HEMANGIOSARCOMA
Hemangiosarcoma is a malignant tumour of the body’s blood vessels. With the exception of the skin form of hemangiosarcoma, which can often be eliminated by surgery, a diagnosis of hemangiosarcoma is bad news. This tumour is associated with serious internal bleeding and rapid internal spread. Most owners are not aware that their pet has hemangiosarcoma, because it causes almost no problems until the time that the tumour starts bleeding. Until this time the pet will behave completely normally. Fortunately, it is not without therapy options and, as long as expectations are realistic, temporary remissions are possible.
There are three classical locations which account for most presentations: 1) skin and subcutaneous forms, 2) on the spleen and 3) heart-based forms
· The skin form of hemangiosarcoma are the best types to have as they are the most easily removed surgically and thus have the greatest potential for complete cure. The true skin form looks like a rosy red or even black growth on the skin. This form is associated with sun exposure and thus tends to form on non-haired or sparsely haired skin, such as on the abdomen, or on areas with white fur. Dogs with short white haired fur (such as Dalmatians and pit bull terriers) are predisposed to the development of this tumour. Approximately 1/3 of cases will spread internally in the malignant way we usually associate with cancer so it is important to remove such growths promptly. It is necessary to take chest radiographs and ultrasound the abdomen and the heart after the diagnosis of skin hemangiosarcoma has been made to learn if the cancer has spread inwards. Surgery alone has been associated with a 172-day (approximately 6 months) median survival time.
· The spleen form of hemangiosarcoma tends to go unnoticed as the spleen is hidden deep in the abdomen and are not visible externally. Splenic growths have the unfortunate tendency to break open and bleed profusely regardless of whether they are benign or malignant. While a splenectomy (removal of the spleen) certainly ends the prospect of this type of life-threatening sudden bleed, splenic hemangiosarcoma is still a rapidly spreading malignancy. When a splenic mass is detected by ultrasound or xray, it is not possible to tell prior to surgery if it is malignant or benign. Surgery and a biopsy are needed to determine this. By time the tumour is detected and removed, the hemangiosarcoma has already spread to other tissues, frequently the heart or liver, and chemotherapy must be used to significantly prolong the pet’s life. Survival time with surgery alone is 19 to 65 days for splenic hemangiosarcoma. With chemotherapy and surgery, a median survival time is 6 months. Although chemotherapy and splenectomy are not a cure, they do allow months are additional excellent life.
Heart-Based Hemangiosarcoma: Like the splenic hemangiosarcoma, the heart-based hemangiosarcoma tends to exert its life-threatening effects by bleeding. The heart is enclosed in a sac called the pericardium. When the hemangiosarcoma bleeds, the blood fills up the pericardium until it is so full that the heart inside is under so much pressure that it has no room to fill with the blood it has to pump. Chest radiographs will show the heart looking spherical due to the blood build-up in the pericardial sac. This condition, if allowed to progress, results in an emergency circulating collapse called a "pericardial tamponade" and can only be relieved by tapping the pericardium with a needle and withdrawing the excess fluid. 63% of heart-based hemangiosarcomas have evidence of tumour spread at the time of their discovery. Survival time for surgery alone (removing the pericardium and snipping off the heart-based hemangiosarcoma) is approximately 4 months. Adding on chemotherapy after surgery can increase median survival time to 175 days. The most current protocol involves injectable Adriamycin (Doxorubicin) every 3 weeks and oral cyclophosphamide at home for 3 days out of the week.
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