Mast Cell Cancer

I wanted to do a blog on basic information on Mast Cell Tumors for it anyone in interested. This is not meant to be a go to source of information, just a brief reference. :)

What are mast cells?

I believe this is one of the most basic questions one can ask. Mast cells or MC are a specialized cell which is considered to be a component of the immune response system. These cells are characterized by the granules which are formed inside them. In the 1800's, Paul Ehrlick believed the granules were meant for nourishment for the surrounding cell and named them Mastzellen, German for food for cells. These cells are thought to be produced in the bone marrow and circulate through the body in immature form before maturing in a tissue site. While distributed throughout the body, mast cells are predominantly found in the skin, gastrointestinal track, mouth, nose, and mucosa of the lungs.

These cells play a primary roll in inflammation and allergic reactions. Once activated, MC release their granules which contain various chemical messengers such as histamine and heparin. Heparin is an anticoagulant. Histamine dilates post-capillary venules and increases blood vessel permeability which causes heat, edema, and redness. It also irritates nerve endings causing pain and itching. Histamine plays a roll in asthma, eczema, anaphalaxis, and possibly rheumatoid arthritis. As one can assume, too much of these can be responsible for a variety of systemic problems.

What are mast cell tumors?

The simplest definition of a mast cell tumor, or MCT, is a cancerous proliferation of mast cells. The tumor itself is not a debilitation; the effects from the granule release can be. As one can assume, MCT can affect not only the length of life, but the quality of life.

What causes MCT and how can they be prevented?

The causes as well as prevention are unknown.

How can they be identified?

MCT can have a wide variety of appearances which makes visual diagnosis difficult. They are commonly observed as either a solitary mass or a small cluster under the skin. The tumors may appear like a lipoma, be ulcerated, have thickenings, or many other variations. A common trait is their ability to rapidly change size from both small to large and large to small. Without a fine-needle aspiration and/or a biopsy, a definitive diagnosis is not possible. MCT are one of the most common tumors in dogs although they are not common in cats and quite rare in humans.

Where are they located?

Mast cell tumors can be located in the places MC inhabit. The most common locations tend to be the skin, spleen, liver, and bone marrow. In dogs, almost half of all MCT are on the body trunk, near 40% are on the extremities (hind legs especially), and around 10% around the head and neck. Around 11% of MCT occur in multiple regions.

What dog breeds are commonly affected?

Beagle, Boston Terrier, Boxer, Bulldog, Bullmastif, Bull Terrier, Dachshund, English Setter, Fox Terriers, Golden Retrievers, Labrador Retriever, Schnauzers, Staffordshire Terriers, and Weimeraner. All dogs can get MCT and Boxers are the most affected.

What are the symptoms?

MCT can also have a variety of symptoms. The most common being the tumor itself. There is a possibility for them to be painful, especially if ulcerated, although usually they are not. Mast cell tumors are unique in that they can rapidly change in size. MCT tend to be locally invasive. Another property MCT can have is swelling, redness, itching and even hives, after palpation or aspiration of the tumors. Mast cell cancer can cause systemic symptoms such as diarrhea, appetite loss, abdominal pain, itching, vomitting, darkened feces, lethargy, coughing, labored breathing, enlarged lymph nodes, etc etc.

How is it diagnosed?

MCT are diagnosed through fine-needle aspiration, biopsy, biochemical profiles, and urinalysis. Once diagnosed there is histological grading and clinical staging to be done. There are three grades and they are based on differentiation of the cells, how quickly it divides, and how invasive to the surrounding tissues. The grade is determined by a pathologist who does staining on the tissues. Good differentiation is grade 1, moderate is grade 2, and poor is grade 3. The process for staging is a bit longer. Lymph cells should be taken from the surrounding regional lymph nodes, thorax radiographs, abdominal radiographs and ultrasound is needed to look for enlarged lymph nodes in the spleen and liver especially. There should also be an assessment of the bone marrow and blood for abnormal mast cell circulation. Staging is to determine the degree of spread throughout the body. Stage 1 implies clean margins,single tumors and no signs of spreading and stage 3 would be dirty, invasive margins, more than one tumor and systemic spreading/

What is the prognosis?

The prognosis is highly variable with MCT. Even though Boxers are more prone to MCT, their tumors are usually less malignant. Usually a dog with systemic symptoms/diagnosis and tumor reoccurance there is a poor prognosis. If a dog is tumor free after removal for 6+ months then the prognosis is usually very good. If the tumors spread to multiple regions the prognosis is poorer. If the tumor does not change size for many months it is usually benign.

What is the best treatment?

Treatment again, varies with each case. Most common treatment is surgical mast cell tumor removal with wide margins compared to other tumor removals. Other treatments include the use of prednisone, radiation, chemotherapy and medications for systemic symptoms. Sometimes the cancer is not curable and the dog must just be made comfortable. Ultimately, treatment is to be determined by a collaboration of a licensed vet and the owner...not a blog post. :)

Other sites for information:

http://www.vetmed.wsu.edu/deptsOncology/owners/mastCell.aspx

http://www.marvistavet.com/html/body_mast_cell_tumors.html

http://www.vrcc.com/disease_mc_tumors.shtml

http://www.caninecancerawareness.org/CanineCancerMastCell.html

http://www.kateconnick.com/library/mastcelltumor.html

My Hooved Carnivore

Two posts in one day? Who knew...

I want to share a fun little story with my readers; all 4 of you? lol Normally I do not feed treats to my horses for safety reasons. If the occasions occurs when I do, it is large pieces such as half a carrot, an apple, or a piece of orange. Like many people, I have had fingers accidentally nipped here and there over the years though nothing damaging beyond a bruise and always 100% my fault.

Saturday morning a family friend came over to meet the two knucklehead horses...then my nonhorsie neighbor decided to join. I let them interact. I gave warnings of not allowing nibblings, lipping, or licking due to possibility of teeth entering the equation to the friend. I also told the neighbor I require supervision if people want to mess with the horses (he allowed his young daughter to pet them when I wasn't home and she got shocked on my electric fence the other day.)

Well all was going well and I went to show the friend Big Horse's bowing trick. Without thinking I went to hand him a treat for doing it well. The treat was a tiny Manna Pro which I normally put in their bucket due to it's size. Well, instead of grabbing the treat the horse had my right index finger. He didn't realize it, he just knew I was mad as a hornet and he began backing away from me. He couldn't figure out why I was following him and was worried even more because I was trying to get him to open his mouth. He had not bit down all the way and I was both trying to get him to open his mouth and keep him occupied where he wouldn't bite all the way. Well, he wouldn't let go and bit down hard enough I heard a crunch so I may have punched him. He let go thankfully.

My mother and the other two watched the incident and asked how I was. I looked at my hand, said I wanted to go to the ER and that I didn't think I should be looking at tendons. I walked up to the friend and neighbor and explained that this incident is not normal and that I hope they now took my warnings seriously. I then went inside, made sure I could still move the finger, washed it, wrapped it and off I went.

My father and I stopped at Jack in the Box for breakfast first before going to the ER. They cleaned it, bandaged it, and gave me lots of antibiotics....it looks much much better already. :)


Day 1...few hours after injury; already swollen closed
























Day 2 after removing the bandage for the first time... yummy

Heartbreak

Now that I have had the unfortunate and heartbreaking experience of losing a much loved family companion to Mast Cell Tumors (MCT), I would like to take the time to share the experience as well as information about MCT.

My boxer developed a few random lumps over the years, starting at age five, that tested as lipomas or fatty tumors. They all looked similar in that they were wide, soft, and not very deep. The appearance of lipomas can vary and I have seen them as large as a basketball on more than one occasion. They are more unsightly than problematic....usually.


At around nine years old, he developed a lipoma looking tumor on his left thigh, not too far from the stifle. Because the million other tumors he had were lipomas and it looked/felt like one, I did not have it checked like I should have. The size and shape remained consistent with time. Around ten years old he developed a dime size tumor near his jawline that very rapidly changed consistency from soft to very firm and lumpy as well as changed to golf ball sized. I took the old guy in to have all of his tumors retested along with the two untested ones. The old lumps were tested again as lipomas but the one on his neck and thigh were both MCTs. My heart broke...

The vets I work with and I began to discuss treatment options. Due to his age and the unlikelihood of it working, chemo/radiation was voted out. He was still his happy, bouncy self but the mass was beginning to interfere. This left us with three options.... 1)Leave the mass and allow him to have a longer life but due to the interference not necessarily one of quality; 2) Remove the tumors, run the risk of it coming back and spreading but possibly have a better quality life; and 3) euthanize. I just could not put him down because he was himself and still fine. We agreed on option 2.

I got almost 4 wonderful months with my boy before I lost him when it metastasized. It was swift so there was very little time for him to be uncomfortable....literally you could find nothing to within only a few days it was back and far bigger than it ever was on his neck and across his shoulder with severe edema.

I made the appointment and he went swiftly and pain free. The vet who did the surgery apologized for not being able to do more. Little does he know how much he already did...he made it possible for my guy to be happy right to the end.


Mr. Melvin Butterbean Wigglesbutt
I cannot believe it has already been a year

Wildlife Baby!

I love working with wildlife almost as much as I enjoy working with domesticated animals. I think it is the problem of them being both unpredictable and unusual that really gets my interest.

The other week I was in charge of all Avian and Mammal care because of a shortness in staffing. I have only had limited training with the birds so it is a bit of a learning curve in some ways. Most of the birds currently are birds of prey so special precautions must be taken when handling them. Thankfully a few of the birds have been either placed with other facilities or released so not too many remain. One of my favorite birds to deal with are the vultures. They are large and lumbering and cute in a big, featherly, death smelling sort of way. The only thing that deters me in my like for them is that as a defence mechanism they will vomit. Think about how that will smell for a moment....they eat dead, often rotting food, partially digest it then vomit directly at you....great! *gag* I'll forgive them simply because they are amusing.

The woodpecker tried to escape and reflexively I grabbed for him and only got the ends of his tail feathers. It felt like a cartoon for a moment because for all purposes he was flying, just couldn't get anywhere in the process. I just twisted my hand a bit so he faced the cage and back in he flew when I let go with all feathers intact. I call that a success.

For another interesting fact....eye protection MUST be worn when handling Heron. One of the first things they aim for in hopes of being let go it going for the eyes with those beautiful bill of theirs. Yikes.

One of the funniest birds to deal with is a barn owl. He will grab the leather glove with his talons and essentially shrink wrap the glove to my hand them sink that beautiful beak in to it. He will fold on to the glove for upwards of ten minutes AFTER returning him to his cage. He also screams. He has a great fear of humans and IF his wing ever heals he will be a good candidate for release since he has not gotten even slightly used to humans or being handled.

BEAUTIFUL birds


Then they scream

Holy Knees Batman!

Let's start of with my feline friend with CRF. Last night she appeared to be glassy eyed as well as unusually unstable in her hind end as well as was dehydrated but eating decently. To help with the dehydration without the proper tool, I pretty much had to force feed her a kitten sized bottle of pedialyte. As of this morning she was not eating and still dehydrated so away she went back to work with me. Her second set of tests had came back and her creatine levels were in the normal range although she does have an elevated liver enzyme. The enzyme was elevated before the fluids and it was hoped it would also come down after the second test when instead it went quite a bit higher. She will have more testing done in the next two to four weeks to keep and eye on it. Dr. C advized me to not worry about it though we will keep an eye on it because it can be a sign of liver disease on top of her CRF although she believes it is elevated simply because of the CRF at the moment. We gave missy her fluids and she was sent home with a goody bag of needles, ringer solution, and a cord so I can do her sub-q fluids at home. She is to get 300ml per day divided in to two times. After her fluid she was much perkier and proceeded to chow down on some food (GREAT!!!) I can say I honestly do not know how long she is going to be with me and while my senses are saying it will not be for much longer, I can at least have some hope.

Onward to the updates....

The older cat who had problems with the anesthesia passed away Monday night. I feel so bad for his owners; I know what it feels like to lose part of the fur family and it is never easy. The young St. Bernard has surgery and had a baseball sized rock in his stomach...no wonder he wasn't feeling good. He is expected to make a complete 100% recovery!

Today I came in just in time to see a dog on the large side of small being prepped for surgery. I enjoy observing Dr. H. because he takes the time to explain the why and how of procedures to me while he is doing them. The palpated the dogs stifle and showed the abnormal movement of the joint; the femur could be moved backward while the tibia came forward independent of each other. The dog tore his cranial cruciate ligament(anterior cruciate ligament or ACL in humans) but he did not believe it had affected the joint capsule because the sinovial fluid of the joint seemed normal and also that there was probably no damage to the meniscus in the joint which is good news for the dog. He explained he was going to use the Lateral Fabellar Technique(Extracapsular Technique); this surgery uses monofilament nylon(heavy gauge suture that doesn't degrade after being autoclaved) to stabilize the joint.


(Photo owned by www.vetsurgerycentral.com)

The technique is used mostly in cats and smaller dogs (in larger dogs the TPLO of Tibial Plateau Leveling Osteotomy is highly recommended.) Two small holes were drilled on the anterior part of the tibia and the suture was threaded through it then the sutures were laced around the femur and placed around the fabella bone. This leaves two suture from tibia to femur. The ends of a suture go through a small metal bands which are clamped in to place. Dr. H. said only one suture is really needed but because the procedure can fail, he would rather the added stability of the second suture are a backup. You do not really repair the CCL in a dog so much as convince the body it is still there and that is why the heavy gauge sutures are used. The body will build up scar tissue around it and stabilize the joint although the range of motion can be affected.

The surgery was a success. :)

*deep breath*

Have I mentioned I would love nothing more than to be a veterinarian???

Day at the LSV

I arrived at the LSV just in time to find a grey long haired cat crashing with techs and a vet wrapped around him trying to get him to come to. The cat in a geriatric feline who came in for a routine dental cleaning only to react poorly to the anesthesia...he had died three times by the time I arrived to the clinic. He had an interesting time with anesthesia the last time he was under in that it took him unusually long to come out of it. In preparation for that, his dose was much reduced...so this time instead of staying out too long he tried to just die in the process. He managed to pull his catherter out and was coughing up a bit of blood. He had to be shaved (I wasn't there for that) and his owners wanted to know about his beautiful grey hair...no offense but the cat is trying to die...the last thing anyone was worried about was the way he looked. He was put on oxygen and got a couple injections(I cannot recall the types) and another catheter couldn't be put it because his blood pressure was far to low and no one could get in inserted. *grumble*

Not long after a pit bull type dog was prepped for neutering which was a success. Then I observed a female mixed breed get spayed. As I walked out of the OR I saw something big and black on the floor of the clinic and thought "WOW, that is a huge dog...um...calf? There is a calf back here and not in the barn?!?!?" It was a two week old black angus bull calf with a bad case of scours...meds, some IV fluids, and ringer solution later and he was feeling much better! Hopefully he will continue to improve.

A year old male St. Bernard came in and weighed in at only 110lbs, already 10-15 lbs less than the previous weeks he had come in. He was presenting with some rattling sounds in his chest as well as discomfort in his hindend as well as abdomen. He was taken to have a chest x-ray where it was found he has a large foreign body in his stomach and will need a trip to the OR. The owner confessed he had eaten shoes as well as random objects. Silly puppy!

Lunch arrived and unfortunately that is my time to leave because I have classes shortly after.

I grabbed my own cat out of the cat kennel. She was just diagnosed with Chronic Renal Failure on Friday and spent her weekend getting IV fluids. Her levels of creatine and something else are being rechecked to see if they have come down some. She is on 2.5mg Benazepril a day for 28 days and she will be assessed as needed.

Anyway...welcome to my day. lol

Welcome to my blog!

First and foremost welcome to the blog!

To give some information on myself I am a "Pre-Veterinary" student and will soon graduate cum laude or magna cum laude with a Bachelor's of Science in Biology with a Chemistry minor and possibly an Agriculture Minor if I can get the final hours needed for completion. I have wanted to be a veterinarian, and more specifically a large animal veterinarian, since I was just a little girl.

After years of not finding a vet to work with because of insurance problems I have work coming out of my ears! I volunteer at two vet clinics; one Exotic/Small Animal Veterinarian(ESV) and an Animal Care Group which consists of ten vets ranging in specialties from small animals to large(LSV). Besides work with the vet clinics, I am a Wildlife Rehabilitation Intern. To top it all off, I am taking 19 credit hours this semester. When do I have time to breath?