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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

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