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BONE CANCER IN DOGS
This article by T. J.
Dunn, Jr. DVM appeared
in a recent issue of
Dog World Magazine
Bone cancer in dogs and cats can be a challenging disorder
to overcome. Although rare in cats, bone cancer in dogs is most common in
large breeds but can occur in
any
canine. Achieving and maintaining good health is a balancing act. A healthy dog exists
only when an incredibly complex series of chemical reactions come together at a
specific time and place. There is an invisible chemical ebb and flow, a true
harmonic resonance that lives within a healthy animal. And when that vibrant
harmony is upset, when the sweet song of life is bumped out of balance, ill
effects sweep over the entire individual.
Cancer is one notable form of disharmony within an individual. The hallmark of
cancer is uncontrolled cell growth, invasion of cells into nearby structures and
sometimes a dispersal to distant organs, which is termed metastatic cancer. And
since any cell in the dog’s body has the
potential to develop into a cancerous
cell, bone cancer dramatically illustrates what can happen when things go wrong.
When a cell turns cancerous by a disruption the cell’s physiology, structure or
function, normal neighboring cells usually consume the rogue cell. On other
occasions the defective cell simply self-destructs and is swept away. But when
conditions are just right… or wrong from the animal’s perspective… a modified
cell, called a mutant, survives the modification, retains its vigor and
reproduces more cells just like itself. Generation after generation of cells
arising from that single mutated cell eventually changes the neighborhood and
carves out it’s own territory, spreading its own bad seeds into more and more
neighborhoods. Metastatic bone cancer cells break away, hitch hike the blood
stream or lymph fluid and travel to entirely new neighborhoods within the dog’s
body and begin the malignant process all over again.
Cancer is also termed neoplasia, which means new growth. A cancerous cell grows
faster than normal and divides and multiplies at an abnormal rate; its progeny
do likewise. From that one abnormal neoplastic cell more like itself invade and
crowd out surrounding tissues. With bone cancer, there are four types of cell
lines capable of evolving into a neoplastic condition:
Osteosarcoma… causing nearly 80 percent of all bone cancers this most common
form of bone cancer arises from cells that deposit bony minerals. Aggressive
invasion and rapid growth make this form of cancer a dreaded threat. The
x-ray image below to the right shows what an osteosarcoma of the humeral
head looks like.
Click on it to see the larger view.
Chondrosarcomas… these tumors arise from the cartilage joint surfaces at the
ends of bone and generally have a less aggressive tendency to invade and spread
than
osteosarcomas.
Fibrosarcomas… originate from fibrous connective tissue adjacent to bone, are
locally invasive into the bone and have a low tendency to spread.
Synovial cell carcinomas... originate from joint tissues and invade the
associated bone. These tumors are less aggressive than osteosarcomas.
A definitive diagnosis of bone cancer can only be made via microscopic
evaluation of a bone biopsy. Veterinary pathologists classify the degree of
malignancy of the cells and likeliness of metastasis to other tissues. Like
seeds on the wind, neoplastic cells can be carried by the blood and lymph from
the original site of the cancer to distant tissues whereupon a new cancerous
growth arises. Called metastatic cancer, whenever distant growths are present in
a dog’s body the magnitude of the ill effects on the patient are remarkably
increased… and the chances of a cure drastically reduced.
Most commonly seen in long bones such as the femur, bone cancer has a
predilection for larger breeds including the Greyhound, Saint Bernard and
Mastiff. Chronic, low-grade lameness with gradually increasing swelling near a
joint will alert the veterinarian to the potential for a tumor to be present.
Radiographs of the affected area often display characteristic changes in a bone
that are totally unlike the defects usually associated with arthritis. On
occasion, an apparently normal dog will be presented with a spontaneous, severe
lameness. Physical examination and radiographic evaluation, to everyone’s shock,
reveals the cause of the break to be due to bone cancer. This break is
termed a pathological fracture and there is an example of a pathological
fracture in the table below.
Osteosarcoma continues to be one of the most challenging types of cancer to
treat. Part of the therapeutic challenge arises from the fact that at the time
of diagnosis there often has already been metastasis to other areas of the body.
Veterinarian Kenneth M. Rassnick, Assistant Professor of Oncology at Cornell
University College of Veterinary Medicine in Ithaca, New York states,
“Unfortunately, at the first signs of lameness, we expect that the tumor has
already metastasized. However, as long as the metastatic cells are still
microscopic and we cannot detect them on radiographs, then dogs will still
benefit from treatment.”
There is no single treatment protocol for all patients with bone cancer;
Rassnick explains that individualized strategies are selected for each
patient.
“Currently,
for dogs with osteosarcoma, I thoroughly screen them for obvious
signs of metastasis. For most dogs, this includes radiographs of the lungs and
physical examination and palpation of other bones. Amputation of the affected
leg is the first line of treatment but unfortunately, amputation alone is only
palliative for a cancer as aggressive as osteosarcoma. Over time, the metastatic
cells will continue to grow in number and size.
If it is determined by radiography, ultrasound or physical exam that there are
no metastatic tumors present, amputation of the affected leg followed by
chemotherapy has proved to be the most effective treatment for osteosarcoma.
There are a number of chemotherapy regimens that we know to be effective at
controlling the metastatic cells.”
Thoughtful consultation with the veterinarian regarding chemotherapy is very
important. Rassnick tells us “The exact chemotherapy protocol will depend on a
number of factors including overall health status of the dog and function of
organs such as the heart and kidneys. We have spent a considerable amount of
time trying to determine the best time to begin chemotherapy. Since we know the
cancer cells have already spread, it is tempting to begin therapy as soon as
possible. Some have even advocated giving chemotherapy before the amputation
surgery or even at the same time. Our studies have shown there is not a
tremendous benefit to instituting therapy that soon, so I generally recommend
having the amputation surgery done, letting my patients heal for 7-14 days and
then begin chemotherapy when the stitches are ready to be removed.”
Not all dogs will be candidates for amputation. Rassnick adds “Some dogs may
have concurrent orthopedic or neurologic problems that may complicate ambulating
with three legs, or occasionally it is the wish of the family not to pursue the
surgery. We can offer palliative options for controlling bone pain including
nonsteroidal medications and even radiation therapy. Localized radiation therapy
to the diseased bone is often a very effective method at controlling the pain
and some veterinary oncologists can now offer this as an option.”
As drastic as amputation seems to be, it should not be immediately rejected as
an attempt at treatment. As a practitioner for over thirty years I have been
amazed at how some canine amputee patients respond and adapt. Each case should
be evaluated on its own merits with attention paid to such factors as the
presence of arthritis in the patient, degree of excess body weight, heart and
other organ function, and the patient’s attitude and ability to adapt to new
situations.
| Click To Enlarge Images Of Bone Cancer Radiographs | |||
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| This image is of a pathological fracture of the femur that was caused by cancer of the bone weakening the bone structure | This closer side view of the pathological fracture is of the patient on the left | The arrow points to bone cancer invading the lateral side of the humerus near the elbow joint | This image displays extreme dissolution of the distal two thirds of the ulna of a dog due to bone cancer |
Until new research reveals more about the menace of cancer’s mysterious origins
and until ways are found to turn off rapidly multiplying cancer cells, we will
need to be on the alert for bone cancer in our dogs. A veterinarian should
evaluate any lameness that persists longer than three days. All dog owners
should be proactive in requesting that an x-ray evaluation be done especially if
swelling is present. And no matter what the diagnosis for the lameness is, be
certain to let your veterinarian know if the expected healing and return to
normal function has not occurred within the expected time frame. The sooner bone
cancer is discovered, the better the chances that treatment will actually affect
a cure.
| Veterinarians In Action... Caring For Cancer Patients | ||||
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| Physical exam... | Radiographs... | Laboratory analysis... | CT Scans... | Histopathology... |
| Every diagnosis begins with a careful physical exam of the patient. The pet owner's history of the patients' overall health status is carefully considered and the patient is given a careful inspection. | Even when external, visible tumors are present, thorough evaluation of the patient includes x-ray evaluation so that subtle internal changes can be visualized. | Specimens of tissue cells and fluid cellularity provide important clues to cancer presence. Occasionally, a diagnosis can be confirmed by fluid and cell microscopic evaluation. | Modern veterinary medicine has access to advanced techniques such as CT Scanning methods that improve data collection and increase reliability of diagnostic evaluation. Ultrasound techniques are also employed. | Specialists in Veterinary Pathology have the final word when it comes to making a definitive diagnosis of cancer in pets. |
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