Tanish’s Trek Through Comprehensive Cancer Care
David Rosenblum likes to tell his wife Pamela that he has a favorite among their dog Tanish’s four legs. It’s the left rear one.
That’s the leg that Tanish (pronounced Ta-neesh), a 14-year-old Pug, nearly lost to mast cell cancer. And that’s the leg that the experts in the Comprehensive Cancer Care Program at Penn Vet’s Ryan Hospital saved through a multi-modal treatment plan of chemotherapy, surgery, and radiation.
Last spring, the Villanova couple suddenly noticed a lemon-sized lump on Tanish’s leg. It seemingly had appeared overnight. They immediately took him to Ryan Hospital, where Tanish has received his regular veterinary check-ups and care since Penn Vet saved his eyesight by treating his pigmentary keratopathy, a disease common in Pugs, and corrected his herniated disk a few years ago.
Blood tests, a biopsy, and a CT scan revealed that the tumor on Tanish’s leg was a mast cell tumor, a common skin cancer in dogs. Mast cells are involved in the body’s response to allergens and inflammation. This cancer can occur in the spleen, liver, gastrointestinal tract, bone marrow, and other areas of the body. Brachycephalic, or flat-faced, breeds such as Pugs, Boston Terriers, Boxers, and Bulldogs are predisposed to this type of cancer.
Mast cell tumors can appear spontaneously and grow quickly as a raised lump on or under the skin. The lumps may be red, ulcerated, or swollen, and they may wax and wane in size.
Mast cells contain granules filled with substances that, when released into the bloodstream, can cause stomach ulceration; bleeding, swelling, and redness around the tumor site; and such life-threatening complications as a dangerous drop in blood pressure and a systemic inflammatory response that can lead to shock.
Mr. Rosenblum said he and his wife were “scared to death. You’re new to the whole thing. All of a sudden this is cancer, and it’s the worst possibility, and it could spread.”
The Rosenblums immediately faced treatment options: amputation of the affected leg or surgical removal of just the tumor followed by radiation treatment. Ryan Hospital, through its Comprehensive Cancer Care Program, is one of only three veterinary oncology facilities in the country that can offer the collaboration of board-certified medical, surgical, and radiation oncology specialists in a single service.
“We thought amputation would be the simplest, with a good chance of success,” Dr. Michelle Giuffrida, lecturer in surgical oncology at Penn Vet and Tanish’s surgeon, said. However, the tumor sat high up on the back of Tanish’s thigh, so there was some risk the cancer could recur, she noted.
“We were going back and forth” between the options, Mr. Rosenblum said. And they needed to decide quickly because of mast cell cancer’s rapid growth.
Mr. Rosenblum even researched canine prosthesis online, but found they haven’t been very successful with rear legs. Ultimately, the couple decided to try to save Tanish’s leg and go with the least invasive option: tumor removal and radiation.
But first the tumor would have to be shrunk to be suitable for surgical excision. So Tanish took a two-week course of prednisone. Unfortunately, that did nothing to reduce the tumor’s size. So Tanish underwent chemotherapy for four weeks, tolerating the treatment well. “We were very lucky in that that did result in shrinking the size of the tumor,” Mr. Rosenblum said.
Then Dr. Giuffrida operated on Tanish, taking out the tumor and lymph nodes around it to remove as much of the cancer as possible while knowing some cancer cells might remain.
Tanish spent one night in Ryan Hospital and then went home with a bandaged leg, pain medication, and a surgical collar around his neck to prevent him from licking his leg. Despite his short stay, he managed to impress his surgeon. “He’s a sweet little pug, interested and independent,” Dr. Giuffrida said.
In Tanish’s favor, his tumor was of the low-grade variety, meaning it had less likelihood of spreading, and minimal cancer cells were left behind, said Dr. Joe Jacovino, radiation oncology intern at Penn Vet. Under those circumstances, radiation has the best chance of succeeding.
Next, Tanish underwent 18 doses of radiation every weekday over three-and-a-half weeks to kill any remaining microscopic cancer cells. He was anesthetized for each treatment.
The treatments caused a radiation burn on Tanish’s leg. “It’s very much like a really bad sunburn. And it continues to build up after you’re finished giving it,” Dr. Jacovino said. “We always tell owners it gets really bad about a week after radiation ends and then quickly heals.”
For two weeks, the Rosenblums had to abrade the dead skin over Tanish’s radiation-burned leg and put ointment on it daily. “That was the worst part of it for him and us,” Mr. Rosenblum said. “He’s such a sport.”
After that, the skin on his leg healed, although the fur within the radiation field has turned white.
It’s been six months since Tanish completed his last treatment. He received a clean bill of health at a recent check-up at Ryan Hospital, where he remains a popular patient. “Every time he comes in, everyone comes to see him,” Mr. Rosenblum said.
Tanish is the poster dog for neo-adjuvant chemotherapy, which refers to using chemo to shrink a tumor so it is more amenable to surgical removal, Dr. Jacovino said.
As for the Rosenblums, every time they watch happy Tanish romp on all fours, they are grateful for Penn Vet’s Comprehensive Cancer Care Program and the choices it offers pet owners.