Multiple Neoplasia Survivor
Jake is a very sweet, 13 year-old, MN, golden retriever who has survived multiple surgeries, radiation, and chemotherapy for several different tumors. Five years ago Jake was treated for sarcoma on his left shoulder with surgery followed by radiation at the University of Missouri. He presented to Iowa Veterinary Specialties in September of 2012 for elevated liver enzymes. An abdominal ultrasound was performed at that time and revealed multiple lesions within the liver and spleen and very slight lymph node enlargement but chest radiographs did not show any evidence of metastasis. Because of his breed and the concern for cancer of the spleen, Jake was transferred to our surgical department for exploratory abdominal surgery with Dr. Krebs. Liver biopsies and a splenectomy were performed, and the histopathology results showed a fibrohistiocytic nodule in the spleen, a benign condition. Liver and lymph node biopsies also showed no cancerous cells. Jake recovered well after his surgery and did great at home!
In January of 2013, Jake came back for a recheck ultrasound. The ultrasound did not reveal any new findings, but the lesions in the liver and the mild lymph node enlargement were still present. Cytology was performed and revealed no evidence of cancer. Dr. Olsen recommended rechecking another ultrasound in 3-6 months to monitor the liver and lymph nodes. Jake did great at home and came back for a recheck in June with Dr. Olsen. Radiographs of the chest were performed before the other recheck diagnostics and revealed a single nodule (3.2 cm) present within the left cranial lung lobe. Dr. Olsen suspected metastatic disease and transferred Jake to Dr. Fox in our oncology department.
During his consult with Dr. Fox, an 8mm anal sac mass that had not previously been present was also found. Aspirates of the anal sac mass and lung nodule were taken and revealed anal sac adenocarcinoma with metastasis to the lungs. Surgical and chemotherapy options were discussed with the owners and they elected to continue with surgery. Dr. Zimmerman-Pope performed a left anal sacculectomy in July, which was submitted for histopathology and confirmed the tentative diagnosis of anal sac adenocarcinoma. A week later Jake had a CT scan performed at Iowa State University to investigate the possibility of any further nodules in the lungs. The chest CT showed no further lung nodules, and Dr. Krebs performed a thoracoscopically assisted partial lung lobectomy of the left cranial lobe. A small (5 cm) thoracotomy was performed under thoracoscopic guidance, and the lung nodule was removed with normal appearing surrounding lung tissue suggesting clear surgical margins. A chest tube was also placed to monitor the accumulation of any air or fluid. Jake recovered well after surgery and his chest tube was removed the next day. He was hospitalized after surgery and looked great when he went home! The histopathology of the lung nodule confirmed metastasis from the anal gland tumor and was evaluated as having clear margins. Jake will be following up with Dr. Fox for chemotherapy treatment.
Jake is doing well and is a happy dog despite his bouts with cancer and multiple surgeries. His quality of life appears to be excellent and he recovered quickly from his chest surgery. Hospitalization following open chest surgery is often needed for several days with IV pain medications. Performing minimally invasive surgery such as the thoracoscopically assisted lung lobectomy tends to lead to shorter recovery and improved post-operative comfort following surgery.
Anal gland and sac adenocarcinoma is a treatable cancer that often allows long survival with an excellent quality of life if treated aggressively. With this tumor, surgical treatment can be rewarding even if lymph node or lung metastasis is present.
Jake is a testament to the resilience of dogs and continues to live a happy life because of his owners’ commendable commitment to his well-being. He continues to fight another day and the members of the Iowa Veterinary Specialties internal medicine, surgery, and oncology service are all closely watching his recovery and further treatment.
Published on October 4, 2016