, and scheduled for a biopsy within 2 days. My vet’s first impression was lymphoma since Goldens are so prone. We both celebrated when the biopsy came back as a very bad staph infection from ? and no cancer cells. Within 2 weeks the lymph nodes in his neck grew to the size of lemons and others were slightly enlarged. This time they aspirated both neck nodes. This biopsy came back with what they felt was a definitive lymphoma diagnosis. Because I refused to believe this new diagnosis (denial?) I scheduled an appointment with an oncologist hoping for a different answer. He too felt no further tests were needed unless I wanted to type the cell for $240 since the report was very positive for lymphoma and it would not change my treatment. At a second visit I insisted on X-rays to be sure there were no masses and they were normal. He has now had 3 doses of lomustine and on prednisone as it is the best I can afford. His neck lymph nodes are walnut size or less and no enlargement anywhere else to date. He has shown no symptoms other than starving from the prednisone and actually gained weight from stealing food. He has not slowed down one bit and swims everyday. They tell me we’re lucky as he is responding so well but the truth is I haven’t accepted the diagnosis yet even though they tell me his infection just happened to be a separate issue.
    I had another Golden who died from lymphoma within 2 months of diagnosis who we treated with a more aggressive protocol. So although I have doubts, we will just continue to treat based on what my vets are saying. When his health begins to fail at some point I guess I will finally believe it.

  9. Cath on May 31, 2013 at 3:50 am

    Hi, I appreciate reading everyone’s input on this awful topic. I am wondering if people here realize that some owners can not afford chemo. I would do anything to be able to afford that but I can’t and now I’m watching my dog act ok on prednisone when I know inside his body is battling lymphoma. He was diagnosed a few days ago. He is a 12 year old happy loving golden. It’s sad for me to think he is not going because of old age but because of cancer. I would love to give him chemo, I have contacted many charities. I am sure he would survive a long time and maybe end up dying of old age instead of stupid lymphoma.

    • Dr. Susan Ettinger on June 2, 2013 at 5:14 pm

      Cath,
      I am so sorry about your Golden. I am well aware that chemo is expensive. I know it is heart-wrenching to want to treat and not be able to. Prednisone does actually help treat the cancer (not just mask it). Dogs on pred have about a 50% response rate and typically feel MUCH better than no treatment. There are also less expensive chemo options that a multi-agent protocol that works for many of my clients. Its not all or none – there are options. I hope you had the opportunity to hear about those from your vet or an oncologist.
      Again, I am sorry about your dog!
      Dr Sue

  10. Mitch on January 15, 2013 at 7:21 am

    My boston terrier was just diagnosed with stage 3 lymphoma. We ar egoing to do the chemo, but she has been on prednisone for 1 week beofre the biopsy results came back because the doctor was sure it ws lymphoma. Now I read that starting prednisone before chemo can reduce the effects of the chemo. What are the stats on this? How badly does it affect the chemo if she started prednisone?

    • Dr. Susan Ettinger on February 3, 2013 at 11:39 am

      Mitch,
      Prednisone started before chemo increases multi-drug resistance to some of the chemo drugs. While being on pred before starting steroids is a negative prognostic factor, nothing is a guarantee. In fact I just this week rechecked a patient of mine who had also been on pred for about a week before starting chemo, and this was 4 and a half years after the lymphoma was 1st diagnosed. So hang in there, and focus on the future and all the things you can do for your dog as you go through treatment.
      All my best, Dr Sue

  11. Robert Redlich on October 27, 2012 at 4:10 pm

    I just discovered this wonderful website.Our 9 year old Havanese was diagnosed last week with stage 4 lymphoma.Chester presented with a 4 day history of lethargy and decreased.Chester had an ultrasound which revealed mid ascites,enlarged peri portal lymphadenopathy,thickened gall bladder and splenic nodules.Liver profile ALT 899,ALP 1365.FNA was positive for lymphoma involving the liver,spleen,peri portal lymph nodes,and abdominal fluid.Chester was started on a regimen of Vincristine,Cytoxan,Doxorubicin 3 days ago.The ascites has decreased and Chester is again energetic.He is to see his vet in 3 days.Is there anything else we should be doing?Thaank you in advance.

    • Dr. Susan Ettinger on October 28, 2012 at 5:51 pm

      Robert,
      When you ask about what else, I assume you are continuing the multi-agent chemotherapy protocol with the oncologist. Once my patients have tapered off prednisone (usually around week 4), I add Apocaps. Check out the Guide for comprehensive diet and supplement recommendations. Glad to hear Chester is responding and more energetic.
      All my best, Dr Sue

  12. Ed on September 5, 2012 at 4:57 am

    Just FYI for those that might be interested, there are a select few vets/ clinics that are now using a dog’s stem cells to transplant to treat lymphoma much as has been done for humans for years. It is probably cost prohibitive for most, but if you can afford to have their stem cells cryo-stored before they get sick, they can be administered to effect what used to be called a bone marrow transplant in humans.
    This in a decent percentage of dogs, is producing a CURE, not an extension of survival time.

  13. Melissa Bausman on June 1, 2012 at 12:32 pm

    Lynnette Favrin – has your vet suggested testing for Cushing’s Syndrome? The symptoms you describe sound as though that might be something to check for. Good luck with your pup!

    Melissa

  14. Nikki on April 20, 2012 at 11:46 pm

    HI, I’m new to this site, but it has already enlightened me on lymphoma. We live on the Gold Coast in Australia.
    We have a staffy that our daughter rescued from some people that were badly mistreating him, he was about 8 months old and had some serious issues regarding temprement, anxiety etc, we have worked with him for the last several years and he is a good boy, still a little unpredictable but we are aware of his ways and never put him in a position of danger or of danger to other people/animals, he is very well behaved, and has never been a problem and always given us alot of pleasure and happiness.

    In November 2011 he was diagnosed with lymphoma and we started chemo soon after on the lopp protocol i think, he didn’t cope too well and was always a bit ‘flat’ or had the runs or indigestion even though we gave him things to counteract the side effects of the chemo drugs, he went into remession reasonably early and then came out bout half way through so they had to use a ‘rescue’ protocol. Around the middle of march 2012 he had a really bad reaction after a vincristine inj, i was up al night with him vomitting, i had to take him to the A/H emergency (which is attached to our specialist’s rooms) He was that ‘flat’ that they could pretty much do anything with him (which is normally not the case until you get his trust) they kept him for about 72 hrs, until he started growling at the vets, and then i brought him home. We decided, after a conversation with the specialist, to stop the chemo. I looked everywhere for info on dogs with lymphoma but kept hitting a wall, untill now. I have bought the dog cancer book, and am reading it every moment i get.
    We are now taking him to a holistic vet who is fantastic, he seems to be better in himself although his lymph nodes are quite large, mainly under his chin and on his chest. The last blood test revealed that all was okay, we’re now just trying to keep him as healthy and happy as possible. My main concern is the ‘end’ result, what happens, I watch him constanly when i am at home and worry that he can’t breathe properly or is in pain (not that he looks it). But can anyone tell me what the last stages are, it sounds horrible but i want to know what to look out for from someone who has gone through it, It is so sad that this happens to a being that certainly doesn’t deserve it, animals offer nothing but love, support, companionship, comfort, joy, happiness etc etc, the list goes on. So far he is okay, but each day is a little different.
    thanks in advance to all of the people who have written in, i’m sure it helps people like me who feel so helpless.
    can some one also tell me if it possible to remove the enlarged lymph nodes if they get to be too large and leave the others? is it even an option?
    Nikki

    • Dr. Susan Ettinger on April 24, 2012 at 3:18 pm

      Nikki,
      Sorry about your dog. Removing enlarged lymph nodes tends not to be helpful in most cases, but I obviously cannot make specific recommendations for your dog. A better palliative approach to provide comfort and relief with neck lymph nodes would be a few doses of palliative radiation. I would check with your oncologist. And good luck!
      All my best, Dr. Sue

  15. Scott Jarvis on March 21, 2012 at 7:55 am

    We are waiting for results for Rusty. He’s a Carolina Dog who turned 12 this year. It’s been an odd path that has the Vet testing everything he knows. Rusty suddenly stopped eating his dry food but devours anything soft. Spurts of energy though you can tell he’s not quite right. I haven’t noticed any diarrhea or vomiting yet but all the other signs are there. He rapidly developed two swollen nodes on his neck, inflammation and extreme swelling in his mouth, swollen tonsils. Vet aspirated and said he had never seen anything quite like it before so we did the biopsy. The samples came back negative. Came back in for a re-check yesterday and after a week on antibiotics the nodes have gone down in size on his throat but now two more nodes in his shoulder have swelled to three times their size. We have a surgery tomorrow to take out one of the nodes and have it biopsied. I was given the Lymphoma speech yesterday and a brief outline of options but the Vet wants to wait and see what the biopsy says.

    I am so glad to have found this blog. I’ll be quickly purchasing the Survival Guide so we can develop a plan on where to go from here when we receive the expected news.

  16. Lynnette Favrin on December 7, 2011 at 2:46 pm

    Hi Doctor: Well here I am hoping to find an answer. I have a 11 year old Chihuahua named Armani who I love more than I can tell you. Approx 9 months ago I noticed his stomach getting to be huge. As I examined a little more I had noticed his hair thinning and in a short time I noticed he had lost a drastic amount of muscle mass. Ex ray show nothing as the fluid was in the way. Unfortunately I can’t afford costly MRI and meds. So he has been on lasex and doing not too bad. He eats like he was starved. I have him on all natural foods chicken salmon blueberries broccoli etc, no sugars. This skinny little skeleton of a dog with a huge tummy is such a brave little dog. He craves attention and seem happy but my heart breaks every time I look at his body. I did have him on chinese herbs. My vet suspects liver or could be prostate cancer as he was not fixed. Have you ever deal with these specific symptons before? Thinning hair, huge potty belly, drastic muscle mas lost. I would appreciate any words of wisdom. Fondly Lynnette

    • Dr. Demian Dressler on December 10, 2011 at 5:54 pm

      Dear Lynnette
      sorry to hear of your little guy.
      The problem is there are many things that create a pot belly and any of them can be going on:
      heart failure
      liver disease
      kidney disease
      low blood protein
      intestinal problems
      endocrine problems (adrenal)
      and more. Without testing it is very hard to say the best way to deal with this, aside from what you are doing. Could add sprinololactone and rutin.Discuss with your vet-
      Best
      Dr D

  17. Shavonne Harpole on December 7, 2011 at 3:19 am

    oh and don’t forget the krill oil if you keep going with the treatments.

  18. Shavonne Harpole on December 7, 2011 at 3:18 am

    My best dog friend was diagnosed with lymphoma at the age of three. I had no idea about his deadly cancer and seemly neither did the general vet I was using. He sent me to the eye specialist who after the second visit told me that her lymph nodes were swollen and I needed to rule out lymphoma. I went that day back to the general vet and the cancer was confirmed the next day. I wish so bad that I had all the information I now know about lymphoma and many of the other horrible cancers that are pets stricken with too early. The information I learned from this site may have provided more time with my best friend. She survived 18 months and we spent every dime to have her with us as long as possible. Regarding the post above, I am not sure of the age of the Great Dane, but loose stool is probably not going to last. My Gia had a few negative reactions, but was very happy until the last two weeks. We tried CCNU at the end twice because the oncologist said I could get six more months. Gia will be gone two years this January, but not one day goes by that I don’t miss her and wish I had know the information regarding lymphoma that I know now. I have never had any regrets about the thousands and thousands of dollars spent to keep her alive and happy. I would regret not having treated her because she is my family. I have another English Bulldog ( last one because of the massive health issues). I drive an hour to his vet who I trust totally. We already had to rule out lymphoma with Tilman when he was a year and half. He had a salivary gland infection, but he now has chronic bronchitis. I guess my point is that I still get the emails about cancer, read them all and learn from them all. I will not let another diagnosis be given too late or the wrong this medications be used. Oh and to the above post, the EKG is necessary to make sure the heart is ok. From my understanding and experience my dog’s heart was never the issue and her other organs were never affected. She just did not respond anymore to the chemotherapy and the lymph nodes were so large that her breathing was not normal. Also to the above post, what protocol are you following? My Gia had the doxy every four weeks. We used the Madison WIsconsin Protocol. You are so right about the signs and I know if I had a better general vet she would have been diagnosed so much sooner as she was at his practice all the time. I am over the top with worry about my Tilman, but if it saves his life or gets him an early diagnosis just like with humans than I did my job as his guardian. Best of the luck with your Great Dane.

  19. Mark on November 12, 2011 at 5:08 am

    Forgot to mention, she’s also on 1500-2000mg/day of Acetyl-L-Carnitine as well.

  20. Mark on November 11, 2011 at 3:39 pm

    Informative article. I would also add swollen lymph nodes to the signs/symptoms list. Our dane has swollen ones in her neck, at first I just chalked it up to not noticing before, but along with her being more lazy than normal I booked an appointment.

    After visiting the normal vet, we went to another vet that treats cancer in dogs, not an oncologist however.

    They started her on prednisone and L-aspariginase that day. 10 days later we began the doxorubicin treatment. Was this a mistake to start the prednisone a full 10 days prior to the chemo drug?

    It’s been 2 months since diagnosis of lymphoma (which I assume started 2 weeks at least prior when I started to notice signs/symptoms). I can’t stress enough for others to follow your advice and be on the lookout for them. She just had her 3rd doxo treatment yesterday, and thus far the worse side effects are about 1.5 days worth of loose stools during the off day from the anti-sickness med Cerenia.

    They want to do another echocardiogram after the 4th doxo treatment, but part of me wants this last treatment to be the last. Cost is part of it, but I don’t really want to push the envelope on heart damage occuring. She is on Ubiquinol (CoQ10), L-Arginine and L-Theanine to enhance the chemo effects while protecting healthy cells.

    Are there any stats on mean survival time of only doing 3 doxo treatments compared to 4-5?

    thanks so much for your time.

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