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Liver cancer questions.

Species: Dog
Breed: shepard, akita, pit
Age: 11-15 years
My dog Penny was on trilo for Cushings - Dec 2010- then she went into Addisons went off trilo and has been off since Sept 2011 - had 2 knees done ACLs and has arthritis and lumbar issues - cushings didnt seem to come back or adrenal glands were damaged - now Pennys blood levels are extremely high such as
AST 91
ALT- sgpt 672
ALK 7399
GGPT 28
ALP 2400
AMY 852
GLU 122
T4 <0.5
ALT 372

Liver u/s
Liver large pedunculated hyperechoic mass with anechoic regions extending from caudal aspect of liver to central adbomen, measuring 12 cm, rest of liver mottled and coarse -
Kidneys Isoechoic cortices versus the spleen
Spleen Normal
Assessment - large caudal liver mass lesiion, neoplasis is suspected. Remainter of epatic changes consistent with chronic inflammation and fibrosis.

Penny is 12...she has been on Rimadyl for a long time-without it she cannot walk...also on dasaquin - adequan shots - not vet put her on liver support meds -- denamarin and Ursodiol - wanted to do biopsy - finically is is hard - so they are saying they strongly feel yes its cancer and if it is what can they do - I wont do chemo and can she possibly go thru an operation - and she has a broken upper canine tooth that is scheduled to come out this thursday - one vet said to it the other said she would wait - ?? she already had to other canine out -
Oral slab fracture of lateral aspect of R canine. small amount of pulp cavity exposure at distal aspect of fracture but not further up fracture. Painful at distal aspect. Gingival tissue looks healty tooth color still normal - not obviously infected at this point -
Surgery or not? Do you think she has much time?? She eats very good - asking for treats - has energy burst - seems alittle more tire - so confused - what are your thought---thank you

Cindy


Online vet, Dr. Marie

Dr. Marie replied:

Oh dear. It sounds like Penny (and you) have been through a lot!

Those liver enzymes have me very concerned as most of them are quite high. The ultrasound results have me worried as well. I'll explain some of the "medical speak" for you.

Regarding the liver they are seeing a large 12cm area that is much more dense than the rest of the liver. This almost always means cancer, unfortunately. The mottling on the rest of liver may mean that there are other smaller cancerous areas as well. Or, it can mean that there is inflammation in the liver, but then the question is why.

You're right in mentioning that the medicines she is on are expensive. As well, there is a concern because Rimadyl is processed through the liver. So, if the liver is struggling (i.e. because of cancer) this can make things worse. But, as you mentioned, without the Rimadyl, she is in pain.

It's really hard to advise you on the canine tooth, especially considering that you have two different opinions from two different vets. If a canine tooth is fractured, it's often hard to no whether or not the tooth is painful to the dog. Dogs aren't wimpy like people. They really don't do anything to show us pain. With that being said, if the vet feels the tooth is painful at the end, then there likely is some discomfort there.

Removing a fractured canine tooth is a major surgery. It usually takes a good amount of time and as you are likely aware, can be expensive.

It is really hard to advise you on what to do here! Let me lay out the pros and cons of removing the tooth and hopefully that will help with your decision.

Pros:
  • She won't have dental pain during the time she has left with us.

Cons:
  • Expensive

  • The anesthetic could be a risk. Most drugs have to be processed through the liver and we know that the liver is diseased.

  • We don't know how much time she has left. It is possible that we do the surgery, spend the money and remove the tooth all very successfully, and she could possibly succumb to liver cancer a week later.



Now, keep in mind that it is hard for me to advise without being able to examine Penny. But, if one of the vets is saying that it may be ok to leave the tooth then I would tend to agree that this would be the better decision.

If there is liver cancer (which it really sounds like there is), there is a chance that we do not have much time left with Penny.

I hope that helps with your decision. Let me know if you have more questions.



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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

its hard cause I do not know how much pain she is in with her tooth - its a difficult decision - if I knew how long she had it would help to make the decision - if it was 6months or ?? I would want it out so she is painless - but if it is a week or ?? is it worth it?? What are the odds of a dog living for awhile like this?? do you think this is all from the Rimadyl or the cushings?? She is so full of energy - yes gets tired - but is happy - wants to eat - so its do hard to make a decsion on anything - the liver meds she is on - again any benifit from them?


Online vet, Dr. Marie

Dr. Marie replied:

I face tough decisions like this every day. It is so hard to determine how long an animal has. And you're right...if we could tell how long she was going to live, then it would be so much easier to make decisions like this.

Has your vet talked at all about doing a biopsy of the liver mass? If we knew what type of cancer was present then this could give us more information on how much time we had left. Most of the time a biopsy can be done with mild sedation.

I don't think the liver cancer is because of either the Rimadyl or the cushing's. While both Rimadyl and cushing's can cause an increase in liver enzymes, neither of them would cause a mass in the liver. Usually we don't know the cause of liver cancer. It's just one of those things that just happens.

I would definitely recommend to stay on the liver drugs. At this point, they can only help. The blood tells us that we have a significantly injured liver and so, anything we can do to support the liver is good.



Customer reply:

yes they mentioned a biopsy at $900 which I cannot do - and if I do it all it will really tell us is which cancer and and idea of how long we have - nothing will change that it is cancer - so by how she is acting now - eating alot - and being very alert and active doesnt help much? things could change in a day??


Online vet, Dr. Marie

Dr. Marie replied:

My experience with liver cancer is that animals do extremely well (and owners have a hard time believing the diagnosis). And then, one day they eat a little less than normal and are a little quiet. And then within the next few days things progress quickly. At this point it becomes obvious that the time for euthanasia has arrived.

Most of the time I find that most pet owners know quite easily when the time has come.

The problem is that no one can tell you how much time to expect. From what you have told me I think 6 months would be very optimistic.



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

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