Too Old for Tumor Surgery?

This is Ling Ling. She’s some kind of a Collie mix, or something.  Sweet dog.  Her picture here was taken a few years ago to illustrate her owner’s great idea for bandaging the elbow.  Who doesn’t have old socks lying around?  I use this technique all the time now.

Last summer, she came in for her checkup in July at the tender age of 15 years.  She had developed a large tumor in front of her left shoulder.  It was about 6 inches long, 3 inches wide and 1&1/2 inches thick, which is pretty big, even for a 57 pound dog.  We did a fine-needle-aspiration to get some cells for examination and it turned out to be a lipoma.  Lipomas are benign tumors of fat cells.  They aren’t usually invasive, nor do they spread to other organs.  Really, they are usually more of a cosmetic problem than a medical problem.  Unless they get big enough to be uncomfortable, that is. 

Ling Ling was so elderly and the tumor was large enough to require a fairly lengthy surgery, and it didn’t seem to be bothering her.  We decided it was something she would probably die with, instead of something that she would die from.

Fast forward to May of this year.  Ling Ling doesn’t feel so well.  She has lost weight and gets around slowly. Her tumor, on the other hand, has been doing great.  It’s up to 10 inches long, 5 inches wide and 6 inches thick now.  Unfortunately, the tumor is not only making Ling Ling feel bad, it’s making the tumor feel bad.  It has grown so much that it appears to have disrupted its own blood supply. There is a rather nasty-looking bulge that looks like it will soon die and rot and burst open.  Not so good.

Well, the tumor did get a lot bigger, and Ling Ling did not get any younger.  In retrospect, it seems that we should have done surgery last July.  But… but… she was so old, and… it didn’t seem to be bothering her.

This reminds me a little of my wonderful Granny.  She developed a hernia when she was 70 years old.  They told her she was too old to have it repaired.  She lived to be 93.  Still too old to have it repaired.  My granny lived with a hernia for 23 years.  That doesn’t sound like fun, does it?

Ling Ling has an amazing constitution (meaning she is one tough old dog), and she has a very dedicated owner (also one tough old dog).  We did everything we knew how to do to support her, and she made it through 90 minutes of surgery like a champ.  The tumor was so big it was like delivering a baby.  It  weighed 3 pounds, and was as big as her head.  I’m not sure how that fits with the rule of “Never eat anything bigger than your head”, but there must be some kind of correlation if we think hard enough.

The mass had disrupted the attachment of some of her shoulder muscles.  I re-attached them as best I could, but this meant that she required immobilization of the leg for a couple of weeks.  With the huge pocket created by the tumor’s removal, we also had to do a lot of bandaging to deal with the fluid drainage.  Fortunately, Ling Ling is not only tough, but a complete sweetheart to work with.

Here she is (at left) two weeks later at suture removal time, walking fairly well, but still with a limp.  She has lost a fair amount of weight.   And here  she is (at right) at her July checkup, two months later, walking normally, and growing her hair back.  She has also gained a lot of her weight back.  She is eating better, and feeling better.  We just didn’t realize how much that tumor was bothering her. 

It’s pretty easy to dismiss an old dog’s slowing down as “just old age”, but many times it is not.  They have bad teeth, or bad arthritis, or that thing you don’t think is so important (like Ling Ling’s tumor) is bothering them a lot more than you know.

With modern anesthetic drugs and monitoring, “too old” is not a good reason to allow a dog’s problem to go un-treated.

Comments

[Naomi]

Good for you, and good for Ling Ling! It's so hard to know what our pets really need...if only they could talk. Glad to hear her recovery is going well. By the way, I work with an FDA cleared PEMF therapy device called Assisi. It uses microcurrents to reduce swelling and edema post surgery. You might want to look into it: http://www.assisianimalhealth.com

Cheers, Naomi

[Linda]

I've been reading your blogs and you do so much to help these babies. They are lucky to have you as their Vet. I have a question but I didn't know where to go to start a new question. My male dog is 10 years old. Yesterday, I noticed he was licking his leg a lot. I felt of it and didn't feel anything and didn't notice him licking it anymore until today. I felt of his leg again today and he has a small lump about the size of my thumbnail and it has a pink area in the center where he has been licking it. It isn't warm to the touch, he isn't limping and he is eating and drinking good and still runs after squirrels, so he's acting his normal self. Should I just watch it and see if it grows or goes away before calling our Vet? If so, is there anything I can put on it - some wound care spray or something? Thank you in advance for your help.

[Doc]

Hello, LInda,

This could be anything from a skin tumor to a reaction to some sort of foreign body (splinter, etc.).

If it doesn't go away on its own in a few days, I'd let your veterinarian look at it. If it is low on the leg, you don't have a lot of loose skin to play with. If it is growing, you want to get it off while it's still small and easy to remove.

[Linda]

Thank you for your quick response. I'll definitely keep an eye on it. I haven't noticed him licking the area yet today and it wasn't wet when I felt the spot but there is still a small lump there. It is located on his forearm, so you are correct, there isn't a lot of loose skin.

[Maria]

Im happy that the doggy is doing well. I have a 12yr old dobie and he had developed a tumor on his chest. Under the car of vet they advised to leave it alone till need be taken out. Well its been a few years and his tumor has gotten bigger. When we decided it maybe a good time to take it out we noticed he developed 4 more on his groin. Well we decided to wait on the surgery for the chest to see how the groin ones
Would grow. They have grown really fast. So fast that they would have to be taken out soon too. My question is.. what do you do? These surgeries are gna be big and im thinking its gna be a hard recovery due to his age given its gna be his upper and lower body whether we do surgery one area at a time or all together. Not only that but its going to cost thousands of dollars for it to possibly grow back faster than before with or without having time to heal up. He is 12years old. Older than most dobermans we know. Im torn. Sld we let him continue to live his best and lay him to rest when it becomes bothersome or if there are any complications or do we do multiple operations?

[Doc]

Hello, Maria,

All of those choices can be realistic. I cannot choose for you. It is certainly true that even if the surgeries go well, you're not going to add another 12 years to his life.

On the other hand, if the tumors are causing him pain, I would schedule surgery for the largest one, and take biopsies from the others at the same time. It is possible that there could be medicine to shrink them to a more manageable size for removal. Or you could just biopsy several of them to see if medication might help shrink them before surgery.

[nancy]

My lab is 11 years old and has several lipomas. One is bigger than a soft ball. I would love to have it removed but she has a history of seizures and the vet is hesitant to remove it. Is there anything that will shrink it?

[Doc]

There was a study published in 2011 about doing liposuction in England. Removal was considered successful in more than 90%, but about 1/3 of them re-grew (apparently not completely removed). Regular surgery has a greater success rate. I don't know of anyone doing it in this country, and cannot find any more recent studies.

They also noted it would not work if it wasn't a simple lipoma, but had other strands of tissue in it.

If this were my patient, I would be getting a consultation with an anesthesia specialist about how best to handle a patient with seizures (or on seizure meds).

[candice]

My 13 year old chihuahua has a fatty tumour on his chest the size of a tennis ball. it was tested and it is not cancerous. My concern is the size since it has tripled in size in the past 2 years. My vet was concerned with removing it because of his age than because of the anesthetic. Now I am worried that it won't stop growing and don't know what to do. I have read so much on the internet in favor and not in favor of surgery. If I knew the surgery would not be dangerous to do I would be doing it today. Not sure what to do . Any suggestions would be greatly appreciated

[Doc]

It sounds like the tumor has become large enough to be uncomfortable to the dog.

If your doctor is uncomfortable with anesthetizing your dog, you might ask for referral to a surgical specialist who has more support personnel.

Without knowing and seeing your dog, I really cannot speculate on the safety of the surgery.

I can say that we routinely operate on dogs of this age who don't have other serious medical problems.