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Featuring Demian Dressler, DVM and Sue 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.


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.


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.


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.

Leave a Comment

  1. 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

      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

  2. 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.

  3. 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!


  4. 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?

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

      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

  5. 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.

  6. 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-
      Dr D

  7. 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.

  8. 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.

  9. 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.

  10. 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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