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

Incidentalomas: when you find a cancer you were not looking for

Updated: October 10th, 2018

Recently, there was an article that caught my attention in the New York Times. In A Tumor is No Clearer in Hindsight, Denise Grady wrote about whether Steve Jobs had made the right decision to wait 9 months to go to surgery after finding out he had a type of pancreatic cancer. The article goes on to discuss the dilemma of what to do when you find an incidental cancer.  An incidental tumor, or “incidentaloma,” does not cause symptoms and is typically found during diagnostics for something else. In people, this is often the case when scans are done for back pain.

Should the incidentaloma be pursued and treated? One may argue that without the diagnostic scan for another issue, the tumor would never have been found. And what if the procedure to remove the tumor can cause complications, even if the complications are rare? On the other hand, maybe if the tumor is detected early, this may be a good time to remove it when it is small.

I routinely encounter dilemmas like this with my patients and their Guardians. Just a few weeks ago, this very scenario played out with Shannon. She is an adorable mixed breed dog – she looks like a cross between a Beagle and a Viszla. Shannon was already diagnosed with nasal carcinoma and was traveling to Animal Specialty Center from Virginia for CyberKnife RadioSurgery. Since my practice is in NY, the plan was to do her CT scan for radiation planning on Monday, and then treat her Wednesday through Friday of the same week. (There is typically a week between planning and radiation treatment.)

On her head and neck CT, the nasal tumor was not her only abnormality. There was also a mass in the region of the pituitary, consistent with what is called a pituitary macroadenoma. These are also treated with radiation, but to treat both would significantly increase the cost of the radiation. And since the plan was to treat her in two days, the radiation oncologist needed a decision from the pet Guardians that afternoon so she could prepare Shannon’s radiation plan, or we would have to put radiation off a week.

So on Monday, as Shannon was still recovering from anesthesia for her CT scan, the Guardians had to make a rather quick decision. I got a consult from our neurologist. He reviewed the options and the possible outcomes with and without treatment. Shannon was not displaying any neurologic symptoms. Her tumor was 0.85 cm, and guidelines are to treat with radiation when tumors are 1 cm or greater. No one knows how long her pituitary tumor had been there, or how quickly the tumor would grow. We do know that the average dog with an untreated nasal tumor only lives 3 months, and radiation can increase survival times to 12 to 18 months. Should they treat both, just the nasal tumor, or not treat at all? What would I do, I thought? What would you do?

We also found another mass on her CT, an oral tumor associated with the lower jaw tucked back by her molars. The radiologist said the appearance on CT was consistent with a benign oral tumor called an epulis, but I told Shannon’s dad (that’s what I call the Guardians) we need a biopsy to know for sure. Again, do we hold off on CyberKnife? Or proceed?

Ultimately Shannon’s family decided to go ahead with CyberKnife RadioSurgery for only the nasal tumor, and we biopsied the oral mass during the first anesthesia. The biopsy confirmed an oral epulis. Like the pituitary tumor, Shannon’s guardians are going to carefully monitor this. Shannon finished her radiation uneventfully, and she and Dad headed back to Virginia that Friday.

Like human medicine, we wrestle with the dilemma of incidental tumors and whether it is ever safe to just watch them. Do we need to treat them right away, or can we just observe them?

 

To learn more about the common dog tumors and treatment options, including full spectrum approaches, check out the Dog Cancer Survival Guide.

Discover the Full Spectrum Approach to Dog Cancer

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  1. Lori M. Shukers on October 14, 2018 at 6:50 pm

    We have a grey hound/boxer mix and he has nasal cancer and I have a few questions. In April 2018 is when he started sneezing and having runny nose so he was put on prednisone and antibiotics. However, these didn’t work.. We noticed something in his nose took him to vet and this was in June 2018. July 2018, he was scheduled for a biopsy and it was taken out of his nose. Within a week it came back. So then there was another biopsy taken in Aug. 2018 and sent in Iowa State University. Both cultures came back as benign. After the 2nd biopsy the tumor was back with in three days.. So then Sept 2018 we were to go and have the rinoscopy done to see how much they can get and see if further down where it started and see if it is cancer. They took a really big culture and it said it was cancerous, it was 4 days and it was back!! That operation was 2500.00. Well, we were told that they could do a nose surgery which would cost $6000.00 or they could do radiation treatment which would cost $8000.00.
    Well we don’t have the money for these procedures so we were trying to find an organization to help us.. Rocky is only 7 and we are trying to find other ideas or help. This week of the 13 of Oct 2018 he has started not wanting to eat, like his throat hurts. I have been able to get him to eat some things but I have to feed it to him. We know with this in his nose it cuts down on him being able to smell, he does seem to have a problem breathing, and snores alot now. However: I am hoping to come up with some ideas, help, whatever we can get.. Thank you so much for listening to our Rocky boy’s story.
    Sincerely,
    Al Kent, Rocky Kent and Lori Shukers

  2. Jan Rasmusen on December 9, 2011 at 12:12 pm

    We successfully removed a large tumor from the liver of my 11 yr. old Maltese in February. During a follow-up ultrasound 9 mos. later, we found a 3 mm bladder wall lesion and progressive hepatic nodules. Two months later we found the lesion had doubled in size to 7 mm diameter. My dog shows no signs of illness. The oncologist wants to remove the lesion and biopsy the liver again. I hate to put my dog through surgery again so soon. I’m told that if this is cancer, it is a different cancer from the liver cancer. The oncologist says the lesion will likely cause bladder, then kidney, infection so we need to remove it even if it is benign. My question: should we cut again? Thanks for any thoughts you may have.

  3. Teresa on December 7, 2011 at 12:27 pm

    My beagle is a mast cell tumor survivor (6 years now). But this morning he was diagnosed with melanoma in his eye and surgery is recommended (not a removal of the eye). I have the Dog Cancer Survival Guide book (which is wonderful) but I can’t find anything in it on melanoma in the eye. Any recommendations on where I can find out more?

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