Hemangiosarcoma Symptoms and Testing For Dogs: Vlog 85

Hemangiosarcoma Symptoms and Testing For Dogs: Vlog 85

(upbeat music) – Hey everyone, welcome back, this is part two of my three
part series on splenic masses, mostly focusing on hemangiosarcoma. And if you’re looking for information on hemangiosarcoma of the spleen, this is the video that
you are looking for. But I’m still gonna
recommend that you please go back and watch part one
because I talk a little bit about hemangiosarcoma there, and definitely wanna emphasize,
if your dog has not gone to surgery yet and you
don’t know what that mass on the spleen is, it may
not be hemangiosarcoma. So go back to part one
and watch that part, and if not, if you’re ready to learn about hemangiosarcoma of the spleen, and I’m sorry that you’re
watching this video, because I’ll be honest
guys, it’s a tough cancer. But there’s hope and there’s
a reason to be hopeful, but it is a tough cancer. When I walk into the exam
room when I’m in the clinics and I meet a new family, a new client, with their pet, with
their dog, with their cat, I always say, “It’s a
pleasure to meet you, “I’m worry to meet you.” And I’m sorry that you’re
watching this video because it sucks when your pet has cancer, and hemangiosarcoma of the spleen is definitely a tough one. But information is power and learning about it is so important. So let’s do it, let’s learn about hemangiosarcoma of the spleen. If you stumbled across this video and you’re wondering about hemangiosarcoma in some of the other places
that we find it in the body, you’re in luck because I’m
gonna talk about that as well. The most common place that
we find hemangiosarcoma in dogs is the spleen, but we
do find it in other places, the heart’s the number two location, so we’re gonna talk about that as well. So as I mentioned in part one, it’s really frustrating when you’re trying to find information about less
common locations for tumors and less common cancers,
and I often get messages from people saying, hey, can
you do a video on this tumor, or you didn’t talk about
this tumor in that location. So I’m gonna try to add a
little bit of information about hemangiosarcoma in
some of the other locations, but really, we’re gonna be focusing on hemangiosarcoma of the spleen in dogs. Let’s do it, let’s break it down. So what is hemangiosarcoma, is an aggressive and malignant cancer of transformed blood vessels. So that is a lot of words, right. So it’s a malignant
cancer of blood vessels. And we have blood vessels
all over our body, but as I mentioned in the introduction, the spleen is the most common place that we see hemangiosarcoma in the dogs. It’s estimated to be about
5% of cancers in the dogs, excluding skin cancers, and about 10 to 20% of these class of tumors of the sarcomas. In part one, if you didn’t watch that, we talk about the double 2/3 rule. But in general, if a dog
has a mass on the spleen, about 50% of them are going
to be hemangiosarcoma. Again, as I went through in part one, the hard part about a dog
with a mass in the spleen is you’re not gonna know what it is and what the prognosis is for your dog until you take your dog to surgery and get back the biopsy report. So doing aspirates, all these things that we’re gonna go through in this video, you’re not gonna be able to know for sure what the diagnosis is until
you take your dog for surgery. However, and again, we
talked about this in part one so please go back and
watch that if you have not, there are some things that can raise our index of suspicion, raise our concern that this is going to be
hemangiosarcoma before surgery. One of those things that we talked about is if your dog has a ruptured mass and is bleeding into their
belly and no history of trauma, wasn’t hit by a car. Another thing is if they’re anemic. If there’s something on their blood work called nucleated red blood cells, so you can ask your
veterinarian about that. Abnormal red blood cell
shape or morphology, again on the CBC, is another
thing that we’ll see, and low platelets. And then how low the platelets is, the further they get lower,
that has also been shown to be associated with a worse prognosis. As I was saying, the most common place that we see hemangiosarcoma is the spleen, the number two location
in dogs is the heart, and I really like to think of the heart as a big blood vessel, and the liver is the next
most common location. When I think about
hemangiosarcoma of the spleen, I think of it about two battlefronts, and if you watched any of
my osteosarcoma videos, I talk about this as well. So the first battlefront is the
tumor growing in the spleen, and we’re gonna deal with
that by removing the spleen, something called a splenectomy. The first battlefront
is dealing with the mass in the spleen, and often
if they’re bleeding, and anemic, and need
potentially red blood cells, and stabilizing your dog. And then the second
battlefront after surgery, if you choose to, is
going to the chemotherapy, trying to delay that metastasis, so the cancer’s spreading,
with the most common places that the cancer spreads being
the lungs and the liver. Hemangiosarcoma is definitely
a treatable cancer, but I’ll be honest guys,
it’s still a crappy cancer. The median survival time of lymphoma is over a year with
chemotherapy treatment, osteosarcoma, the median survival time is a year with surgery and chemotherapy. There’s still pretty low
one year survival rates, it’s still about 10% with
surgery and chemotherapy. So it’s a tough cancer, we desperately need new treatment options. We’ll talk about that in part three and some of the studies going on. But it’s a frustrating cancer for sure. In part one, we talked about that, and please go back and watch that, what are you gonna see with
a dog with hemangiosarcoma. Sometimes it’s very vague,
they’re just not eating, they’re tired, and sometimes
it’s very dramatic, that they collapse, their gums are pale and they’re shocky,
’cause they’re bleeding into their abdomen and they don’t have that blood in their bloodstream, and they’re not getting
oxygen to their brain, to their muscles, to their other organs, so it can be very, very dramatic. So again, it could be very
vague and non-specific, they’re just tired and not eating, to this shocky condition
where they’re going in on emergency because they’re
bleeding into their abdomen. And I do go into that in
a little bit more detail in the first part. So let’s talk about who
gets hemangiosarcoma, which dogs are most at risk. So classically, it’s been thought to be a cancer of large breed dogs. So the classic breeds
that we typically think of are German Shepherds, Golden
Retrievers, and Labradors. And if you’ve watched
any of my other videos or some of my other social media, you guys know I do Labradors, I’m always thinking about hemangiosarcoma. But let’s not be breedist as I say, because just because you
have a German Shepherd that has a mass on the spleen, German Shepherds and these other breeds, I mean German Shepherds especially,
they also get hematomas, and they also get hyperplastic nodules. So again, just because they have a mass in the spleen, as I said in part one, it’s not always hemangiosarcoma. And really guys, every dog is at risk, large and small breed, for
hemangiosarcoma, sadly. And it’s probably under-recognized
in other breeds, as well. And last year, at one of our
major veterinary conferences by Dr. Moneyono, who really studies this, he really said that it’s
probably over-diagnosed in the large breed dogs, ’cause we have breed bias towards that. So again, it’s something that is a cancer that we can see in large and
small breed dogs, as well. So, I did promise you that in addition to the splenic form of hemangiosarcoma, I wanted to include a
little bit about some of the other common sites that we see. So again, right atrium, the
heart is the second most common and the liver is the third. The kidney is also, again,
so we have blood vessel, this is a cancer of blood vessels, like I said at the top of this talk, so it’s a malignant
cancer of blood vessels, and we have blood vessels
everywhere in our body, so you can have this cancer
superficially in the skin, the layers under the skin, you
can have it in the muscles, so intramuscular hemangiosarcoma, and practically in every organ. So the kidney is one that
that has been reported to potentially have a better prognosis, with a median survival time of nine months with just surgery and no chemo. So that’s definitely better. And you’re gonna want to watch part three where we’ll talk more
specifically about the prognosis with the different treatment
options for the splenic form. And then I also want to briefly highlight on the non-visceral,
so the non-organ forms of hemangiosarcoma,
’cause they’re different than the splenic forms
that we’re talking about. So one that I’d like to
highlight on is the subcutaneous, so the layer under the skin. They’re a little bit
difficult to prognosticate, but typically, they do better, much better than the splenic form. So the problem is the literature is a little bit all over the place. But in general, some studies show that with surgery and chemo,
the median survival time is about a year and a half, so way better than the splenic form. Another study showed that surgery alone, 50% were alive at one
year, so still better. Another study showed surgery and chemo, doxorubicin, which again, we’ll talk about for the splenic form in part three, three years, so even better. But then another study
showed only eight months with the same protocol of
surgery and chemotherapy. But in general, in my opinion, the subcutaneous do better with surgery, so that’s gonna be a
nice big skin surgery, just like our other lumps and bumps, we do aspirate these before surgery. And then I do follow up with
chemotherapy afterwards. The skin, so the more superficial, and again, you’re gonna
need your biopsy report to tell is it, can’t look at it and know if it’s of the skin layer and the subcutaneous layer. These tend to do really, really well. Sometimes they recur,
sometimes they’re multi-focal, but these tend to have
a pretty good prognosis, and I typically do not recommend
chemotherapy after surgery. So again, the superficial ones, the ones of the skin
have the best prognosis of all of the hemangiosarcomas out there. So let’s talk about the
rates of metastasis. And even though it sucks to hear guys, it’s really important to
know because this is why I’m so adamant about doing those x-rays before we go to surgery. So this is one of the cancers with a really high spread
rate or metastatic rate. So it spreads early and widely, so it can go to a lot of places. It’s estimated that about 50%
of dogs will have detectable, what we call gross
metastasis at diagnosis, with the liver and the
lungs being the most common. So again, that is why those chest x-rays before you go to surgery are so important. It’s also the most common
cancer to spread to the brain. So I think it’s really important that we’re doing those tests
before we go to surgery, to the best of our ability, to find out if the cancer has spread, so we can make good
decisions for your pet. So your dog is at the veterinarian and your dog has a splenic mass. What tests are you going to do, want to do before you go to surgery? Definitely, definitely, definitely, I’m gonna highlight which are the things that you need to do and
which are the things that you can probably not
waste your money doing. Okay, I’m gonna just give
you the bullet points. Do blood work for sure,
CBC, chemistry panel, I like to send a urine out to the lab, it’s just called a minimum database. Definitely do three-view chest x-rays, and I like to do an ultrasound. Those are my minimum
tests that I like to do before they go to surgery. And we’re gonna go through the other ones that you don’t need to do. Okay, so what are we seeing on blood work? Some dogs will be very, very anemic. The thing with anemia is it depends on how much they’ve bled and
when they’ve been bleeding. As I said in part one, some of these dogs have been bleeding on and off, and transfusing, absorbing that blood. So it will really vary
on very severe anemia to actually not anemic at all. So it will vary, and sometimes it’s something called regenerative, if it’s been going on,
their body’s going to try to be making more red blood cells, their bone marrow’s going to be trying to make more red blood cells. Sometimes their white
blood cell count is high, some dogs will have low platelets, and platelets are important for clotting. It’s estimated that 70 to
over almost 97% of dogs will have low platelets. Sometimes it’s mild and not a big deal and sometimes it’s severe and your vet’s gonna wanna know that, because they’re not gonna wanna take them to surgery with the severely low platelets ’cause that’s gonna make them at risk for bleeding at surgery. So those are things that
your vet’s gonna check before they go, and there’s
different tests that we can do. We can do something called
a coagulation panel, many hospitals can do that in-house. They can clip a toenail,
make sure they clot, they can check, it’s called
buccal mucosal bleeding time. So you definitely, if
hemangiosarcoma’s suspected, your vet’s gonna do something
to check clotting times before you take your dog to surgery. 50% of dogs with hemangiosarcoma
will have abnormal ability to coagulate their blood and
you definitely wanna know. So if they can’t do a coagulation test, which not every vet can
do, they can clip the nail, they can check the bleeding
time on the inner lip. So those are things
that we can do as well. And again, you wanna check
liver and kidney function with the chemistry panel as well. Really important, guys. You want to make sure your
dog does not have metastasis to the lungs with
three-view chest radiographs before you go to surgery. This is a cancer with a
very high metastatic rate. We need three views so laying
on both sides of the chest, it’s estimated that you can miss a nodule about 20% of the time by
not taking three views, so really, really, important, because the prognosis
is significantly worse if they’re spread to the lungs. And I have had cases that
didn’t have chest x-rays, went to surgery, had the spleen removed, came to see me at that,
about two weeks after surgery in anticipation of starting chemotherapy, and I note that chest
x-rays were not taken and we take chest
radiographs or chest x-rays and they’re spread to the lungs. And maybe those owners
would not have taken the dog to surgery, so
it’s a tough cancer. I think it’s mandatory, if you watch my mammary,
breast cancer, video in dogs, 50% are benign, 50% are malignant. It’s reasonable to take
off that mammary mass, it’s a superficial surgery, and then find out if
it’s benign or malignant and then go back and take chest x-rays. So I’m pretty practical when
it comes to working up cases, I think you should be taking chest x-rays before you take your dog to
surgery for a splenic mass. That’s my opinion. Okay, ultrasound. Ultrasound is better than x-ray, the problem is not every veterinarian has ultrasound available. But the reason is, especially
if they’re bleeding, if there’s fluid in the abdomen, we get better detail with an ultrasound that you can lose on x-ray. But what’s really important,
and I talk about this, again in part one, is that you cannot, with an ultrasound, if
there’s masses in the liver, multiple masses in the spleen, you cannot tell whether they
are benign versus malignant. And my husband is an internist,
board-certified internist, does ultrasounds day in, day out. I’ll show you guys videos,
we’ll show side-by-side pictures of ultrasounds of a benign
mass and a malignant mass of the spleen, and they look the same. So you cannot tell with ultrasound whether it’s hemangiosarcoma
or benign hemangioma, so ultrasound is a great
test to do before surgery, just to look around, it’s
gonna be less affected by the abdominal fluid,
it’s gonna confirm the mass, look at the rest of the spleen, look at the rest of the organs, but it’s still not gonna tell you the diagnosis of the spleen. So again, you need to go to surgery and get your biopsy back. So that’s really the take
home message with ultrasound is it’s not gonna be able to tell you whether it’s hemangiosarcoma or something benign or
another malignant cancer. Okay, so you got your chest x-rays, hopefully got an ultrasound, and you’ve done your blood
work, and your urine test, including something to
check clotting times. So what are maybe some
diagnostics that you can skip? You know me, maybe you don’t know me, but I love aspirates. So my whole lumps and bumps program, see something, do something,
why wait, aspirate, is all about doing aspirates before you remove a mass of the skin. Don’t aspirate a mass of the spleen. So there are some where we do. But usually, these masses
that were suspicious of hemangiosarcoma, which
again, we can’t tell, they’re very complex-looking masses. And hemangiosarcoma is known to bleed, they’re very friable masses,
very delicate masses. And there’s a couple reasons that we don’t wanna do aspirates. One is they’re usually non-diagnostic, so you just get back blood, so it’s a waste of time and money. And number two, they tend to bleed, so there’s a risk of hemorrhage, that we’re gonna make your dog bleed. So two very good reasons
that doing aspirates are not worth the time
and energy to do it, and they’re risky for your pet. So we don’t usually do it for
these complex-looking masses. There are definitely times when we see a solid mass in the spleen that we do it, there’s many times that we do it. But for these masses
that are often suspicious for hemangiosarcoma, we
just can’t get an answer with an ultrasound-guided aspirate, so I don’t bother doing it. If there’s fluid in the abdomen, the question is can we submit that off to the lab for fluid analysis, where they look at those
cells under the microscope. It’s usually also,
unfortunately, non-diagnostic, don’t get an answer, it’s
often 150 to $200 test. There’s just often not
enough cancerous cells in there that they catch them, so I don’t usually submit that as well. It’s good in other situations, lymphoma and things like that, but just not usually a useful test to make the diagnosis for hemangiosarcoma. Again, we’re trying to figure
out before we take your dog to surgery, does your
dog have hemangiosarcoma, that’s the point, is
there a way to diagnose before we go to surgery. The other question I
often get is do I need to do an ultrasound of the heart, because the second most common location for hemangiosarcoma is the right atrium, so part of the heart. And it was thought that dogs
could have both lesions. So I don’t usually, based
on some newer evidence and thoughts in the oncology community, I don’t usually, for a
dog with a splenic mass, do an ultrasound of the heart. Obviously if I’m working up a dog where I think they have a heart mass, and they’re having heart issues, of course we’re gonna do
an ultrasound of the heart. One thing that is important
of dogs with splenic masses, benign or malignant, often
have what’s called arrhythmias, abnormal heart rhythms. Again, that doesn’t mean
if they have an arrhythmia that they have a benign
mass or hemangiosarcoma. So we do typically have them hooked up to an EKG during surgery
and after surgery. Good news is most dog’s
arrhythmias will resolve about two days after surgery, and most of the time they
don’t need to go home on an anti-arrhythmic
medication, oral medication. Sometimes they do and
it will still resolve. The other thing that I wanna bring up as we wrap up this part two is incidentalomas. Hmm, we make up the funniest
words in medicine, don’t we? So incidentaloma is a word to talk about an incidental mass found on the spleen. So again, I mentioned this in part one, you’re doing an ultrasound
for something else, maybe kidney disease, or your
dog has elevated kidney values on blood work and you’re
doing an ultrasound and ah, they found a splenic mass. So is that the same as the 2/3 rule in terms of being malignant versus benign and hemangiosarcoma? And actually, there was a study in 2016 of just over 100 dogs, and dogs with an incidental splenic mass are less likely to have hemangiosarcoma
and malignant cancers. And actually, in this
study 70% were benign and only 30% were malignant. And in that study, size
was not prognostic, and actually, the bigger
ones tended to be benign. So that’s a really important thing. Another study that I wanna mention before we wrap up this part,
looked at over 500 dogs, which is really, really good number for a study in veterinary medicine. And they looked at the risk of a dog dying in the perioperative period,
so that post-surgical period, because that is a scary period if your dog is going to surgery. And so things that
increased the risk of death around that surgical
period was low platelets, and the more their platelets were lower, the greater the risk, anemia, lower than 30%, and arrhythmias. So again, just things to think about that just increase how
critical your pet is, and again, that just critical nature of the time after surgery. So it’s always, we’re take a deep breath and just get through it
and hope for the best. So I think those are some
important statistics to know. All right guys, that
was a lot of information about hemangiosarcoma. So just to highlight, we talked
about how the dogs present, what symptoms you may see at home, we talked about the different tests that you’re gonna do when
you go into the veterinarian, and in part three, I
hope you’ll come back, we’re gonna talk about the
different treatment options and what the prognosis is, and we’re also gonna talk about
some of the new treatments that are in development. Thanks for watching, I
hope that you guys found this helpful. Please, you know what helps me, help you, comments, let me know
what you found helpful, what I forgot, and please
don’t forget to subscribe. If you know anyone that you think this information’s gonna be helpful, please share it with them. Thanks so much for
watching, I look forward to seeing you at part three. And don’t forge to check out some of my other videos as well. Hope to see you soon. (calming music)


  • Mindi Van Houten says:

    Great information! I lost my chocolate lab Max to a splenic tumor this past April; oddly enough my other lab was diagnosed also but several months before we found out Max had it and she's still with us with no treatment. Our vet gave Shelby, golden lab, 30 days, next month, it will be 1 yr and that's without treatment. I'm constantly checking her gum color and her belly is so big 🙁 She's only had 1 major bleed. She also has hypothyroid and has idiopathic epilepsy. This past Saturday, she collapsed having 2 seizures back to back, could this be caused by the splenic tumor?

  • Teanne Basham says:

    Loved your parts 1 and 2 on HSA. Looking forward to part 3. I have a Golden who had a small lump under her tongue 2 yrs ago and it was dx with HSA. Then another one last year under the tongue which was removed with clean margins. 2 yrs ago we had an US done and there was a "shadow" on the spleen. Last month she started having some small bleeds but recovered nicely. Then 3 weeks ago we decided to have the spleenectomy because the US showed a large mass with bleeding. She had a liter of blood in her belly when they removed her spleen. She is doing great now and her usual self. They did find some more "spots" under her tongue but just used some freezing tx on them because she had a rough surgery. We've decided not to do chemo since we know it has spread and just plan to give her a good quality of life with her time left. She also had a melanoma on her eye before we rescued her and she lost her eye. So we think she's had enough. She is such a sweet loving dog though. If there was a chance for remission we would do everything possible. How do you feel about our decision? She's about 9 yrs old-we're not totally sure.

  • glamdolly20 says:

    Hi Dr Sue – My dog died 4 months ago of Hemanciosarcoma, despite surgery to remove a mass from her liver. She was 13 years and 5 months old. From the time the vet felt the lump, to her death was just 9 weeks. She recovered well from the surgery so I was hopeful it may have cured her, but then the biopsy result came back as hemangiosarcoma.
    I feel doubtful the surgery gave her any extra time with me. But I would do the same again because I wanted her to be rid of that horrid tumour – and of course surgery was the only hope of curing her, had it been benign, and the only way to find out definitively what the mass was.
    Can you answer a question that has been puzzling me? I was told about my dog's abdominal lump by a vet in mid February this year, and despite handling her every day I had never felt it myself. The surgeon who removed it told me it was huge, 'bigger than her head', and she was a tiny Maltese. It scares me that I was never aware of it, and only took her to the vet because she suddenly went off her food.
    If the tumour had been discovered earlier, say a few months before when it was much smaller, and removed then, am I right in thinking that still would NOT have been a cure because Hemangiosarcoma is incurable? But presumably if it had been removed when small, she would have had a better prognosis? The surgeon told me she could not be confident she had left a good margin of healthy tissue, because the tumour was so big. She was a small Maltese who at her heaviest weighed 7lbs, and at time of surgery was only around 4lbs, so there was hardly any room for the mass, it had grown so big.
    I hope to get another dog someday, and am worried about the same thing happening when the dog gets older and the likelihood of cancer increases. I am still stunned that I didn't feel this huge mass in my little dog's tummy, and by the time a vet did it was too late for it to be successfully removed. If a vet can feel an abdominal tumour, could a pet owner be trained to recognise one by touch? I think if I get another dog, I would get an ultrasound scan every year after age 7 and perhaps twice yearly after 10. Is that a wise precaution?
    Any tips you can offer would be much appreciated!

  • Jill Stout says:

    My girl (9 yr old Great Dane) had a Spenectomy with an 11 pound tumor removed 2 weeks ago. The spleen had torsioned which gave us symptoms. The tumor had not ruptured nor was it bleeding. Our Vet did not send for biopsy, he said he was sure it was HSA. He said he did not see any metastasis. So, we are holistically treating her as if she does have HSA, but now am unsure what to do. Should I continue? How will I know whether she actually has HSA?

  • Dr.Varsha Scooby says:

    Dr how do you approach a cranial mediastinal mass which was confirmed hemangiosarcoma?
    Patient is a 12 years old male neutered German shepherd dog🙁
    We are not sure if he is fit for chemotherapy
    Tumour looked too invasive in CT scan

  • Bridget Parker says:

    My Staffy Bella was diagnosed with a 14 cm splenic mass a week ago after an ultrasound. At first I didn’t want to do the surgery because of the risk, but after researching I am fairly sure I’m pushing forward with it. She’s still eating and playing, but has lost a little weight and has shown mild anemia.

  • Felicity Jung says:

    Hi Dr Sue, My dog has a mass that is related to either the spleen or liver. They are not sure which. What is the prognosis if it is on the liver – worse or better than the spleen? Additionally, if there is metastases, is there a place where you would advise not to go through with the surgery as it would really hurt my dog? I know you mentioned the lungs but i do want to be informed before i make the decision. Rex has a CT tomorrow and possibly surgery. I thank you in advance!

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