If you were just told that your dog has a mass in the spleen, you need to watch this video. No, not every mass in the spleen is hemangiosarcoma. No, we cannot …
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– Hey everyone, I'm Dr. Sue, Cancer Vet.
Welcome back to the vlog.
If this is your first
one with me, welcome.
If you are returning, thanks
so much for joining me again.
Today is going to be a three-part series
all about splenic tumors,
so masses in the spleen.
And that can be a tough one because often,
if you're told that your dog
has a mass in the spleen,
we often don't know what it
is until we go to surgery.
So there's so much information
from me to break down,
that I'm breaking it into three parts.
So let's kinda highlight
what we're gonna talk about
in the three parts, and then
we're gonna dive into this one.
So, in the first one,
we're gonna do an overview.
I really want you to know, not every mass
on the spleen is hemangiosarcoma.
It's definitely the most common one,
but all masses in the spleen
are not hemangiosarcoma.
So we're gonna talk about the 2/3 rule
and what some of those other masses are.
And when can we be more suspicious
that it might be hemangiosarcoma?
And when we might be less suspicious
that it's hemangiosarcoma.
But ultimately guys, we don't
know until we take our dogs
to surgery, what that
mass on the spleen is.
And that's really frustrating.
So we're gonna talk about that.
In part two, we're gonna
talk about hemangiosarcoma
which is the most common malignant tumor
that we see in the spleen, and we're gonna
break that all down for you.
In part three, we're
gonna talk about treatment
and prognosis for hemangiosarcoma.
So three parts, let's
break it down, let's do it.
All right, I have a couple of tips for you
when it comes to masses in the spleen.
So, as I mentioned in the introduction,
often a mass in the spleen, it's hard.
So I you know me, and
anything about my lumps
and bumps program, I'm a
big advocate of finding out
what a mass is before we go to surgery.
And the hard thing about
these masses in the spleen
is that we're often have to take our pets
to surgery to find out what they are.
And all to often, I hear,
it's hemangiosarcoma.
It's not worth going to surgery.
And I want to dispel that myth.
So I have a couple of
tips and tricks for you.
So number one guys, all masses
in the spleen are not hemangiosarcoma.
Number two, if your dog has an ultrasound
and they see nodules in the liver,
we can't automatically,
based on appearance
of those nodules, say it's
metastatic hemangiosarcoma
or hemangiosarcoma that
has spread to the liver.
Just like that primary mass in the spleen,
we're often gonna have to go to surgery
and get biopsies of that.
Even the surgeon, your
veterinarian at surgery,
cannot tell with their
eyes what those masses are.
So nodules in the liver
and the spleen at surgery,
we can't tell the hemangiosarcoma
that has spread or metastasis.
Another myth out there
about hemangiosarcoma
is that if there's a
large mass in the spleen
or the liver, it automatically
means that it's malignant.
And that's not true and
there are studies that show
that often the large
masses are the benign ones.
So again, you don't wanna
make a life or death situation
based on the size of a mass.
So just because it's a
big mass, does not mean
that it's malignant hemangiosarcoma
in your dog's spleen.
There is a study that came out
in the last couple of years
that says that incidental masses
in the spleen are more likely benign.
What do I mean by incidental?
We'll go through this a little bit later,
but that means if your
dog's getting an ultrasound
for something else and
they happen to find a mass
in the spleen, that is
gonna be less likely
to be hemangiosarcoma than some
of these other masses in the spleen.
And the other thing I really
want you to know guys,
is hemangiosarcoma is a treatable cancer.
It's still a tough cancer, you know,
when we look at the
survival times with surgery
and with chemotherapy,
they're not as good as,
I'll be honest, as other
cancers like osteosarcoma
and lymphoma and mast cell tumors.
But we do improve survival
times with treatment,
but it's still a tough cancer.
And we need better treatment options,
and I'm excited that there
are some new therapies
out there being studied.
We don't have a cure for it,
but it is a treatable cancer.
So that's what we're gonna
break down in this first video
and the upcoming two videos,
so let's start to do it.
So I keep saying it's not
always hemangiosarcoma.
Do I have the facts to back that up?
I do guys.
So there's something
called the double 2/3 rule
for masses in the spleen,
what do we mean by that?
If a dog has a mass in the spleen,
2/3 of them are malignant.
And of those malignant ones,
2/3 of them are hemangiosarcoma.
And so, 2/3 of 2/3 is about 44%.
So to simplify it, in
general, about 50% of dogs
with a mass in the spleen are
going to be hemangiosarcoma.
So again, 2/3 are malignant
and of the malignant ones,
2/3 of those are hemangiosarcoma.
And again, 1/3 of those
are going to be benign.
So we're gonna talk more
about hemangiosarcoma
in part two of this, but
I know a lot of people
are watching this and it
is the most common one,
so I do think it's worth just touching on
some of the key points of hemangiosarcoma.
Again, it's not the only tumor
that we see in the spleen.
If your dog has a mass in the spleen,
it's definitely the most common.
It's as we say, it's locally aggressive,
so it's really aggressive,
it's gonna start to grow
pretty quickly in the spleen,
and highly metastatic.
So it gets into the bloodstream
and will spread to other organs.
So the liver and the lungs are the two
most common places that it spreads.
So, the other problem with this tumor
is that it's a tumor of blood vessels.
So often, these tumors are very cavitated
and filled with little chambers of blood
and these can rupture and in part two,
when we talk about the
symptoms that these dogs have,
the reason that this is
such a devastating cancer
for so many owners is often the first time
that we find out that our
pet has hemangiosarcoma
is when it ruptures and
they have something called,
a hemoabdomen, where they're
bleeding into their belly.
So even though we don't see them bleeding,
they're collapsing because
they're losing that blood
out of their bloodstream
into their abdomen.
The hard part, the frustrating
part for pet owners is
we don't know the prognosis for a dog
with a splenic mass until
we take them to surgery
and we get back that biopsy,
which can often take,
you know, three to five to
seven days, up to a week.
And that's when we know the diagnosis
and that's when we know the prognosis.
And as I mentioned in the introduction,
the size, what it looks like at surgery,
what it looks like on ultrasound
are not gonna be good
indicators that your dog
has hemangiosarcoma or something benign.
Treated dogs do live
longer than untreated dogs.
But one year survival
rates are still very low
compared to some of the
other more common cancers
like lymphoma and osteosarcoma,
whether median survival
times are often a year.
So they do live longer with treatment,
but the one year survival rates
are very frustratingly low.
Both as an oncologist and a pet owner,
I agree that the one year
survival rates are very low.
Okay, so let's talk about
some of the other masses
that we do find in the spleen.
So I said 1/3 of the masses are benign.
That would be great, those are some
of my favorite phone calls to make.
So there are noncancerous masses
that we see in the spleen.
That could be a hematoma, or
that could just be an abcess.
Sometimes we just see something
called nodular hyperplasia.
That would be something
else that's benign.
But we could see granulomas
in the spleen as well.
So these are all noncancerous things
that we see in the spleen.
There's also a benign
tumor called hemangioma.
So again, those typically
make up for about 1/3 of the
nonmalignant masses that
we see in the spleen.
Okay, we said 2/3 of the masses
that we see in the spleen
are malignant, but they're
not all hemangiosarcoma.
They're not all made of blood vessels.
So what are the other tumors
that we see in the spleen?
And I do get a lot of
messages from pet owners
who have less, their pets
have less common tumors
that they're often frustrated
that they can't find
a lot of information on the internet
or on YouTube or on my YouTube channel.
So I am gonna spend a
few minutes going through
some of the other malignant tumors
that we see in the spleen.
We have lots of blood
vessels in the spleen,
so when they become malignant,
that's hemangiosarcoma.
We have lymphoid cells
so we can get lymphoma.
There are normal mast cells,
so those are inflammatory cells
so you can get mast cell
tumor in the spleen.
There's a lot of connective tissue
that holds the spleen together.
When that becomes malignant,
you can have something
called a fibrosarcoma or some of those
other connective tissue cancers.
And then there's smooth muscle that helps
the spleen contract, and
when that becomes malignant,
there's quite a mouthful,
it's called a leimyosarcoma.
Osteosarcoma I've seen
in the spleen as well.
So extraskeletal, outside
of the skeletal system,
osteosarcoma as well.
And then sometimes we see something called
undifferentiated sarcomas as well.
So you would think, well
these must be better, right?
Than hemangiosarcoma
'cause that's the worst.
They can be better, but
often a lot of these dogs
getting them out to the
one year anniversary
can be a challenge as well.
Tumors like leimyosarcoma,
the smooth muscle
malignant tumors do also have
a very high metastatic rate.
So after the spleen is
removed, after splenectomy,
I do recommend chemotherapy.
I definitely have dogs
that get to the one year
anniversary, but it's not like, ooh,
they're super fantastic,
better than hemangiosarcoma.
They can still, they still are aggressive
and they still typically are going
to require chemotherapy afterwards.
Lymphoma is gonna be one
that we're definitely
gonna recommend chemo and
mast cell tumors as well,
are gonna be ones that we're gonna
recommend chemotherapy as well.
Another one that we often
see involving the spleen
that can have that sort
of mass-like appearance,
but often moldable masses would
be malignant histiocytosis
which is a cancer that is often, we see
more commonly in Bernese
Mountain dogs and Rottweilers,
but often multicentric, so
we see in multiple organs
like the liver and the lungs.
Sometimes the spleen and some other organs
like that as well
including the bone marrow,
sometimes the skin as well.
So again, there are
other malignant cancers
that we see in the spleen,
but we're gonna spend
most of our time talking about
hemangiosarcoma in the next part.
Before we get to that, I am gonna mention
in this video, some of
the symptoms that we see
because I think that's really important,
whether it's hemangiosarcoma
or any of the splenic masses.
So let's talk about some of the symptoms
that you may see with a
dog with a splenic mass.
So what do we typically see with a dog
that has a splenic mass,
whether it's hemangiosarcoma,
something benign, or one of
the other malignant tumors
that we talked about?
It can really vary, and that's, again,
one of the challenging
things with these dogs
with masses in the spleen.
So sometimes they're gonna
be vague and nonspecific
and you're gonna be
shocked to find out that
your dog has a mass in its spleen.
Sometimes their abdomen will be distended
or enlarged, they're not eating that well,
they can be tired, depressed, weak,
sometimes even some vomiting and diarrhea,
and then sometimes, as I mentioned,
they're bleeding into their belly,
and they're bleeding into their abdomen
so it can be really, really dramatic.
They can collapse,
their gums can be white,
and they can be in something
called hypovolemic shock,
and that's because,
again, they're bleeding
into their abdomen and
they lose that blood
from their blood vessels,
from their vascular system.
So, again, it can be really dramatic from
just not eating so well,
to hypovolemic shock
and they need to go in on emergency.
The other interesting thing
with some of these dogs
with bleeding masses is
sometime they're bleeding
very slowly and they'll bleed a little
and the dogs will actually
absorb that blood,
so they auto-transfuse themselves,
and so sometimes the owners will look back
and say "You know, a couple of weeks ago
"Duke was a little bit
off for a couple of days,
"seemed kind of sluggish and tired
"and then kind of perked back up,"
and sometimes we will
run blood work and we'll
see that their anemia is regenerative and
they're showing signs
that they had an episode
where they were anemic but they're making
more red blood cells.
So again, sometimes if
they have a slow bleed
and they can absorb that
blood and transfuse themselves
it's better but it's when they have a big,
dramatic rupture of that splenic mass
and they're bleeding so
much that they can't absorb
it that quickly, that's
when they're gonna need
to go to the doctor, to the veterinarian,
and often it's on
emergency, and then things
get really accelerated quite quickly.
When you go in on, you
know, to your veterinarian
whether it's during regular office hours
or if you have to go to
the emergency clinic,
your veterinarian, the ER
doctor, often they'll feel
the abdomen, sometimes
they're gonna be able
to feel a big spleen, they
may be able to support that
with radiographs, x-rays, an ultrasound
is definitely preferable
as we'll talk about
a little bit more in part two.
There is, you know, we were talking about
in the beginning of
this video when can you
raise your index of suspicion that
that mass in the spleen is
hemangio versus something else.
There was a study,
'member, I said it's about
a 50-50 split, right?
Two thirds of two thirds is about 45%,
and studies do show
that about 45 to 60, 65%
of dogs with a mass in
the spleen are hemangio.
But, if your dog is
bleeding into their abdomen,
again that's called a hemoabdomen,
and no history of trauma,
so they weren't hit
by a car or anything like
that, it actually goes up
to 80 to about 85% that
it's gonna be malignant
and hemangiosarcoma, so again, that's why
emergency vets that I know work with say,
"Uh, a dog with a splenic
mass that comes in
"on the ER is always hemangiosarcoma,"
'cause they're usually seeing the dogs
with the ruptured splenic mass,
so that does have a
greater likelihood of being
hemangiosarcoma versus
an incidental mass found
in the spleen, or a non-bleeding
mass found in the spleen,
which could be one of the other tumors
we talked about, hemangioma,
or maybe one third
of the benign things that we talked about.
So, again, you're still not gonna know
until we go to surgery.
So, they're tough cancers,
they really, really are,
'cause again one of the take home messages
I really want you to
know from this part one
is it's not always hemangiosarcoma,
you're gonna need to go
to surgery to ultimately
know what the diagnosis is for your dog.
But I do hope that you found this helpful,
please come back for
part two where we'll be
focusing on the different tests
in a little bit more detailed,
in-depth dive into hemangiosarcoma,
we'll be talking about
some of the tests that you're going to be
discussing with your veterinarian,
what we commonly see on those tests,
which are the ones that you definitely
want to do before surgery
and which are the ones
that you can probably
decline, especially if
you're working on a budget,
and then in part three
we're gonna talk about
treatment beyond surgery,
we'll talk about some
supplements that have
some interesting studies
on them, and some new
treatment options and
studies that are in the works
which I'm really, really excited about.
And the prognosis as well.
So come on back for
part two and part three,
please leave comments,
did you find this helpful?
What have been your
experience with this cancer?
I know it's a tough
cancer, it sucks, it does,
but again, I'm here to
give you options, and hope,
and I hope that you found this helpful.
Please come on back for the next video,
thanks for watching.
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