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Hey Frankie- an article about mast cell tumours

It is safe to say that Frankie’s owners are some of my favourites. Over the last couple of years I’ve mostly seen them with a very dignified and sweet-natured flat coat retriever called George. Very sadly some months ago he lost his long-standing and very stoic battle with a slow-growing liver tumour and had to be put to sleep.

A couple of weeks ago it was my turn to see their other dog, Frankie. Frankie is a nine year-old golden retriever and her owner had become concerned about some rather large lumps and bumps that had been growing very slowly for some months. This is a pretty common scenario in many older dogs and by far the most common cause is a lipoma. These are fatty deposits under the skin and are usually smooth, round, non-painful and often nothing at all to worry about unless they grow to a size that makes them an encumbrance.

Frankie had three lumps of varying sizes but they didn’t really feel very typical of lipomas because there seemed to be involvement of the skin, which is unheard of with fatty lumps. None of the lumps had grown quickly or seemed to be painful or ulcerating but one on her back leg was a size that was going to start to become very difficult to remove. We decided the best thing to do would be to have her in and deal with all three at the same time.

The surgery was quite lengthy simply because of the size and positions of the three masses; one big one on the hind leg, a smaller one inside the same leg and a medium-sized mass on the opposite shoulder area. All the lumps came away well from the underlying tissue and did not seem to be infiltrating aggressively into the surrounding tissues. It can be quite a hard decision to make with such lumps because of the inherent, although small, risk of anaesthesia and the fact that obviously we don’t want to put dogs through surgery without good cause. Owners are also often reluctant to put their animal at risk for something that may seem quite trivial in its apparent effect on their pet. One of Frankie’s owners is a human oncologist (cancer specialist) and this makes them very aware of the possibility of tumours. I think it was also fresh in their minds having recently lost George.

We sent both the small masses away and, because of the size of the other, half of that one. It is always very useful and often important to send such lumps away for analysis even when you may feel that it is of little use in apparently innocent looking lumps. In this case I was very keen to do this because the lumps were not typical of most we see. I hoped they would turn out to be cysts but the appearance when we cut the large one open was not highly supportive of that.

Having analysis done tells us a number of things. Not only can you find out exactly what the lump is but you can be sure of whether the whole thing has been successfully removed and get an idea of what sort of outlook the dog has in the case of cancer and also decide if any further surgical or medical treatment is necessary. It can be extremely hard or impossible to be sure by looking that you have removed a whole tumour. This is because some locally invasive tumours will have microscopic seeding of cancerous cells into the surrounding tissues that are invisible to the naked eye.

To be honest I wasn’t really too concerned about Frankie’s lumps so was, not-surprisingly, upset to see the report when it returned. All three lumps were mast cell tumours. Mast cell tumours can be extremely aggressive, spread internally and the worst ones can kill within months of diagnosis. It seemed so unfair after losing George.

They are a mass in which it is absolutely essential to have them analysed because they are a tumour which needs to be graded on how aggressive they are. The grade has a massive impact on the need for further treatment and also life-expectancy. Grade 3 are the worst cases and require massively wide excisions in all directions, which alone can be difficult to achieve in some areas. These cases also do best with either radiotherapy or chemotherapy after the surgery because of the high likelihood of spread within the body. The average survival time even with these measures is often not good. At the other end of the spectrum are the grade 1 tumours. These can be cured with surgical removal and are not very likely to spread inside but do need to be carefully monitored. Most mast cell tumours are single masses but in 6% of cases and in Frankie’s case they can be multiple. This can mean they have come from a single one and spread but can also be separately arising lumps that are unrelated.

If ever there was a silver lining, this was one of them. Frankie’s report said all three masses were grade 1 and the two that we had sent intact had been completely removed, with no way to tell with the third. So what does the future hold? We will take some more bloods to check for any signs of internal problems and we will watch with hawk eyes for any regrowth where they were before. She will also have her regional lymph nodes checked regularly to feel for enlargement. There is also the possibility of xrays of the chest and abdomen and even ultrasound to be as sure as possible that there are no internal masses but this isn’t really needed at this time. Although she’s been unlucky, she’s been luckier than some and it certainly could have been a whole lot worse.

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