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Healing & Alternative Health
Dr. Carson's Holistic Animal Care:
SIGNS OF AGING IN THE DOG AND CAT, PART XXIX:
Organs of Reproduction: Mammary Gland Cancer: Diagnosis & Treatment
by Kathleen M. Carson, D.V.M |
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If you find a lump or lumps in your dog or cat’s mammary glands (MGs) and bring your animal to your veterinarian, how does he or she determine if your animal has mammary gland cancer (MGC) or not?
Your veterinarian will first ask you several questions. If you report that the mass(es) has/have grown rapidly or have multiplied, or if you’ve noted ulceration over/around the lumps, or any blood-tinged discharge coming from the lump(s), your veterinarian will be very suspicious of MGC.
She’ll next do a complete physical examination. Part of this exam, of course, will be to take a visual view and palpation (feeling with her fingers) of the lump(s) [aka mass(es)].
Your veterinarian will be looking/feeling for several things: she’ll feel to determine the number of the MG mass(es); she’ll also want to measure the size of each mass. Remember that last month we said that benign tumors are more likely to be smaller and fewer. The size of the tumor(s) plays an important role in determining the prognosis (eventual outcome) for your pet if it turns out the masses are malignant. (The smaller the tumor, the better the prognosis; the larger the tumor, the poorer the prognosis.)
She’ll also check to see if the mass(es) have distinct or diffuse borders, and whether they adhere to the tissues underneath. Benign tumors are much more likely to be small and few in number, with distinct borders, and they move freely in the surrounding tissues. On the other hand, malignant tumors are more likely to be larger and more numerous, with more diffuse borders, and they’re more likely to adhere to the tissues under them.
Your veterinarian also will check for any fluid or blood draining from the mass(es) and whether there is ulceration over and/or around the mass(es). Both these will make your veterinarian suspicious of malignancy.
Next, your veterinarian will palpate the lymph nodes which are in your animal’s axillae (“armpits”) and inguinal areas (groin). MG cancers spread via the lymph system. MGs #1, 2, and 3 (starting at the front end of your animal) drain to the axillary lymph node on their same side, and MGs #4 and 5 drain to the inguinal node on their same side. [This pattern of drainage is true for the majority of animals, but there can be exceptions: in some animals, MG #4 also drains to the axillary node; in others, MG #2 and 3 also drain to the inguinal node. There also can be some crossover from one chain of MGs to the chain on the other side, thus spreading the tumor(s) across the midline.]
What happens next? Since canine and feline mammary masses are approached somewhat differently, I’m going to first discuss the situation with dogs, then cats.
Dogs
Your vet will do a fine needle aspiration (FNA) of the MG masses and possibly the associated lymph node(s) of your dog. A FNA is usually not sufficient to accurately tell whether a mammary mass or node is benign or malignant, but it is useful in determining if the lump is some other type of tumor, like a mast cell tumor, or whether it is a primary inflammatory lesion. (To further confuse the picture, multiple mammary tumors may be of different histologic type and of varying degrees of malignancy within the same patient, so the FNA results may vary according to where she aspirated her samples of tissue.)
Your veterinarian also will want to do some blood and urine tests to get an idea of the general state of your dog’s health, in part to determine if he/she can tolerate surgery(ies). She will also want to take some thoracic radiographs (chest X-rays), since, if the mammary masses are malignant, one of the first places they spread is to the lungs. These radiographs can also give your veterinarian some information about the health of the organs of the thoracic cavity: heart, lungs, trachea, esophagus, and major blood vessels such as the aorta. This information will also help your veterinarian to judge whether your animal is a good surgical candidate.
If your animal’s inguinal node(s) are large or feel otherwise abnormal, then your veterinarian may want to do radiographs and/or ultrasound of her posterior abdomen, looking for enlarged sublumbar nodes, which are under the spine; this enlargement, if present, is a sign that the cancer has spread into your dog’s abdominal cavity.
If metastatic masses are found in the lungs, and/or the sublumbar lymph nodes are enlarged, it may be too late to do surgery, since surgery is done to (hopefully) prevent the spread of the cancer from the local area(s). However, if the masses are causing your animal a great deal of discomfort or pain, surgery may be done to give temporary relief and to increase your animal’s longevity by at least a bit.
If no lung metastases or enlarged sublumbar nodes are found, then the next step would be one of these: if the masses are small, movable, and not fast-growing, what’s called an excisional biopsy will probably be done. This procedure consists of removing part of several of the mammary lumps without attempting to remove entire mammary gland(s). If the biopsy (histopathology) report shows signs of malignancy, then more extensive surgery, including removal of the associated lymph node(s) would be the next step after that.
On the other hand, if the tumors are large, fast-growing, ulcerated, and/or draining, the excisional biopsy will probably be skipped, and a wider, more extensive surgery will be performed.
Surgical excision is the best treatment for malignant mammary tumors. It is curative in 50% of the cases. The type and extent of surgery depends on how malignant the tumor(s) appear to be. It ranges from 1.) what is called a lumpectomy, where just the mass itself is removed; through 2.) a simple mastectomy, where the whole affected mammary gland plus regional lymphatics and lymph node are removed; to 3.) a regional mastectomy, where the affected gland plus adjacent glands, lymphatics, and nodes are removed (depending on where the mass is, this usually is MGs #1, 2, and 3 plus the axillary node, or MGs #4 and 5 plus the inguinal node); to 4.) a unilateral mastectomy, where the entire chain of 5 MGs on one side plus their associated nodes, are removed; to 5.) a bilateral or radical mastectomy is performed, where all the MGs from both sides plus their associated nodes are removed. This surgery could also include removal of some of the muscle underneath a mass if the mass has adhered to that tissue.
Cats
A complete physical examination and a pre-surgical workup, including blood and urine tests, thoracic radiographs, and possible abdominal ultrasound will be done just like it is in dogs.
FNAs are recommended in cats only to see if other disease(s) are causing the lump(s). They will not differentiate between benign and malignant tumors.
Since 85% of feline mammary tumors are malignant, the surgical approach is more aggressive in this species. Excisional biopsies are not recommended; radical mastectomy, or removal of the entire chain of 5 MGs and some of the surrounding tissue, is the surgery which is usually recommended. If cancerous tumors are in MGs in both the right and left mammary chains, usually one chain will be removed at a time, since, with the wide margins of the surgery, there wouldn’t be enough tissue left to to pull the surgical margins together after the masses and associated tissues are removed. If a cat is not a good surgical candidate for a lengthy, aggressive surgery, or if the tumors are very small and mobile, a more conservative surgery may be performed to buy the cat a little more time and to relief discomfort if a tumor is ulcerated or draining.
Of course, in both dogs and cats, biopsies of removed tissues are sent to a veterinary pathologist for histopathological evaluation to determine 1.) if the tumors are malignant, and, if so, what type of cancer(s) are involved. The most common type of MGC is what’s called adenocarcinoma; as nasty as it is, it is the least malignant of MGCs. The other possible types of MGC are ductular carcinoma, carcinosarcoma (mixed), and inflammatory carcinoma. These last 3 MGCs are listed in the ascending order of malignancy. However, the degree of invasion of surrounding tissues by the cancerous tumors may be more important than histopathological type in determining prognosis.
Interestingly enough, mammary tumors in dogs may include tissues which contain cartilage or bone; this would come about if the original mammary gland cells mutate into cartilaginous or bony cells!
Chemotherapy or hormone therapy is given to some patients post-surgically, especially if only partial removal of the tumors/MGs was done, or if the cancer is a very aggressive type. Some patients respond to these kinds of therapeutic agents. At this point, exact, time-tested protocols for these types of treatment have not been established. Consultation with a veterinary oncologist would be highly recommended in determining what is best for your dog or cat.
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Dr. Kathleen Carson, DVM
Veterinarian & Author
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Dr. Carson received her Doctor of Veterinary Medicine degree from the University of California at Davis in 1968. She's been a small animal practitioner (dogs and cats ) for all the years since, except for a short stint at the San Diego Zoo when she first graduated.
She belongs to the American Veterinary Medical Association and the American Holistic Veterinary Medical Association.
Since 1974 she's lived and practiced in the South Bay Area near Los Angeles. She started the area's first house call practice in 1976 and the first pet crisis/loss group in 1989. The human-animal bond is of special interest to her.
She started exploring complementary veterinary medicine in 1987. Her practice became 100% holistic in 1996. She utilizes acupuncture, herbs, supplements, Bach Flower Remedies, homeopathic remedies, nutrition and medications for her patients in her practice.
She's currently taking a leave of absence from her house call practice due to health reasons but continues to do phone consultations and to write.
E-mail:
Critterhlr@aol.com
website:
http://www.holistic
vetconsult.com
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