Benign Tumor Growth

October 10, 2013

The good news is that Cara Mia is Cancer Free, the bad news is that the tumor is still growing.  Last year when she underwent her regimen of Bicarbonate infusions the tumor mass reduced in size to about 3cm.  It is now approximately 7cm, and as it sits directly behind her left anal gland, it is obstructing her from defecating.  She strains and shows tremendous frustration at not being able to pass matter past the obstruction.  In addition, her stool is thin and almost ribbon shaped, due to the mass pushing against her canal.

This obstruction is going to require surgery.  The lucky part is that the placement of the mass allows it to be removed from the outside of her bottom, rather than from inside the anal area. Firstly it is safer because the nerves that control incontinence are above the mass, so she should not have any fecal incontinence; Secondly, it is a cleaner surgery and lastly, it will remove the entire mass.  This is called debulking the tumor.  Had the tumor been cancerous the surgery would be much more extensive and there would be great concern for her quality of life and actual survival.

Of course any surgeon will have to agree to bicarbonate irrigation during surgery and a bicarbonate solution drip for the two-three days she will spend in the hospital.  Also we would need facility to feed her the EFA’s which helps in recovery by oxygenating the cells and blood and killing off free radicals, that may instigate post-surgical risks. 

So we will keep you up-dated on her prognosis, as we go about selecting a surgeon and preparing for her care.

Other than the frustrations when trying to relieve herself, all is well in Cara’s world.

November 10, 2013

 As you know when we cured her Cancer, the tumor was left behind and while begnin, it continued to grow.  It is now about 8cm and blocking her from defecating.  She experiences tremendous frustration and pain. We elected to travel to Davis as the Chief Surgeon and Department Head at the UC School of Veterinary Medicine, Professor G. Hunt, agreed to perform this very delicate operation on Wednesday morning.
 
There are issues which leave some trepidation: Cara Mia is 12.5 years old and that is an advanced age for a German Shepherd to undergo general anesthesia, although she is in excellent health physiologically.  It is important that Professor Hunt not to sever any of the nerves that surround the anal sacks to prevent fecal incontinence. Great care must be given to preventing infections, again considering her age. 
 
But there is no alternative except putting her down and neither Alexa nor I can bring ourselves to do that.
 
Send good thoughts and wishes. God willing, we should be back by Saturday with a happy and much relieved Cara Mia.
November 12, 2013
Here is part of the Notes written by the UC Davis  doctors:
Abdominal ultrasound showed profound enlargement of the sublumbar lymph nodes – we found 3 lymph nodes of 2cm, 3cm, and 5cm in height. We are concerned that this most likely represents lymph node metastasis of the suspected malignant tumor of her anal sac. We are also concerned that the enlarged lymph nodes are the primary cause of Cara Mia’s difficulty defecating, by impinging upon her colon and rectum and compressing them against the bony pelvis. While it is certainly possible that her anal sac mass is playing some role in her straining, we think that it is less likely to be functionally preventing the passage of stool.Thoracic radiographs did not show evidence of pulmonary metastasis, although it is possible that there may be microscopic disease that we cannot see on radiographs at this time.

We recommended fine needle aspiration of the anal sac mass as well as the sublumbar lymph nodes as we did not have a definitive diagnosis from her previous aspirate. You have elected to decline this diagnostic test today.We consulted with our soft tissue surgery service, and as Dr. Hunt has discussed with you today, we feel that it is important to proceed with a CT scan prior to planning surgery for many reasons. It is unlikely that simply removing the rectal mass will resolve her problems with defecating, as the lymph node enlargement is much more likely to be the primary cause; the CT scan can help us determine the level of compression.

We would recommend removing both the mass and the lymph nodes if it is possible. As the lymph nodes can sometimes have a significant blood supply, there is a risk that Cara Mia could die while on the table from hemorrhage during removal. There is also a risk that following removal of the rectal mass, she could become incontinent with her stool. We would like to perform a CT study to evaluate these risks as fully as we can, and determine the extent of disease for the best possible surgical planning.

We recommend also following up on her blood calcium levels and monitoring this. They are not very high right now, but this could get worse in the future and high blood calcium can potentially lead to kidney damage and gastrointestinal signs such as vomiting and diarrhoea.

It is very likely that there is microscopic cancer in other lymph nodes that we cannot see. It is likely, that following surgery she could have future enlargement of other lymph nodes. Our hope would be that it would take several months (6-12 months), as the type of tumor we suspect in Cara Mia tends to be slow growing. Following surgery, our recommendation would be to proceed with chemotherapy (carboplatin or mitoxantrone) to try to slow down further spread of disease.

You have chosen to take Cara Mia home today and pursue another week long course of the bicarbonate and EFA treatment that you have previously performed. We feel that taking a week to attempt this will not negatively impact her other treatment opportunities, but we recommend monitoring her pain and discomfort at home as you make your decisions for her care. We also recommend rechecking her calcium levels before and after her treatment to ensure that this is not elevating further. After this course you plan to return for further surgical planning.

Thank you again for bringing Cara Mia to our Oncology Service today. She is a beautiful dog and has been a wonderful patient for us; we are so sorry that she is struggling with this difficult disease and we do hope for the best possible outcome for her.

 

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