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

How to Use the Mitotic Index to Make Decisions About Mast Cell Tumors

Updated: September 30th, 2019


Is using the mitotic index mast cell tumor diagnosis useful? In some cases, not as much as others. But when it’s useful, it’s REALLY useful!

There is a lot of uncertainty in canine cancer, and mast cell tumors are the tumor type that proves it. Mast cell tumors are tricksters, with seemingly benign tumors sometimes turning out to be very aggressive … and often enough to be confusing, vice versa. When we’re talking mast cell tumors, we are definitely in what I call “the gray zone.” Determining just how aggressive the tumor is up front is important when it comes to making treatment decisions, which is why Dr. Ettinger, my oncologist co-author, suggests looking at the mitotic index for mast cell tumor assessment.

The most common instance of confusion in mast cell tumor diagnosis is for the grade 2 mast cell tumor.  As you may already know, the “grade” is a measure of how aggressive a cancer is.  When we say a cancer is a “high grade malignancy” we mean it is hard to cure.  A “low grade” growth is easier to cure as a generality (but not always), usually by surgical removal.

Grading Mast Cell Tumors

In mast cell tumors, the grade is usually broken down into three levels, with grade 1 being the lowest and grade 3 being the highest and most aggressive. (There is also a newer, 2-tiered system of grading mast cell tumors that may be available to your oncologist and may be useful in real “gray zone” cases.)

So, if your dog has a grade 3 mast cell tumor, it’s considered aggressive cancer. Aggressive cancers do things like regrow in the same spot even after surgery (recur) or spread to surrounding areas (local invasion). Aggressive cancers can also spread to distant sites … places like the spleen, liver, bone marrow, or other remote areas, which is called metastasis.

If your dog has a grade 1 mast cell tumor, thankfully, it’s considered less aggressive. This means that it is likely going to be cured with a surgery with wide margins that gets the whole tumor out. This doesn’t mean that grade 1 is ALWAYS cured with a surgery — just that it is more likely to. And make sure you ask for wide margins!

Grade 2 mast cell tumors are intermediate, by definition, and highly unpredictable. These are the tumors that earn mast cell tumors their nickname “the trickster.” Grade 2 mast cell tumors can behave aggressively (like grade 3’s) or more like benign growths (grade 1’s).

It’s grade 2 mast cell tumors that can most benefit from a mitotic index measurement. The number will be on your biopsy report.

Get the Biopsy!

You will not know the grade of your dog’s mast cell tumor until after the biopsy is performed, of course, so you can’t use the mitotic index for mast cell tumor assessment until AFTER you get that tumor surgically removed (with wide margins, please!).

If you are looking at a grade 1, the likelihood that your dog will need more treatment is low. For a grade 3 tumor, which is seriously aggressive, you are almost certainly going to get more treatment recommendations. But what about that gray zone, the grade 2 mast cell tumor?

There are a couple of ways to treat a grade 2 mast cell tumor. You could do a second excision (surgery) with wider margins. You could add chemotherapy and/or Palladia to your treatment plan. But which action plan to take is in the gray zone until another bit of information:

The mitotic index!


Mitosis is a part of cell division, the way that cells replicate themselves. You can actually see mitosis happening in cells under a microscope. It looks something like this.

Public Commons Image https://commons.wikimedia.org/wiki/File:Major_events_in_mitosis.svg

To get the mitotic index, the pathologist looks at a slide with a very thin slice of your dog’s tumor tissue on it. The tissue has been stained so it is colored and they can easily see which cells are dividing (in mitosis). They simply count the numbers of these cells to get the mitotic index. The higher the number, the higher the mitotic index and the more aggressive the tumor.

If you think about it, this will make sense. The more cancer cells divide, the faster they replicate themselves, the bigger the tumor, and the bigger the problem for your dog. More cell division, faster growth, higher mitotic index.

Mitotic Index Mast Cell Tumor

So what does the mitotic index actually mean for mast cell tumors?

Well, generally, a lower mitotic index is better. Fewer dividing cells = a less aggressive cancer.

For grade 2 mast cell tumors, the magical number to hope for is a mitotic index of 5 or less.  These dogs, with conventional care alone, have a median survival time of 70 months, or nearly six years. That’s a nice long median survival time.

Unfortunately, dogs with grade 2 mast cell tumors with a mitotic index of greater than 5 have a dramatically shorter median life expectancy of only 5 months. This is quite a dramatic difference.

Here is the abstract to show you where I am getting this information.

Bottom Line: How to Use the Mitotic Index for Mast Cell Tumor

Again, you might not really need to consider the mitotic index if you get a grade 1 or 3 tumor. In those cases, your direction will be more clear-cut.

But in cases where we have a grade 2 mast cell tumor, the mitotic index (MI) can help you make decisions about what to do next.

If you have a grade 2 mast cell tumor with a mitotic index of <5, your minimum treatment surgery with a wide excision of 2 to 3 centimeters. If you have that already, you might not need any more treatments, but your oncologist might want to use other steps, including chemo and/or radiation. With a median survival time of 70 months, taking those extra steps might not feel necessary in every case. (Remember, I don’t make direct advice over the internet, because every case is different. I’m not saying that you should not get extra treatment if your dog’s MI is under 5. I’m just saying in general, they may not be as necessary.)

But in cases where we are looking at grade 2 mast cell tumors with a mitotic index of >5, these cancers should be considered very, very dangerous and aggressive.  If your dog is young, and you would expect her to live a long time if she weren’t sick, you might be more aggressive with the treatments than you would if the MI were <5. I would certainly consider chemo and radiation with your oncologist.  If your dog is close to or beyond his average life expectancy, I would suggest it is time for ethical considerations and maybe a focus on life quality enhancement.

Regardless of the grade of tumor or the mitotic index, your dog will benefit from the dog cancer diet, supplements, life quality enrichment, and the other complementary aspects of care Dr. Ettinger and I cover in detail in our book The Dog Cancer Survival Guide.


Dr D

Discover the Full Spectrum Approach to Dog Cancer

Leave a Comment

  1. RJ on August 19, 2019 at 8:52 am

    But in cases where we are looking at grade 2 mast cell tumors with a mitotic index of 5?

  2. grozdana zahtila on July 15, 2019 at 3:21 pm

    Hi, I am so confused of what to do for my thirteen and a half Shit Tzu dog. Last November he had removal of Two large mast tumors low grade 2. Two months ago I felt two more and they grew very quickly. He had surgery June 21, 2019 and his stiches removed week after. The biopsy shows progression. I went to see an oncologist and they found 2 more aggressive mast tumors. I found two more lumps by his stiches. My Vet and the oncologist suggest Palladia treatment. I know every dog is different but I am afraid of the side affect and the quality of life for him. My family and friends think that I should let him be. Can you please give me your sugestions. My email is zahtilag@gmail. com Thank you so much

  3. Carisa Mainiero on May 17, 2019 at 7:58 am

    In January, my dog had a mast cell tumor removed from the top of her paw, near her toes. It was a low grade 2.
    One week ago, she had another mast cell tumor removed from the same area, and she also had two digits removed. The tumor came back as a stage 3 with a mitotic index of 100. My oncologist recommended chemo.
    I am uncertain as to how to proceed. All of the literature that I find says that her life expectancy is about two months with such a serious tumor (although I can’t find any literature addressing a mitotic value that is so exceedingly high).
    Do you have any advice for me? I am so heartbroken.

    • Molly Jacobson on May 17, 2019 at 3:11 pm

      Hi Carisa, thank you so much for your comment. We’re not veterinarians, so we can’t offer medical advice, but it’s a good idea to make a list of questions for your oncologist so you can make this decision. Ask questions like “how much time do you think we have if we don’t treat?” and “how much time will chemo gain us?” And keep in mind that no one has a crystal ball, so nothing is guaranteed 🙁 You should also try addressing all the other things that can be done: nutraceuticals, anti-metastatic supplements, diet changes, and mind-body strategies: https://www.dogcancerblog.com/articles/book-excerpt/cancer-treatment-for-dogs/

      In the end, cancer is just totally heartbreaking, as you’ve discovered. So while you’re taking care of your dog, please remember to take care of yourself, too, and first. The first section of The Dog Cancer Survival Guide has lots of coping strategies that can really help. https://dogcancerblog.com/book. And don’t forget to reach out for support. If you have a copy of the book, you can join our private “book club” support group on Facebook, for example. It’s super helpful! https://www.facebook.com/groups/dogcancersupport/

      Much Aloha, Molly

  4. Brett Chatz on December 31, 2018 at 11:23 am

    What is a mitotic index of 31/10?

    • Dog Cancer Vet Team on January 2, 2019 at 2:10 pm

      Hi Brett! We’re not veterinarians (or pathologists 🙂 here in customer support, so we can’t say for certain, but we assume that what those numbers mean is that when the pathologist examined the tissue, they used a 10X power field of view — that’s the 10 — and counted 31 cells undergoing mitosis. So your mitotic number is 31, which is certainly greater than 5. However, the best way to get this answered is to ask your own vet to tell you what that /10 part of the number means. They will be able to tell you for sure, either by phone or email.

  5. Katy on October 16, 2018 at 9:20 am

    Hi there,

    i found this after trying to figure out what to do for my Pittie. He was diag with Mast Cell Tumor Stage 2 but with a high mitotic index of 52. It was in his nail bed where the tumor started and his toe was amputated, we recently found that it has gone into the lymph node. The next step is for an ultrasound to see if it has spread to his organs which is $900. They then want to start Chemo. My question is with his Mitotic so high and in his lymoh node we are not being told what his life expectancy is if we just keep him comfortable for now or will chemo even give us any time like 3 years. Please help as we have already paid 2,100 and no treatment has been started.

    • Dog Cancer Vet Team on October 22, 2018 at 7:47 am

      Hi Katy,

      Thanks for writing! We’re not veterinarians here in customer support so we can’t offer medical advice. However, we can provide you with information based on Dr. Dressler’s writing

      Deciding on a treatment plan for your dog is one of the hardest choices you have to make as there are so many things to take into consideration (finances, your dog’s personality, your personality, treatment options, age, etc), and there really is no one right fit because each dog and their situation is unique. This is where Treatment Plan Analysis can be really beneficial. Here’s an article on how to end treatment plan analysis paralysis that you may find useful : https://www.dogcancerblog.com/blog/make-decisions-dog-cancer-treatments/

      You also have to factor in your guardian type– do you want your dog to be as comfortable as possible? Are you okay with handling the side effects of particular treatments? How important is quality of life? Here’s a link to an article on this topic that you may find beneficial: https://www.dogcancerblog.com/blog/why-your-personality-is-so-important-to-your-dog-with-cancer/

      You know yourself, and your boy the best, so once you figure out what is most important to you, and take all of those factors into considerations, you can then decide on a treatment plan for your boy In the meantime, as Dr. D writes in the article above, you can make changes to your dog’s diet, and implement life quality strategies.

      We hope this helps! 🙂

  6. Donna Parniuk on September 14, 2018 at 12:21 pm

    I believe there is a typo in the following paragraph; I believe you meant to write MI >5, NOT <5, since this conflicts with the previous paragraph stating a MI<5 is not as aggressive.

    "But in cases where we are looking at grade 2 mast cell tumors with a mitotic index of <5, these cancers should be considered very, very dangerous and aggressive. If your dog is young, and you would expect her to live a long time if she weren’t sick, you might be more aggressive with the treatments than you would if the MI were <5. I would certainly consider chemo and radiation with your oncologist. If your dog is close to or beyond his average life expectancy, I would suggest it is time for ethical considerations and maybe a focus on life quality enhancement."

  7. Donna Parniuk on September 14, 2018 at 12:21 pm

    I believe there is a typo in the following paragraph; I believe you meant to write MI >5, NOT <5, since this conflicts with the previous paragraph stating a MI<5 is not as aggressive.

    "But in cases where we are looking at grade 2 mast cell tumors with a mitotic index of <5, these cancers should be considered very, very dangerous and aggressive. If your dog is young, and you would expect her to live a long time if she weren’t sick, you might be more aggressive with the treatments than you would if the MI were <5. I would certainly consider chemo and radiation with your oncologist. If your dog is close to or beyond his average life expectancy, I would suggest it is time for ethical considerations and maybe a focus on life quality enhancement."

  8. Merry Gwynn on December 4, 2017 at 7:01 am

    The “grey area” is particularly vexing us. Our 3 1/2 year old yellow lab had a mast cell tumor removed from her paw. it is healing and the surgeon said he got good margins. He also removed a lymph node right behind her knee which had a very few cancer cells. They are calling it a Grade 2 high grade tumor but the mitotic index is 1. The Oncologist is suggesting a series of 8 chemo shots. We are almost ready to go with this, but this low mitotic index makes us believe she might be fine for a number of years without chemo. Any thoughts would be appreciated.

  9. Kaye on December 17, 2015 at 7:32 am

    I do hope this entire blog posting will be made available to help others. We lost our beloved BRT yesterday afternoon to adenocarcinoma. We have responsibly loved and owned dogs and horses for over 40 years. She was 9 years and 8 months old. Average life expectancy is 12-14 years. She was always well cared for as a retired AKC champion and family member. Our hope is that this information will help others faced with mammary tumors in beloved canine soul mates.
    History She had a small mammary growth removed about 2 years ago – the vet gave us the choice of a biopsy which we declined. Never, ever decline a biopsy – a good vet will demand that a biopsy is performed! Two weeks ago, we notice a reddened, inflamed mammary gland and visited our routine vet the next morning. This is the synopsis of a horrific series of events:
    1. Detected mammary mass and immediately visited our local vet
    2. Large mass examined, measured, and 10 day course of antibiotics prescribed (cephalexin1000mg twice daily) and a herbal alternative to boost immunity. MISTAKE #1 – at this point I should have secured a second opinion by an oncologist.
    3. No initial needle aspiration or biopsy under sedation was offered or performed
    4. No chest films offered or performed
    5. No improvement of inflammation and getting bigger at 10 days. Returned to vet and agreed to have the mass surgically removed, biopsied, and adjacent lymph node biopsied.
    MISTAKE #2 We should have second opinion specialty care before any surgery performed.
    6. Agreed to have herbally derived preparation that generates apoptosis in cancer cells applied around excised margins during surgery as discussed with vet. MISTAKE #3 – should have obtained second opinion from oncologist.
    7. Brought our angel home next day with dozens of staples, drain tubes, more cephalexin and tramadol for pain. E-collar, confined to our bedroom, no mobilization except potty break. Basically had a bi radical mastectomy with three glands and lymph node removed.
    8. Less than 36 hours later noticed a couple of staples open – called and was instructed to treat with raw honey compress and bring her back in a couple of days. Picked up more tramadol for pain at clinic. Later that evening, more staples began to open in her groin area. Given same care instruction for the new area. During the next 24 hours her entire abdominal area opened little by little. We took her to an emergency clinic at 9:30pm that same night thanks to the quick insistence of her breeder who was here for a visit helping me change her bandaging. Our angel endured another prolonged surgical procedure to clean out the infected, now totally open, surgical wound in an attempt to save her life. It was a long night at the emergency clinic. Baytril, Clavamox, and metacam for pain given to her at discharge. Only then was I given a pragmatic picture from ER vet about the gravity of this infection and the care that would be required for her to have a chance to survive and heal.
    9. As follow up to ER clinic instruction, the next morning we took her to a highly recommended clinic that is vet to friends of our breeder. All records transferred to new practice with extensive experience in open wound care and cancer treatment. They agreed to admit her to conduct emergency wound care. Less than 24 hours after the emergency clinic visit, our sweet girl underwent a third surgical procedure to effectively and skillfully clean up and treat the putrid surgical wound to prepare for healing from the inside out with what we all believed was a good prognosis for recovery.
    10. Histopathology report 5 days after surgery and biopsy sent to specialty vet from local vet. Results showed stage 3 adenocarcinoma, lymphatic and vascular involvement with a high mitotic index. She should never have had any surgical intervention much less one that was so extensive.
    Heart breaking, we said goodbye to her yesterday afternoon. In her stoic and loving Black Russian Terrier nature her tail was wagging as I lay beside her and gave her all she would eat – her favorite treat of baby carrots. She is always with us and I hope we have helped guide you in a more informed direction if you should have to address this serious health issue.

    • Amber Wyckoff on January 19, 2019 at 11:28 am

      Oh, My, God… I would be furious. and totally heartbroken! I’m reading this article because of my dog with MCT, and happened upon your comment and it just breaks my heart!! I am so sorry you had to go through that. I hope that the vet who performed that surgery has been held to account.. no one should ever have to go through something like that.

  10. Susan Kazara Harper on June 23, 2015 at 8:29 pm

    Oh Carolyn these are the questions for which there is no definite answer. Could it all be gone? Yes! Should you let your guard down? I never do. Always stay vigilat. If cancer has once been present I think of it as an invading army inside my fenceline. I can purge the army, but I’m not going to switch off the alarm system if one crazy soldier could still be hiding. Celebrate the joy and have fun with your dog! That’s it’s own medicine. What a wonderful, clever girl to have done so well with the surgery. And she’s feeling your relief too. Keep up wonderful nutrition, limit exposure to carcinogens and cheap treats, and keep up the vet checks. Ask your vet what you might need to watch for, then just make it a task without the worry. Play every day and cuddle every day. Trade your worry for awareness and live in the moment with your girl. Good luck!

  11. Carolyn on June 2, 2015 at 5:58 am

    My 14 year old Jack Russell was just diagnosed with a grade 2 mct a month ago. It was removed over a week ago. It was cutaneous and my vet did a very large scale removal it looks like. The lab results show the grade 2 mct has a mitotic index of 13. It also showed the neoplasm completely abuts the layer of panniculus muscle. Of course I am copying this from the lab report because I had no idea until today what any of those words mean. My question is this…could all of it be gone, and no further worries? She’s acting very happy and perky. Just like normal. No lethargy, healthy appetite, etc. Because she is acting so healthy and happy, could that mean she is perfectly fine? If it had mestastisized (sp?) to other areas, wouldn’t she be showing some distress?

  12. Nicole on January 10, 2014 at 11:32 am

    Dr. Dressler,

    My 8.5 year old ridgeback has had several mast cells removed all with clean (3cm) margins. Recently an old growth that had been there for >4 years was removed and the pathology came back as a Grade III with a mitotic index of 0-1. Her other newer mast cell removals were all low grade II’s with MI 28wks before removal the prognosis is more favorable. Additionally Roamansik EM et al reports mitotic index predictive of survival in grade II however the sampling of Grade III with MI <5 was too small. The data seems to suggest that MI is a good predictor of the nature of the cancer. My question is this-how can a tumor be graded a III i.e. aggressive yet with a MI approaching 0? My dog is perfectly healthy, has been fully characterized with ultrasound, spleen biopsy, and has not sign of spread. Is chemo is this case the right approach?

  13. Roy Goble on October 23, 2013 at 4:20 pm

    Great article, thanks for the help. One follow-up question: what precisely is meant by “conventional care alone” in this instance? Our 8-year old Golden Retriever has had several mast cells removed, and thankfully the index is zero. Prognosis is good. But is “conventional care” something beyond good diet, regular exercise, and routine checkups?

  14. Wendy on August 20, 2013 at 5:43 am

    My 7 year old labradoodle was just diagnosed with a mast cell tumor, grade 2 with no dividing cells. The tumor, on her toe,was mostly removed except for the part that wrapped around her nerves. Should we watch and wait or go see an oncologist? What do you think they will recommend? And should we do it? In the mean time, is there anything else I can do for her to keep her healthy? Thanks. Wendy

  15. Tony on September 26, 2012 at 4:45 pm

    I have a 7 year old German Shorthair pointer who had a grade 3 mast cell tumor removed that was on his scrotum, he had his whole scrotum removed as a result. All his blood work came back great, I had an ultrasound done on him to see if there was any spreading to his organs, and that all came back clear, and all organs look good and there was no signs that it had spread. They didnt aspirate any lymph nodes, and said it really wasnt nesecary because there was no signs of mast cells on the organs?? Does that sound correct? I guess my major questions are what is the next steps? Should I go see a specialist? He is feeling fine, eating and drinking just like normal, there seems to be nothing out of the ordinary. I just really dont know what to do, and just want to help my buddy.
    Thank you,

    • Dr. Demian Dressler on September 28, 2012 at 12:49 pm

      Dear Tony
      don’t play with a grade 3 mast cell tumor and assume it is now gone. Your dog’s body is in a state that is different from that of a healthy dog and stopping at this stage makes no sense, to put it bluntly. You need diet, apoptogens, immune support, other nutraceuticals (read the Guide), and should be considering chemotherapy and other items at least. Get more info ASAP, and discuss with the vet/onc these next steps.
      Dr D

    • Dr. Susan Ettinger on September 30, 2012 at 5:02 pm

      Hi Tony,
      Grade 3 mast cell tumors (MCT) are quite aggressive, but still treatable. The rate of metastasis is about 50 to 90%, and a bone marrow is typically recommended in addition to the ultrasound. I would definitely recommend seeing a specialist as I generally recommend chemo for grade 3 MCT, especially considering the location. An oncologist can go through the details and make specific recommendation for your boy.

      I have 4 or 5 posts on MCT so far (mor to come) and I would suggest you check them out. In addition, there is a complete chapter on MCT in the Guide.

      Start here: https://www.dogcancerblog.com/blog/the-oncologists-thoughts-on-mast-cell-tumors/

      Good luck!
      All my best, Dr Sue

  16. ted boganowski on September 2, 2012 at 6:42 am

    i have read that trypsin enzymes have a digestive effect on malignin enzymes in cancer there is evidence that this may be possible even with fast -growing cancer ,. college of natural medicine.some one have information on it thank you

  17. Sue - 19.8.2012 on August 18, 2012 at 10:01 pm

    Hi, Our Jenny (jack russell – 12yrs) has a mast cell tumor on her chest just by her right front leg, she cannot have surgery and has had chemo (Lumestine- not sure of spelling) two sessions but to no avail. It is growing all the time and has now spread to her lymph node in her neck. Like many of the people on this blog, I would like to know what to expect if anything as times goes on. She is still eating well and their is no sign of diaorhea, but she does pant a lot and drink a lot. please could you help We love her dearly she is our baby. Thank you

    • Dr. Susan Ettinger on August 27, 2012 at 3:54 pm

      Hi Sue,
      There are other chemotherapy options for Jenny if you choose. Progression on one drug does not mean others won’t work. Have you discussed other options with an oncologist, like vinblastine, Palladia, Kinavet?
      It’s hard to predict how things will progress. Good questions for your vet who is most familiar with Jenny’s case. Is she on pred? That can cause increased drinking and panting and is often used for MCT. Also check out the MCT chapter in the Guide and more blogs to follow shortly.
      Good luck, Dr Sue

  18. Eileen Tredway on August 14, 2012 at 5:31 am

    I have a 9 year old mixed chow-chow breed. He recently was diagnosed with a mast cell carcinoma (that was quite large) on his side. It was removed. The cells were well differentiated cytologically and his mitotic index was 2. He healed well from the operation and exhibits no other symptoms. BUT, there is another mast cell carcinoma towards his chest area. (An in office aspiration confirmed) We don’t know if it was missed earlier or if it is new. Vet is recommending Carafate 1G to protect his stomach and 4 weeks of Palladia. Thoughts?

  19. Lisa on February 20, 2012 at 6:01 pm

    My 13 year old cocker mix had a tumor removed from his right rear leg in july of 2011. We did not have it analyzed but the vet said it looked like cancer but thought he got good margins. 4 days ago we took him to the groomer and because his hair had grown so long, we did not notice a recurrence of several tumors to the same leg and a large mass in the right lower abdomen. Our vet says it is a recurrence of cancer that has spread to the lymph nodes in the abdomen and nothing can be done. We understand the advancement and are coming to accept his days are numbered but can you give me any idea what to expect in the coming days? He is still acting normal, eating, playing, and frankly seems well. How long can we expect him to be well. What will be the first signs of a decline and how quickly will it go from there? I have never had a pet to go through this sort of illness and we want care for him as best we can but not prolong any suffering. Thank you.

  20. Nunz on February 11, 2011 at 2:54 am

    Hi Dr Dressler

    Thnx for a fantastic site. I’m enjoying reading it and finding out that I’m not on my own!

    Here is our story.

    We have a 6.5 year old dogue de bordeux cross with T cell lymphoma. We caught it early (stage I b) and removed the lump from her tummy and have had 6 months of chemo… Apart from a few chemo side effects, she is enjoying a good remission, almost a second puppyhood!

    We have since discovered another lump on her neck/shoulder, which a Fna showed some mast cells, which led to a biopsy to determine what it was. The first labs report was inconclusive, however a second lab believes it is Subcutaneous (hypodermal) Hemangiosarcoma!

    What is interesting and why I am writing is that the mitotic index is 1-3. And the majority of the biopsy was non cancer cells.

    So, in line with your advice to get as informed as possible, I’d love your opinion as to a course of action.

    Obviously she will have a limited life expectancy due to the lymphoma, so i am wondering whether the removal of the slowly developing sarcoma, will just give her less quality of life (due to the surgery etc) or would removing the sarcoma give her the best chance of seeing out the remission?

    I guess, in a nutshell, which cancer do you think will get her first?

    The reading i have done so far indicates that the sarcoma can be quite quick, however i can find no information about the mitotic index and what kind of growth timescale that may represent..

    FWIW, the original lumps (as measured by the vet) have been steadily reducing in size.

    Anyway, i thought I’d put this out there and see if you could shed some light!

    Once again thanks for listening.

    Kind regards


  21. Amy on February 2, 2011 at 11:01 am

    Hi Dr. Dressler -it’s me again
    I left out above that when my dog’s cancer recurred – another small surgery was done, but the vet knew he did not get it all because of the location. Bella, (my dog), had a hard time healing from the surgery – because of the location her staples an stitches kept coming undone and she had to go back numerous times as well as be treated for an infection. When my vet was on vacation, however, another vet at his practice was able to do the stitches quite well and they stayed. This episode, however, may be attributing to his reluctance to perform surgery yet again. She is now almost 11 and has been through quite a lot – it was something that we had all agreed on regarding not adding stress to her life – but now that we are here and she is just fine in every other way – we don’t know what to do.
    Thanks again

    • DemianDressler on March 8, 2011 at 9:41 pm

      Dear Amy,
      have you guys tried Apocaps? This would be an idea. Also, if it regrows, you might consider a salvage procedure: Neoplasene.
      Finally, it might be time to go back to the oncologist..
      I hope this helps,
      Dr D

  22. Amy on February 2, 2011 at 6:50 am

    Dear Dr. Dressler,
    My 10 year old hound/terrier mix was first diagnosed with a fibrosarcoma in her rear area two years ago. She had surgery and underwent a complete round of radiation (21 sessions). The surgery could not get all of the tumor because it is very close to the anal area. She seemed fine for a year. This past summer the tumor came back. The vet did not want to operate again and the oncologist told us that chemo would only give her a 25% chance at extending her life an additional 6 months to a year. We were told she had a “couple of months left.” We did not want to stress her out any further so we decided just to try to keep her as healthy in every other way as possible. We have been using your diet mixing in stasis breaker and wei qi booster. She is completely fine in every way on an appetite and energy level. The problem is the tumor is getting huge. We just tried an experimental round of injections of Kyosenex but it did nothing. The tumor is quite large on her buttocks and we are worried it will soon interfere with her being able to have comfortable bowel movements. We don’t know what to do because she is so fine in every other way. She does not seem like a dog who is anywhere near dying. I just cannot imagine euthanizing a dog that is alert, happy and energetic. Please give us some advice. And thank you so much for the Cancer Diet – I am convinced we would not have had her these additional months without it.

  23. […] However, if you receive a diagnosis of MCT ask your vet some questions.  What is the grade?  Is it a I, II, or III.  A grade I means they caught it early.  If it is II or III ask your vet what the lab results say about it.  Both of those MAY require additional treatment.   Also, ask what is the Mitotic Index.  You want it to be below 5 out of 10.  That is another measure of aggressiveness and can be correlated to life expectancy.  The higher the index the shorter the life expectancy.  See Dr. Dressler’s article about grades of MCT and Mitotic Index:  https://www.dogcancerblog.com/blog/dog-cancer-decisions-in-the-gray-zone/ […]

  24. Janet Mathis on October 25, 2010 at 6:27 am

    My nine year old Jack Russel started vomiting on Thursday, I kept giving her water and chicken broth, she continue on Friday and on Saturday when she began to have diarea. She began to have seizures. On Sunday my Vet met me and began her on IV fluids, he wants to deep her and give her two days of rest for her liver to regenerate bllod cells, she is not any better, what are her chances.

  25. DemianDressler on September 5, 2010 at 8:36 am

    Dear Tricia,
    I am so sorry to hear this sad and traumatic experience. Two points for you:
    1. The cancer took your dog. That’s the bottom line. When one looks at it from the big picture, even if there were some side effects from the Kinavet (which is possible, in particular the vomiting and dehydration and maybe the liver stuff). The reason is that a dog does not quickly pass away like this (in what sounds like multisystem failure) typically from Kinavet. We know the cancer was disseminated and this was the critical issue causing the tipping point.
    2. Please also read this post:

    There are more answers that you should read about in the Guide as to cancer progression and causes that would help you, and some steps for you as well that might help.

    Dr D

  26. DemianDressler on September 5, 2010 at 8:14 am

    Dear Vicki,
    this is a good question and a tricky one. You should read the sections on treatment plan analysis in the Guide. I will be writing a blog post as well that will help answer questions like these so stay tuned- should be up today.
    Dr D

  27. Vicki on September 3, 2010 at 11:34 am

    My dog Bodie was just diagnosed with osteosarcoma in his front left leg. The vet recommended amputation for pain management which I understand and would not object to, my question concerns his age. He is a 12.5 year old lab mix. Do you think this surgery is too “big” for such an old dog? He is otherwise healthy, the cancer is has not spread and he is happy. They said w/ surgery and chemo he only has 10-12 months on average. I want his final months to be pain free but I dont want him to have to endure a major surgery if it’s not needed. What are your thoughts? Thank you. Vicki

  28. Tricia on August 27, 2010 at 4:22 pm

    My 11 1/2 years old golden retriever, Honey, passed away Monday August 23. Her path report noted liver cancer – primary hepatic/biliary carcinoma but could also be metastastic – so no definitive report. Her last ultrasound, taken on the 18th, showed that 2 lymph nodes were greatly enlarged along with her liver. She had had surgery 2 years ago to remove a thyroid tumor in her neck. It had not metastisized and she got along great after surgery. I was told that, if the carcinoma in her liver was thyroid, Kinavet could help. I decided to try the drug. At this point, there was no telltale signs of the cancer. I gave her 200 mg on Wed night; I gave her another 200 mg Thursday night. She was feeling bad and had diarrhea – a small amount; also, her nose started running- water would drip freely from her nose; Friday I came home from work to check on her and found that she had vomited bile; She wouldn’t eat Friday but drank water. I decided to stop the Kinavet and called the vet, who agreed and prescribed a nausea tablet. Sat am she had diarrhea; by midday she had drank some water, ginger ale and ate a can of chicken noodle soup by 10pm; however she was totally weak. Sun she wouldn’t eat or drink – water was dripping from her nose and her eyes were running, like she was crying. Sun afternoon she vomited very mucousy bile 3 times – I took her to the emergency room and was told she was dehydrated. Mon am the vet called to tell me she had walked around a bit however, her heart chambers were not pumping in sync – the chambers were pumping randomly although there was oxygen in the blood. She was going to monitor Honey another day and do another blood panel. Less than 20 min after the 1st call, she called to tell me her heart had stopped. Could the dehydration with the Kinavet in her system caused her heart to shut down? How long would the Kinavet remain in her system – (she weighed 61 lbs)? I was supposed to give her 200 mg every 24 hours and I gave her the drug on Wed and Thurs. I had breast cancer – mastectomy and chemotherapy. I had a heart check to determine the strength and health of my heart before chemo was started. I realize that my drug was different and of course I’m a human. Could the 400 mg of Kinavet strained/harmed her heart? The vet also told me Mon that she showed signs of jaundice in the whites of her eyes. The cancer was found in her liver -could the Kinavet have stressed her liver enough to cause it to shut down? I got Honey when she was 7 weeks and she has been my child, best friend and companion. I am trying to deal with the reality that she’s gone (it’s like a bad bad dream ). I made the decision to try the Kinavet as I wanted to keep her with me as long as possible. Please help me find some answers. The vet said that she thought Honey had issues we weren’t aware of. It happened so fast. Wed day she ate well, ate several milk bones and went for a walk with me Wed night albeit she walked slow and wasn’t her usual perky self. Mon she was gone. If her cancer was advanced, would she have gone so fast in the course of 4 days? Please help me.

  29. Matt on April 6, 2010 at 4:40 am

    Dr. Dressler, my almost 6 year old American Bulldog just had a mast cell tumor removed, it was a grade II with mitotic index of 9. She is overall healthy happy and now that the stitches are removed seems to be back to normal. Met with oncologist who recommended Vinblastine and Pred for 8 weeks. My question, the tumor removed had clean margins, they got it all according to pathologist, is chemo worth the side effects given this bad tumor was removed cleanly? This dog gets really nervous at the vet, stresses her out badly, very badly. I hate to take her to the oncologist for 8 weeks unless I knew it was worthwhile for her life. Any comments or recomendations for me on a cleanly excised grade II tumor with mitotic index of 9? Is it possible that it is cured now???

  30. Cindi on January 18, 2010 at 11:43 am

    Your book and blog don’t mention hemangiopericytoma or fibrosarcoma. Any input on those?

    I’m also wondering if your vitamin D information is up to date.
    Vitamin D levels can definitely be improved in humans, and the current recommendations for the majority of people is 10,000 IU for 6 months, then test levels. This is considered the #1 bang for your buck regarding cancer.

    So it would be surprising to me that dogs really can’t benefit from supplements, and I wonder if they truly get toxicity at low levels, or if that is that old information. A year ago a lot of doctors were saying that people could get toxicity from 1000 or 2000mg of D. And that has been proven as false.

  31. Allie on January 17, 2010 at 6:53 am

    Hi Dr. Dressler,

    I just came across this post and was wondering if you could help me with a question? My dog had a grade II MCT on her skin that was removed in August 2008 and we found in August 2009 that it has spread to a lymph node on her chest. That was removed with clean margins and she underwent chemo (vinblastine and pred) and is doing well.

    I came across this post and went and checked her records (which I got from the clinic thanks to your ebook) and saw that it said “one or two” cells were in mitosis per 400x field (on the pathology report from the lymph node.) So, what would be the mitotic index for that? Is it one or two? Or higher?

    My dog’s oncologist did not mention M.I. to me, and I did not think to ask about it at the time.

    Thank you!

    • Dr. Dressler on January 22, 2010 at 11:10 pm

      Dear Allie
      The mitotic index refers to the biopsy of the cancer itself, not a lymph node. Which are you referring to here?
      Dr D

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