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Just want another opinion. I have a 14 year old lab mix. We…

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Just want another opinion...

Just want another opinion. I have a 14 year old lab mix. We found a lump in her mouth last july and removed it. It was malignant melanoma. Because of her advanced age I chose palliative care only. We have had her on prednisone and she has been doing well with no signs of metastasis. Today we found another lump in mouth in the same spot. My vet says if we remove it will probably come back fasted than the first time. trying to decide what to do. If we should remove or not. My biggest concern is quality of life. She is an old girl. also wondering how much time we have left

Submitted: 4 months ago.Category: Dog Veterinary
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Answered in 7 minutes by:
3/9/2018
Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago
Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 18,824
Experience: Over 20 years of experience as a veterinarian.
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Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

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Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago

Melanomas in dogs behave much differently depending upon where they originate.

Those found in the oral cavity are extremely malignant and aggressive. Even with clean margins we expect the tumor to recur if we do not follow up with radiation, and chemotherapy and/or vaccine therapy. That's because by the time we see the tumor it has sent cells out into circulation and we would expect some malignant cells to be found in the tissue around where the tumor was originally found, distant from the tumor itself so not necessarily seen on the original pathology check, and are also often found in the regional lymph node and possibly the lungs.

Treatment of choice with the best possible outcome for melanomas includes surgery, then radiation treatment if there is any possibility of an incomplete excision, followed by the Merial melanoma vaccine (Oncept). This vaccine is a new DNA vaccine treatment. This is not traditional chemotherapy, it works by stimulating your dog's immune system to fight the tumor and is tolerated extremely well by most dogs. It is expensive but it increases survival rate and good quality of life from a few months for dogs that have no treatment to two plus years in many dogs that have surgery, the vaccine therapy, +/- radiation therapy if needed.

I understand not wanting to put her through chemotherapy, because when we think of chemotherapy we think of making them sicker. Chemotherapy in dogs is different than in people. Chemotherapy can be used for dogs that have tumors that we cannot remove surgically and are not responsive to radiation therapy, or when metastatic spread (tumor cells found in the lymph nodes or other filter organs in the body like the lungs, liver and spleen) is present. We use chemotherapy to keep them feeling as well as possible as long as possible. We do not expect a cure with our canine patients. There is a promising new therapy using small molecules that block tyrosine kinase receptors that you might want to discuss with a veterinary oncologist if your pup has tumor metastases.

In cases where owners choose surgery alone we expect the tumor to come back very quickly, usually within a couple months, but almost always within 6 months. Her tumor free period of almost 7 months is amazing. As your veterinarian advised once the tumor comes back if we remove the recurrent tumor we would expect to see another regrowth very quickly, often within weeks, because there are likely still some tumor cells growing from the original tumor and now too from the secondary tumor seeding the area surrounding the new tumor. If there are no signs of metastases yet, she seems to handle anesthesia fine and the new tumor is small now it may be worth removing it just to slow the inevitable a bit, because these pups seem to feel pretty when the cancer is small and localized. If she were showing signs of metastasis I would feel differently, that would mean her good quality of life time is short no matter what we do.

Eventually when she has metastases, another tumor grows and we can no longer remove it as the tumor grows expect to see drooling, often with blood, difficulty chewing, foul breath, and eventually difficulty breathing when it spreads to the lungs. The local lymph node(s) will likely to increase in size too.
Best of luck with your pup, please let me know if you have any further questions.

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Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago

Hello, I wanted to make sure that you didn't have any further questions for me, and I'd like to know what you decided for your pup. If you could give me an update that would be great, thank you, ***** *****

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Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Kara
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