MCT and incomplete excision...radiation??

MolROYlly

Boxer Pal
(LONG)
Hello all, i haven't posted here in a while, but here goes. My molly is 7 yrs old spayed female. She was just diagnosed with having a mast cell tumor a few weeks ago. I noticed the the tumor roughly 2-3 months earlier but thought nothing of it as she just had aspirates done on 2 other masses and both came back as lipomas, so i assumed this was another. Well, it turned out to be a mass cell tumor which seemed like it popped up overnight but hasn't grown for the 2-3 months. So we went to an oncologist for consultation. We knew going in that due to the spot where the tumor was (hind leg wrapped around tendon), it would be impossible to get clean margins. So we started surgery knowing we couldnt remove all of it, but was still the best option to remove as much as they could. They told me surgery went well and all things considered, they feel they got as much as they could out and only microscopic cells should be left over. They aspirated the local lymph nodes to make sure it didnt spread, which was the case. The biopsy came back as a low grade 2 (grade 2 acting like grade 1).

Due to not being able to remover tumor entirely, the next recommended step is radiation. $6.5k procedure plus going to the hospital mon-fri for the next 2 weeks. Originally, they told me that they feel they got all the visible tumor tissue out and only microscopic cells should be left over. Now they're telling me that they think they might've left actual physical cancerous tissue. If the former, i would've felt confident just waiting and seeing if the tumor comes back again as ya'll may know, at worst there are only 1 in 3 cases where the tumor comes back even with incomplete margins/excision. With the latter (physical tissue left over), chances of recurrence are more than 80%. This is where radiation comes in. They told me that radiation is the best option we have to have the best chance the tumor won't come back, but as ya'll know radiation is no guarantee either, especially when radiation now has to kill physical tissue as opposed to just microscopic cells.

I asked about my other options and my oncologist really didn't give any as she said radiation is my best option. She said we could wait and see but its going to be a gamble and they believe the tumor will come back. I also asked whether if the tumor does come back, will it be the same low grade tumor or will it be worse. She told me usually it will come back the same but has a chance to be worse. Most mast cell tumor website state the opposite that they will almost always come back worse....Do i believe the interwebs or an oncology intern and resident consulting with the head oncologist over at this particular university vet hospital??

Right now, im leaning towards just waiting and seeing. If it does likely come back, the plan is to just remove it again. Prednisone, benadryl, and pepcid for the next 4 months to help. Im just very afraid that it might come back only in a year or less, and we would have to do surgery again and at that time do radiation.

Honestly, i would have to borrow the money for radiation in some way as i do not have that kind of money. What would you guys do in my shoes? Again to summarize, its a low grade 2 tumor that was localized and not spread, imcomplete excision due to location, radiation recommended but not guaranteed cure although 80-95% chance of non-recurrence, and wait and see is the other option but doctor feels that there is a good chance it will return. Thanks again for your help!!

Roy and Molly
 

Gatorblu

Boxer Insane
UGH! I feel for you, and I honestly don't know what to tell you. I just find it odd they didn't want to talk about other options. My girl just had a tumor removed and thankfully they got it all, but before surgery they had discussed the possibility of oral chemotherapy if they wasn't the case. I would ask again for all the options, the costs, and the prognosis of each one. Tell them you want ALL the information. Tell them you understand what they are recommending but you want all the info anyway. Good luck to you and Molly,
 

MolROYlly

Boxer Pal
Thank you for the kind words. I actually have been in contact and updating my regular vet throughout this whole process. I told her about all this today (all of this happened yesterday) and she's going to talk to the oncologists about our case. When i told her, she told me the hospital's reports were "unnecessarily ambiguous", so shes gonna poke around for me and we'll see what comes out of that.

When the oncologist was telling me about radiation and i was asking about other options, she just had this look on her face that said to me "radiation is your only hope, tumor's coming back". Whether she was really thinking that...only she and god knows...but i just got this impression that she really believed radiation was my only option.

Ill know tmrw what my vet finds out
 

Cami

Boxer Insane
There are a ton of threads here on BW documenting my girl Cami's experiences with MCT's. Not once was radiation EVER brought up by her oncologist who is the leading researcher/doc on this type of cancer, (Dr. Cheryl London, Ohio State University). She was involved with developing the first ever FDA approved cancer drug for dogs. If radiation was the norm for an incompletely excised MCT I would have heard about it (meaning it would have been suggested). Any MCT removed with OR without clean margins has a 50% chance of returning. Do a research here about the use of Vetalog. It is used after surgery to blast away any remaining cancer cells. We used it for complete tumor death minus surgery many times on Cami. It is a very common drug and an inexpensive choice. The tumor - in our case was injected every couple of weeks until the tumor was gone. I am not sure what the protocol would be for dirty margin surgical procedures as we always opted to see if a tumor grew back (per the oncologist) - NONE ever did and multiples were removed without clean margins, including a walnut sized grade 2 on her back. She had over 16 tumors in her lifetime (I lost count after 16). I personally would not utilize the radiation option AFTER surgical excision. Prior to surgery maybe to reduce the size if it were huge but never after. Just my opinion. I work with animals for a living and have seen the aftermath of radiation on dogs with MCT's (grade 3's, large in size, terrible location and on Palladia as well).
Did they offer you a percentage of success with the use of radiation??? If they could offer 100% success with no chance of pain for my pup, no additional tumors EVER then I might think about it but sadly they can't do that. Whatever you decide will be the best decision Molly.
 

MolROYlly

Boxer Pal
Wow...your response just completely threw a wrench in their diagnosis. I dont remember her giving me any type of percentage of non-recurrence with radiation, but the general consensus is 80-95% of non-recurrence. Is that the case with molly...i have no idea. I know she said she felt the tumor had a good chance of coming back. It was wrapped around her tendon in her right leg ankle area, and so they had to scrape behind the tendon without being able to visibly see everything, thus the fear of incomplete excision vs just dirty margins. But what really surprised me was that your doctor has never recommended radiation even with incompletely excised tumors.

My regular vet just told me that she tried to contact an oncologist she knew but wont be in till monday, so we'll see what that oncologist says then.

Im definitely going to ask about vetalog. I've never heard of it, but then again, i havent even come close to the amount of research i did for the diabetes insipidus my molly has. So i got much to learn...

Also, what did your doctor say about if the tumor comes back, will it come back as the same grade or will it come back worse? Im ok with waiting and seeing even if radiation is highley recommended, but im very worried about the tumor coming back worse than before and possibly spreading.

I will note that i got a different oncologist everytime i went. The first one had a bunch of letters following her name and same with the surgeon, but the following 2 doctors were just an intern and a resident that consulted with the 2 very experienced oncologists above. So i dont know if the decision to recommend radiation was due to their inexperience or if the 2 experienced oncologists were pushing radiation as well.

Most of the general MCT literature had radiation as the recommended treatment for an incompletely excised tumor, but i've also read other studies questioning the need for radiation even if tumor is incompletely excised, thus creating a doubt in my head with their diagnosis.

My head is just spinning right now...

Roy and molly
 

Cami

Boxer Insane
To be honest the conversation about a tumor returning and what it might return as (grade) was never brought up in nearly 5 years of dealing with MCT's (her first was at age 2 and we lost her just shy of 7 due to heart issues). I know that if left untreated a grade one will NOT turn into a grade 2, etc... It might get larger, invade more tissue but it won't be a "worse" tumor grade (a worse tumor due to size, yes). They are what they are. They don't morph into something else. That being said there isn't anything saying that a 1 gets surgically removed, stray cells are left over that don't get absorbed/killed by the body and then a grade 2 tumor takes up residence in that same spot. Stranger things have happened. Was that the original tumor regrowing or a new one by coincidence? That question probably can't be answered.

What does the pathology report say? What was the mitotic index? That should be a helpful determining factor in your decision making process. Grade 1's, even those that mimic grade 2's don't typically metastasize (spread). So many vets (including oncologists) treat the numbers and not the patient (specifically the breed when it comes to MCT's). Boxers are just DIFFERENT (in most cases) when it comes to this kind of cancer.

My girls oncologist said it to me like this with regards to incompletely excised tumors......"It may or may not come back. Until it comes back there is nothing to deal with (always lots of worry but that is how we pet parents are)." A 2nd surgical procedure comes with a 2nd set of potential complications. **Again radiation was NEVER mentioned or suggested. I trusted HER. I am not a vet and I am not saying that radiation isn't a smart choice for your girl I am just sharing my own experiences/opinion.

I know the road you are on currently. I spent a large portion of Cami's life mourning her death. She was such a sick girl (on paper) from day one. She read the Boxer Handbook and made sure to cross off the majority of ailments that affect Boxers. I spent YEARS researching every illness she was afflicted with. She never acted sick. She never felt sorry for herself. She only wanted to PLAY. Such a happy girl who literally changed my life. I could only arm myself with as much information as I could and then ask those who knew far more than me what their thoughts and opinions were. I didn't always follow the many vets advice but I took everything in so that I could make a better educated decision for her. In the end I know I did my best even though I couldn't save her. I know that I tried and she was thankful for that. Your girl has a great advocate in you. You won't do wrong whatever you decide.
 

Independence

Boxer Insane
Having dealt with a boxer with MCT and lymphnode involvement Grade 4 (the worst). We would had done and pain anything. No chemo or radiation for his tumor. These treatments do nothing for MCT's. The medication Cami is referring to in her post is the medication we were lucky to get into the study portion. It's called Palladia and if you do a search here you can see our journey with MCT and Palladia. Cami is a wealth of knowledge on this topic. She really help us thru a tough time when our Indy was diagnosed.

Wishing you well. It is obvious you care for your pup like we do. We will keep you both in our prayers. Please keep us updated on Molly's progress.
 
Top