What I Would Do for My Dog with Lymphoma
Sue Ettinger, DVM. Dip. ACVIM (Oncology). Dr. Sue is a boarded veterinary medical cancer specialist. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), she is one of approximately 400 board-certified veterinary specialists in medical oncology in North America. She is a book author, radio co-host, and an advocate of early cancer detection and raising cancer awareness. Along with Dr. Demian Dressler, Dr. Sue is the co-author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity.
Updated: November 2nd, 2021
Summary
What would a veterinarian oncologist do for her dog with lymphoma? Dr. Susan Ettinger tells us how she would handle this dread disease.
When Guardians come in for a consultation with me after receiving a cancer diagnosis, they often ask “Doc, what would you do if this was your dog?”
I usually refuse to answer the question (with one important exception, which I will get to in a moment).
It’s very difficult for me to answer that question because there are way too many personal factors that go into the decision of what to do. In addition to the overall prognosis for that particular cancer, there could be other pre-existing conditions. It can become very complicated, and so much just depends upon the person who is asking.
So I can’t tell you what I would do, because really my answer is irrelevant at best and confusing at worst.
Everyone Is Different, No Answer Is the Same
Some Guardians want to be aggressive and take the treatment approach associated with longer survival times, even if it costs more, requires more visits to the oncologist, and has more side effects.
Others don’t.
For example, when I tell some Guardians the median survival time for their dog’s cancer is 18 months with treatment, they don’t feel that is long enough … while others will tell me that getting an extra three months is more than they hoped for.
What I would do for my dog is likely not what you would do for your dog.
I used to say I would have given Paige, my Labrador, a kidney if she needed it and it was medically an option.
I would have given my dog a kidney if she needed it!
(She is no longer with me, but she did not need my kidney. And no, you cannot transplant your human kidney to your dog.)
I am pretty aggressive with medical options for my own pets.
For example, I am not afraid of some side effects from diagnostics and treatment, especially when the “side effect” of not treating is worse (in my opinion).
I am more likely to go for surgery, radiation, and/or chemotherapy for my dog than choose a palliative approach such as pain management only.
But that is a pretty generalized statement. It’s what I would do — and that doesn’t mean it’s what YOU should do.
And again, my choice may not be the choice of the Guardian sitting across from me in the exam room with their dog by their side.
So, in order to keep from projecting my personal feelings onto Guardians, I usually just refuse to answer that question.
When it comes to lymphoma, I answer the question: CHOP.
Except when it comes to lymphoma. When it comes to lymphoma, I will share what I would do.
For me, that is an easy choice: I would treat my dog with a CHOP multi-agent protocol.
For much more of Dr. Sue’s insights into Lymphoma, get a copy of the Dog Cancer Survival Guide and read chapter 29, which starts on page 297.
Dogs with Lymphoma = CHOP Protocol
This protocol is a cyclic protocol usually lasting 5 to 6 months. In each cycle, the protocol includes vincristine, cyclophosphamide, and Adriamycin (doxorubicin). In the 1st cycle (usually the 1st treatment), the dog may also receive Elspar. Prednisone, a steroid, is also given orally daily for the 1st 4 weeks during the 1st 4-week cycle.
It’s typically a nineteen-week protocol, and it involves plenty of vet visits and some heavy-duty chemotherapy drugs. If it sounds like a lot, you’re right, it is.
So why do I universally recommend it?
For dogs with lymphoma, chemotherapy has a significant and positive effect on not only how long a dog lives but how well they live. Let’s look at some numbers.
Typically, a dog with lymphoma lives only one (1!) month without treatment.
The median survival time with a multi-agent chemotherapy protocol is 13 to 14 months.
So if your dog has lymphoma, and you don’t treat with chemo, you would expect to have one month more with your dog. But if you DO get the CHOP protocol, it would be reasonable to expect that your dog would live another 13 months.
Note: median survival time of 13 months means that of all dogs with lymphoma who undergo this protocol, half are still alive after 13 months. We don’t know, of course, which dogs will make be in the 50% who die earlier, and no one can guarantee your dog will be in the half that lives past 13 months. But it’s a REALLY long time compared to other cancers and other protocols!
Don’t Be Scared of Side Effects!
Dogs tolerate chemotherapy treatment so well that their life is considered good to great by most Guardians in my practice during the protocol and after the protocol (when they are in remission).
There is a LOT you can do at home to help with side effects. This webinar is a must-listen!
Dogs with lymphoma treated with chemotherapy live longer and live well.
So, yes I would treat my own dog for lymphoma with chemotherapy. No question for me.
Best,
Dr. Sue
Sue Ettinger, DVM. Dip. ACVIM (Oncology). Dr. Sue is a boarded veterinary medical cancer specialist. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), she is one of approximately 400 board-certified veterinary specialists in medical oncology in North America. She is a book author, radio co-host, and an advocate of early cancer detection and raising cancer awareness. Along with Dr. Demian Dressler, Dr. Sue is the co-author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity.
We have chosen to only test our dog with lymphoma with prednisone. It’s been 5 weeks since she started showing signs of an issue and 3 weeks since we have started treating her. She seams to be responding well to the prednisone. But does have soft stool. Ultra sound and biopsy indicated many clusters of lymphoma but not spreading to other areas like kidney and liver. We do not know if it is B ot T cells. How long can we realistically hope she lives? Also vet treated her once with chemo and prednisone before we opted to only do prednisone and a few days later had some blood . But that stoped. When will we know she is failing?
Dear Dr. Sue,
Can you tell me up to what age you would recommend using the CHOP protocol? Our dog is an 11 year old Golden Retriever. She was diagnosed 5 weeks ago with lymphoma and has been on prednisone. We are taking her to an oncology specialist this week and are trying to prepare for what they might recommend. Our dog is in good health otherwise. Thanks for getting back to me.
Hi Jill! Dr. Sue doesn’t monitor comments, but I have a good article for you. There is no age at which cancer treatments become inappropriate — it all depends upon the dog, what other health conditions are going on, and, of course, your instincts as a parent. If your dog is otherwise in good health, CHOP might very well be helpful. It’s really about asking the oncologist “what exactly do you expect to gain?” And then “How likely is that to happen?” And then “what happens if this doesn’t work out?”
And then deciding whether CHOP is worth it to you based on all those answers.
Here’s a good article for you to read to help you set up your thinking:
https://www.dogcancerblog.com/articles/choosing-treatments/is-my-dog-too-old-for-cancer-treatments/
Warmly,
Molly
Our 14-year old Golden Retriever male was just diagnosed with lymphoma. Due to his age and advanced arthritis, he is not a candidate for chemo. Can you offer any advice for us?
In March 2020, I noticed I could feel my 11 year old Siberian Husky’s 2 lymph nodes under his jaw could be felt for the first time while petting him there. He was Diagnosed with Canine lymphoma and started Chemotherapy in April 2020 which was L-CHOP-CCNU-MOPP. By the 2nd or 3rd treatment all his Lymph nodes had shrunk back so small they could not even do a biopsy on them and his blood tests were perfect. He finished his Chemotherapy the 2nd week of November 2020. I am told he was in Remission during treatment for 7 months and then 3 months remission after Chemo treatment ended. Thus, in Feb 2021, while petting him I noticed I could feel the 2 lymph nodes under his jaw again. He went back to his Oncologist 2 weeks later and was indeed diagnosed to be out of remission.
He was immediately put on Tanovea, with his next dose scheduled 3 weeks later.
3 days later after this treatment I could not longer feel his lymph nodes under his jaw.
Upon this 2nd visit, I was told his Lymph nodes could be felt again and that although the same size as 3 weeks earlier, were not larger, and not considered large, but more prominent than normal.
I was shocked as I could not feel them and still cannot feel them, even after being able to during both the initial diagnosis and then the first out of remission diagnosis.
He has 2 Oncologists, the primary and her associate.
The primary saw him 3 weeks ago and put him on Tanovea, but the Associate saw him yesterday and said she felt the Tanovea should have shrunk them. Thus, she put him on Mitoxantrone every 3 weeks.
The other suggestion was alternating the Mitoxantrone with DTIC, but required him to be administered with an IV for several hours, and other issues.
Thus, I went with the single treatment of Mitoxantrone every 3 weeks, and possible shortened to every 2 weeks.
I am so stressed, as my dog had reacted so fast and well to the L-CHOP-CCNU-MOPP and during the past 7 months under chemo (Remission) and 3 months no chemo (Remission), and even now a month later as gained weight and/or remained stable, has had a very healthy appetite, and just before he came out of remission had returned to running 3 laps at full speed around our big back yard.
Obviously, under the chemo now his energy levels have lowered, but his appetite and weight are all good.
I still do not fully understand why and when I can feel those Lymph Nodes as opposed to when and why the doctors can.
Also, I do not fully understand why the change in medication, although they explained everything to me very well.
The stress is making me dumbfounded I guess.
Any thoughts and opinions on all of this would be appreciated.
My 10yr old golden has been on prednisone since Aug. he has cutaneous lymphoma, red lesions on his skin. They went away initially and now he has them on his face. I just ordered apocaps. I emailed the vet also, last 10 days his face is getting worse. What can we do, I don’t have the time or money to go to oncologist, please help
Thank you Dr Sue,
Michelle Lynn
We have a 7-yr old Rottie who was diagnosed with B-type lymphoma in November 2019. We went through CHOP, as recommended, but he went out of remission 2 months after we finished it, that is, way earlier than the average 6 months. We started a rescue protocol and the remission did not last long either. Then another protocol that we had to stop in October 2020 because he did not go into remission. Our last oncology visit was on October 27, 2020, and at that point, given our pup’s history and response to treatment, we were told he had 1-4 weeks or 2 mo max. He is still ALIVE and doing well. Everyone calls it a miracle but no one asks “What are you doing?” Typical, right?
What are you doing for him? Holistic treatment? My 6 year old has lymphoma. 90 days post diagnosis, doing cancer diet, krill oil, mushrooms, golden paste. Low dose prednisone on and off since his lymph nodes are still there.
I think the Doctors always give the lowest estimate to not get expectations up, and then when the life span ends up going well beyond the estimate, is a pleasant surprise, which is better than disappointment after a optimistic estimate.
Just my 2 cents.
I wish you and your doggie all the best.
We pick up our 7 year old American Staffordshire Terrier’s ashes from his 3rd oncologist tomorrow. He was diagnosed with B cell lymphoma on August 15, 2020. We were told he would not have bad side effects, 12 months mean survival times, good quality of life and treatment cost approximately $9,000. We could afford to buy our dog a year or so with no guarantees of course. Wisconsin Madison protocol began four days later. He went into partial and full remission within 2 weeks. A few days following Doxirubicin, we thought our dog might die. He recovered from this treatment through his first hospitalization. We should have stopped chemo at this point. Two weeks following a modified CHOP (with lomoustine) protocol, our dog relapsed. Before starting MOPP rescue protocol our costs for chemo, labs, x-rays, hospitalizations, meds, etc. exceeded $20,000. Would I give my dog CHOP again? Definitely not. It is much more than the money. Following 5 months grieving over our pet’s disease, our grief continues, compounded with regrets that we made our dog so sick.
My dog Luna, an 8-year-old Golden Retriever, just finished CHOP today. She got, for graduation, a lei, a certificate, some beads, and a wonderful bandana from, Arizona Veterinary Oncology, that says she licked cancer. While I know she is likely still on borrowed time considering it is B lymphoma, I am so happy we went through with the CHOP protocol with your encouragement.
Going through this treatment has been so rewarding for not only my dog but for my wife and me as well. She is more active than she has ever been! She is feisty and super loving more than she ever has been before. In the weeks leading up to her lymph nodes swelling in her neck to the point I could notice them, she was very down and almost reclusive. She has lost a bunch of fur and all her whiskers since we have begun treatment, but she is as soft as a puppy right now and I’m told this is rare with Goldens. I kinda like having a puppy without the super-sharp teeth 🙂
I am so glad I found your blog DR SUE! It gave me hope in the darkest days from when she was first diagnosed. Not knowing if she had B or T was heartwrenching. As she was diagnosed with B, I kept watching your blogs and it really gave me hope. She was diagnosed in July 2020 and she is happy and healthy today. Yes, she had a few minor setbacks with nausea and reluctance to eat but those were all minor. It has definitely been expensive but every day I have with her is worth it all. No question whatsoever. The best part about all this is she is happy, healthy, and VERY active. She puts up a great play fight with our other male golden every night! Just as she has done with cancer.
One of the most interesting things I’ve learned about this whole experience is how these drugs in CHOP were discovered and how they even help humans. If you have time and are new to the protocols look them up. Truly fascinating. Every day with Luna is a gift and DR SUE I sincerely thank you for promoting the CHOP therapy for dogs with lymphoma. I know this may not be forever, but every day I am thankful for another day I get to spend with Luna.
Thank you so much!!!
I have a beautiful labrador with a number of medical issues due to a road accident after which he lost a leg.
Hes a fighter and came through the operation to save him having arrested twice on the operating table. He went through months of uncertainty and rehabilitation, but finally came out the other side a happy healthy dog again.
So it broke my heart when at only 6 years old, last month he was diagnosed with lymphoma.
The first sign was a raised lump on his tummy that was put down to a heat spot last summer.
It didnt go away, despite creams and baths.
In the autumn it suddenly grew to three times the size and was bright red and weepy.
Straight to the vet, after removal the biopsy showed aggresive cancer. Two weeks later his leg swelled up to three times the size and he could hardly walk. It floored me. The deaded news was lymphoma.
I made the descision to have chemo on the advice of my vet (vinblastin) and hes responding extremely well! After only three weeks (three injections) and daily steroids hes like a pup again.
Its almost lulled me into a false sense of security because i know its only for 12 to 18 months but hes almost good as new………. there are virtually no side effects and i cant believe it. Its wonderful.
To anyone out there whos making that descision , if affordable, please do it. Its worth every penny to see him skip and play again and share precious time together.
We have a three year old Scottie who has been diagnosed with lymphoma. He unfortunately has T cell. He has been getting the CHOP treatment for about two weeks it is not working. Do we go ahead with another regimen or give up? I would like to give him as much time as possible because he is wonderful boy and so young. I don’t know if there is a holistic approach that might help if the new chemo dies not. I don’t think the oncologist has a lot of hope for the change to work.