#haemangiosarcoma

Some cancers of the liver show up on blood tests, some don’t.

Haemangiosarcoma is a malignant cancer of blood vessels. It can arise in the liver, or arise elsewhere and spread to the liver, as this type of cancer spreads anywhere and everywhere very easily. And it’s a vrey nasty cancer, with an average survival time of around 60 days from discovery. It’s very common in larger dogs and moves so fast that most dogs don’t even look sick or display weightloss until it’s too late.

There are multiple liver factors tested on most blood screens which test either how the liver is functioning or whether there is compromise to the liver tissues. Haemangiosarcomas don’t typically compromise the liver function, but they can cause elevations in the enzymes that indicate what the liver tissue is doing, like AP and ALT.

Of course, some senior dogs have high AP and ATL anyway from benign, lumpy livers which don’t affect them at all.

And sometimes Haemangiosarcoma doesn’t cause any changes on blood tests at all until it’s too late.

At best a blood test might show something is maybe up with the liver, but you’d need imaging to follow up on it. Haemangiosarcoma is sneaky and fast.

The day starts like any other day in small animal veterinary practice. A nurse takes a phone call about a seven year old German Shepherd who's a bit lethargic but only since this morning.

Well, that could literally be anything.

The dog and its humans arrive a few hours later. Now she wont stand up and they need help getting her out of the car.

The first alarm bell starts ringing.

A nurse and I go to the car. The dog's in the back seat, lying on her chest, puffing softly with her abdomen distended.

A second alarm bell starts ringing.

Before even trying to get her inside the building, I flip her lip to look at the colour of her hums. They are paper white.

A third alarm bell rings, loud and clear.

We hoist her inside on a blanket and waste no time bringing the ultrasound to her. It takes seconds to confirm her abdomen is full of fluid, blood that should have been in her veins. Her breathing changes and suddenly she looks weaker, even more tired than she did before.

A fourth great big alarm bell sounds.

I already know the dog has a haemabdomen. She's bleeding out into her abdomen, probably from a tumor. In German Shepherds the odds of it being a haemangiosarcoma are almost a certainty, and the average survival time after surgery would be around 60 days. The owners either have to choose between emergency surgery right now, or euthanasia.

But I need them to choose fast because I can see this dog fading, and that last big alarm bell is because this dog is going to die very, very soon, and it wont be a peaceful death unless I step in.

I know the dog's going to die anyway. But I want her to have a good death, not a frightening, gasping one.

So I make everything happen fast. I explain what’s going on, only two options available and I am kind of rushing to get a catheter in which still explaining to the owners what it going on. The vein in hard to find, it doesn’t pop up like it should, but I can get it first try. The dog’s head it kind of limp in my nurse’s hands, and she gives me a worried look. She knows too.

I manage to perform the euthanasia before the dog becomes distressed.It’s faster than I would like, but at least it’s smooth. The humans have time to grieve afterwards. I apologize for everything happening so fast, and they say they understand, but it’s still fundamentally unsatisfying. It doesn’t feel like a good job, even though diagnosis and treatment were rapid.

Would it have been different if the dog had come in first thing this morning? Maybe. The diagnosis wouldn’t have been any different but the humans would have had more time to understand what’s going on. It’s still the right outcome for the dog, she was trying to die in front of me, and surgery would likely have been too late.

This morning the dog who had been lethargic just for a few hours didn’t necessarily sound like an emergency, but if they had waited any longer she would have had an unpleasant death.

My arch nemesis.

Seriously, this sneaky, vindictive little sod is an extremely aggressive, malignant tumor arising from blood vessels. Usually it grows on the spleen or the liver, but will also grow on lungs, kidneys, adrenals, the HEART and anywhere that you know, you can find blood vessels.

Because it’s made of cancerous blood vessels, it’s structure is basically just a mess of twisted vessels and capillaries in a great big blob. This means two things;

They have excellent blood supply, allowing them to grow quickly and they rapidly spread anywhere blood can reach. Anywhere.

They have almost zero connective tissue, meaning that there is very little to stop them when they start to bleed, which they will do at the drop of a hat.

Can you see how this is a terrible combination?

Sometimes we will detect a mass in the abdomen at a routine general checkup. Sometimes the dog will present for being ‘off color’ and you discover an anemia. Sometimes they present for collapse when a tumor is actively bleeding. Sometimes they present with sudden death and a body cavity completely full of blood.

And lets say you identify one of these dogs with only a single visible tumor, lets say the spleen. You can remove the spleen, no problem. You can even remove the spleen if it’s actively bleeding out, and save the dog’s life.

For a little while.

If you remove the single haemangiosarcoma, and can find no other visible tumors, even on Xray, Ultrasound and full body CT scan, that dog will on average survive 62 days.

62 days.

Not weeks, days, before the haemangiosarcoma claims it anyway.

Even if you put them onto chemotherapy (which is not as rough an ordeal as it sounds), the average survival time only increases to around 6 months. Its pretty bleak.

And which dogs are most likely to be affected by this cancer? Usually larger dogs, like Labradors and German Shepherds, but any breed can be affected. Its usually the nice dogs. Its rare in cats, but can happen. I’ve even seen it in a goat.

I haven’t posted photos because it’s a lot of gore. Picture big blood blisters on all the abdominal organs, and non-clotting blood cascading out of the abdominal cavity. You need big buckets to even see what you’re doing.

Ulcerated haemangiosarcoma in a 17y.o. terrier mix. 

I’m sorry to hear that your dog has this diagnosis :( Fingers crossed, the medication given to you by your vet will extend her quality of life.

I would stay away from home remedies that involve alternative or chinese medicinal properties until you know exactly what your vet is prescribing, and what is in the home remedy. You would be running a high risk of synergistic or antagonistic effects of the drugs, and could therefore result in over/underdosages. 

Haemangiosarcomas, especially those arising from the spleen and liver, generally don’t provide a good prognosis, and if you haven’t seen clinical signs like weakness, inappetence, and weight loss yet, you are likely to in the near future. In these cases, I tell owners that it doesn’t matter *what* is being fed as long as your dog is willing to eat. Anything that she will eat is better than nothing. The body will feed the tumour before it will feed itself, so any sign of weight loss tells us that the body is losing out majorly.

If you are starting to see weight loss and muscle wastage, I would swap her food to a puppy diet, or even critical care prescription diets, as they are higher in fat and calories. If she is reluctant to eat, you can tempt her with cat food, as they tend to be more palatable. Your vet may prescribe mirtazipine or other appetite stimulants if necessary, and there is also an option of placing feeding tubes.

There is some speculation that high levels of omega 3,6,9s have anti-angiogenic and anti-neoplastic properties, which may help with the slowing of tumour growth. Another study has shown that dogs fed on a high fat diet vs a high carbohydrate diet had longer remission periods.