Our amazing rescue dog, who we have had for less than a year, just a had a small growth removed from his elbow. It was biopsied and turned out to be a soft tissue sarcoma (specifically, a hemangiopericytoma), grade III (the worst/highest/most malignant grade). He is only about 6 and has absolutely zero symptoms or pain, but the oncologist tells us that the median survival time for this type of cancer is 8 months. We don't know what to do next.
The surgery was successful in removing all the detectable cancer, but because of the location, it had what they call "narrow margins." The oncologist called this type of cancer "sneaky," and said that with surgical margins this narrow, there is almost certainly at least a little cancerous material left -- it tends to have roots, like mold. Between that and the high grade of the tumor, it's almost guaranteed that it will come back at the same site, at which point it's likely to spread very quickly to other areas that are untreatable (usually lungs). They did x-rays and it hasn't spread YET, though there could be cancerous cells elsewhere that are currently undetectable.
The oncologist essentially gave us four options:
1. Chemo. Apparently there's no evidence that chemo prolongs survival time with the type of cancer, but people sometimes choose it anyway to feel like they're doing whatever they can. Very well tolerated in dogs.
2. Radiation therapy at the site of the tumor. The goal would be to kill whatever cancerous cells might be lurking post-surgery, to decrease the chance of the tumor re-growing and then spreading. VERY expensive ($8,000 or more), and the closest facility that offers radiation is two hours away. We'd have to go there for treatment every single day for 3-4 weeks.
3. Amputation. Same goal as radiation -- get rid of all remaining cancer at the original site. "Affordable," as these things go, and would (obviously) ensure the tumor doesn't grow back. (They'd prefer to do a second surgery to get wider margins, but can't in our case because the tumor was right on the elbow and there's nowhere else to go. So wider margins = amputation.)
4. Do nothing, watch him closely, bring him in for chest x-rays every few months to monitor potential spread.
Apparently with treatment that's considered "aggressive," which would be radiation or amputation, the median survival time is potentially a year+. But all of the numbers we're getting are SO frustrating, because ultimately they don't really know a ton about this type of cancer and the studies that have been done were really small. Like, one paper says that tumors reoccur at the original site in 75% of dogs with a grade III sarcoma... but if you look at the actual data, it was 3 out of 4 dogs. So who even knows! The whole conversation feels a little bit like one giant shrug emoji.
We'd love to do the radiation, and we can technically afford it. But our dog is highly anxious, and he's pretty sure that being in the car is actual torture. He paces in the backseat, whines, cries, and is clearly super unhappy. We just don't think driving him four hours a day for 3-4 weeks is the right call (even if we could figure out the logistics, which would be complicated with us both working).
Given that, it seems like amputation is the best option. Dogs do well on three legs, we're told, and this guy is also totally, completely lazy. A ten-minute walk is the upper limit of what he's interested in doing, and he pretty much just wants to spend his life on the couch halfway in somebody's lap. So we wouldn't be robbing him of his favorite activities or anything. But still, it feels absolutely WILD to consider removing a leg from a young dog who at least SEEMS 100% healthy and happy. But that's just me projecting my own feelings onto him, right? And if it gains him any extra time at all, surely it's worth it?
I'm trying to write this clearly and concisely, but the truth is we're just absolutely gutted. Exactly one year ago literally TODAY, we had our previous dog (a greyhound) put down because he had really aggressive bone cancer. We got our current guy just a few months later, and he's been such an unbelievable joy. He was very obviously abused in his former life -- he cowers if you pick up a broom or gesticulate too wildly, and the vet found BB pellets embedded under his skin when they did chest x-rays recently. But even after all that, he's the sweetest, most cuddly dog I've ever met. All he wants is love, and it breaks my heart that he had so many bad years and now will likely only get a couple of good ones.
I'm sorry, I realize most of this is not really a question. So I guess -- has anyone else dealt with this kind of cancer before? And what would you do here? |
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