Cancer sucks.

Cancer sucks. How profound is that? I just get so wiped out some days with that horrible diagnosis. A pet comes in for a "simple" limp and I have to give this life and death news. Why does it seem to happen to the nicest pets with the sweetest humans? Some people think cancer is on the rise. It sure could be. Maybe we are better at making the diagnoses, better tests and all. People allow us to do more diagnostically for their critters, too, including advanced imaging like MRIs. I know pets are living longer than they used to, what with better nutrition, better medical care and more pets living cushier lives indoors with their humans. Older animals get more cancers, for sure.

But Chloe is only 6 years old! Talk about a nice dog with a sweet, loving family. She is a wonderful Saint Bernard, full of life and happy to see everyone she meets. Her owners noticed she was limping on a front leg a few weeks ago and didn't think much of it. Then all of a sudden the carpus (wrist) area started to swell up like a balloon and they decided to bring her in to see me. My heart just sank; a giant breed dog (Chloe is around 140 pounds) with a swelling of a long bone almost always equals cancer. I prayed I was wrong. The swelling wasn't particularly warm to the touch, there were no obvious wounds or punctures and it was fluctuant (soft.) Chloe didn't cry when I palpated it, but did lick my hands to let me know she didn't like me messing with it. Radiographs (x-rays) of the swollen area would help us with our diagnosis.

Chloe's owner was particularly concerned about her anxiety during the exam. She seemed to settle down a bit in the examination room but he thought lifting her up to the x-ray table would set her off again. Fortunately, my x-ray machine is a small, portable unit (I used to be a mobile equine (horse) vet exclusively) so we were able to bring it to her and radiograph her leg right there on the floor of the exam room. My technician and assistant put on lead aprons to shield themselves from radiation, then had the owner briefly step out of the room. It only took a few minutes to get the needed images.

Osteosarcoma (primary bone cancer) has a very typical appearance on radiographs. There is an area of lytic bone. (It looks like it has been eaten away.) Sometimes there is a "sunburst" pattern, bright areas of new tumorous bone growth. There can also be small pathologic fractures at the site since the bone is so weak in this area. There are certain bones and certain sites where it is predisposed (most common.) Chloe's lesion was on the distal radius and ulna. This type of cancer does not like to cross the joint, so adjacent bones are not involved as would be the case for things like bone or joint infections. Chloe's adjacent carpal bones were fine. We are sending the radiographs to a radiologist for review as we do all of our films, but the diagnosis is fairly certain. So tragic.

Osteosarcoma is a painful disease. Most dogs are euthanized because of this pain very soon after the diagnosis is made unless we can find a way to control it. Amputation is an excellent choice for our patients because they usually have 3 other good legs on which to get around. Chloe doesn't. She has some pretty bad knees and hips, so those back legs couldn't support the additional weight if we were to amputate a front leg. It is possible to use radiation for palliation (pain control.) This requires general anesthesia and is very expensive. Remember I told you about my own dog, Verbal, having radiation for her cancer 2 years ago? It was about $4,000 at that time. Palliative treatments aren't as intensive (don't require as many treatments) so wouldn't likely be quite as expensive, but could be in that general ballpark. I don't know if Chloe's family will choose this for her or not. For now we have Chloe on some really good NSAIDs (non-steroidal anti-inflammatory) meds as well as an opiate drug. There are other drugs we can add as needed to control her pain if her owners think she needs them.

Usually by the time we see a swollen bone with osteosarcoma, we can assume it has metastasized (spread) to the lungs. If the pain of the primary bone lesion doesn't do her in, the coughing/respiratory problems from the lung pathology will. It is a horrible, horrible disease and one I wouldn't wish on anyone. I feel so badly for Chloe's wonderful owners. I have a nice little booklet for them to use to help their children deal with the upcoming loss and grieving that will result when it is time to say goodbye. Times like this I really feel helpless for the owners, but I know I'll at least be able to help alleviate her suffering when that time comes, a choice we don't really have as humans. Cancer, indeed, just sucks.

Peace,
DrReneigh