Liver Cancer and Tumors in Dogs

Liver Cancer - Hepatocellular carcinoma

Question: Dear Dr. Mike:

Just wanted to update you on 99s case. As you recall, she's the 7-year-old female, toy fox terrier with the awful liver function tests and extremely enlarged liver, confirmed on ultrasound. I decided to go ahead with the needle biopsy. She had it done 3/2/01. She is doing so well it's remarkable. I asked them to repeat the superchem panel again at that time because her abdomen had shrunk down to normal size from looking like a pot belly pig. I knew the tumor was still there because I felt the enlarged liver upon palpation but to look at her you could not tell there was anything wrong. Her labs came back markedly improved even better than the initial panel! As you know, they had gotten worse when the panel was drawn three weeks after the initial panel in preparation of the biopsy which I canceled initially...out of fear. Anyway, the cytology report gave me hope because it said possibly nodular hyperplasia vs hepatocellular neoplasm which I read as that either way. I was wrong. The final histopath report revealed hepatocellular carcinoma. I was shocked beyond belief as I thought for sure it was a benign tumor since she has not been sick and her labs were so markedly improved and her abdomen had shrunk in size.

I just got back from the oncologist follow-up visit. I guess my vet phoned him before I got there to let him know that the liver was infiltrated as opposed to involving only one lobe therefore making her condition inoperable. On the one hand that makes it easier on me because I do not have to be faced with the decision as to whether or not to do the big liver surgery. As you know, I was not to crazy about the idea of putting her through that since she is not sick.

On the other hand, they only give her 6 months to a year to live. They are still very much concerned about the hypoglycemia (her glucose has been down as low as 14 but was up to 60 at the time of her last panel). The oncologist said there are some medications that aren't really considered chemotherapy but have been known to slow down the cancer's rate of growth. Have you heard of these types of medications? Also, why do you suppose her abdomen has shrunk so much if this is a cancer? Have you ever heard of biopsy results being wrong?

Again, thank you so much for your valuable time and expert input. I don't know what I would have done without you and your website during this time of crisis with 99. All of my friends with animals are now subscribers as well. Keep up the great work! Regards to Michal and all your other helpers.

Sara...still sad in Las Vegas.

Answer: Sara-

There are definitely times when biopsy interpretations are incorrect but this is not highly likely. I tried to find information on how often hepatic carcinoma was confused with other problems and couldn't really find anything on that. There was a notation in one of the references about the difficulty in making predictions about how fast hepatic carcinomas will spread and about longevity associated with the tumors when they could not be removed, so I would hope for the best ( a longer time before the tumor causes problems) but be prepared for the oncologist's estimate to be correct.

Treatment to help the rest of the liver function well can be very beneficial and is probably at least part of the reason that the abdominal swelling is under control and that 99 continues to feel well. I am not sure if this is what the oncologist is referring to but that seems possible. Medications like SAM-e (Denosyl SD4) and ursodiol (Actigall Rx) may be helpful in maintaining the function of the liver tissue that is not affected by the cancer. There may be other medications that the oncologist is thinking of that also provide benefits. It may also be helpful to use a diet high in n-3 fatty acids or to supplement the diet with these, as that might help, too. There is a medication somatostatin, that is used to help slow the growth of some liver tumors in humans but I was not able to find much information on its use in dogs (one article about using it for insulinomas, which is not the same tumor you are dealing with). I don't see any reason not to try it, except perhaps expense, if the oncologist is familiar with it and this is the medication that was referred to as potentially helpful.

I am not sure what the best approach to the hypoglycemia is. There is a medication, diazoxide (Proglycem Rx) that can help with low sugar levels from tumors but dogs with liver disease are reported to be more sensitive to side effects, so it would have to be used carefully. It is also reported to be very inconsistent in its effect when it is not used for insulinoma therapy. Frequent small meals might help to keep the sugar levels constant, as well. This would be the best approach for a patient who can not store adequate sugar in the liver to allow for consistent control of blood sugar levels.

It is important to use a special blood tube made for blood sugar analysis or to separate the serum from the blood cells as soon as possible, in order to get accurate blood sugar results. The reason that I mention this is that I have not seen blood sugar levels as low as 14 in a patient that appears to be doing well, except when we did not separate the blood cells from the serum quickly enough. Red blood cells continue to use the sugar in the serum until they are separated from it. If the blood sugar was this low in a sample tested immediately in-house or in which the serum and red blood cells were rapidly separated, it would be very worrisome.

It would be a good idea to keep some source of rapidly available sugar, such as table syrup or Karo (tm) syrup or cake icing around the house so that if there is a seizure or loss of consciousness due to low sugar levels you would have something to administer to increase the sugar levels. These products just have to be put in the patient's mouth to be absorbed (they are absorbed by the oral tissues). Usually, administering these types of things will reverse a hypoglycemic episode pretty quickly but it may be necessary to repeat the dose several times to maintain the effect.

Good luck with all of this.

Mike Richards, DVM 3/28/2001

Liver Cancer in Golden

Question: Dear Dr. Mike,

My 8 1/2 year old golden retriever, Sarah, has been diagnosed with inoperable liver cancer. Her doctor prescribed cortisone tablets to increase her appetite, because her primary symptom was loss of appetite. The cortisone helped for the first few days. We took her to a cancer specialist who is recommending treatment with a combination of chemotherapy and interferon. The specialist thought she would be a good candidate for the chemotherapy because she appeared to have few ill effects from the cancer, so far. She seemed energetic and curious and her blood counts were good. However, in just the last few days she has stopped eating completely. She is very thin, although her abdomen is distended. We have tried enticing her to eat with everything we can think of, but nothing works. Can you suggest anything that will help her to eat? I'm also interested in what you think of the odds of the chemotherapy extending her life, assuming we can get her to eat somehow. Please respond as soon as you can.

Thank you for your help, Susan

Answer: Susan-

The type of cancer present has a tremendous influence on how well chemotherapy will work. If you can tell me what the cancer is (if there has been a biopsy) I will look into it more specifically. In general, though, chemotherapy usually does prolong the lifespan of patients who are treated with it. This benefit is partially offset by undesirable effects of chemotherapeutic agents. These effects tend to be less severe in dogs than they are in humans but they do occur. For many cancers, chemotherapy will provide about 4 to 8 months of life over non-treatment, with most of it being of acceptable quality. The question then become does this make enough difference to pursue it? For some people, and some dogs, the answer is obviously yes. For others, this is merely the prolonging of an inevitable event for a few months. I believe this is a personal decision rather than a medical one, except for the part where you get the best possible estimate of what chemotherapy can do through identification of the tumor and consultation with an oncologist and the best estimate of the cost and the commitment that must be made to see the chemotherapy through. We have people decide to go for chemotherapy and decide not to. For the most part people seem to be glad they tried when they do try it but many clients are content they made the right decision in not pursuing chemotherapy, too. If you think that Sarah has the right personality to accept treatment and enjoy life with some inconveniences, I think there is no reason not to try chemotherapy.

The only things that I know of that seem to help with appetite are pain relief, which is worth trying even if there is no evidence of pain, and control of nausea, which may or may not be a problem. I don't know of a good appetite stimulant for dogs. Sometimes, using a feeding tube (esophageal or gastric) is really helpful in pets that have cancer, allowing them to be fed and gain the benefits without having to force feed them orally when they really don't feel well. This can result in an improvement in their overall condition and that can be the thing that helps bring back their appetite. There is an aversion to feeding tubes among veterinarians and their clients, due to the need for surgery, the increased nursing care that must be given at home and a general feeling that a feeding tube signifies a real downward spiral -- which really is not always the case. It is something to consider, especially if you do decide to opt for chemotherapy.

I wish I had an easier solution.

Mike Richards, DVM 12/4/2000