Monday, March 14, 2016

Boston terrier mast cell tumor: Dealing with incomplete margins

Sinead the Boston terrier asleep
Sinead the Boston terrier spent most of her weekend in this position. Taking walks, playing with toys and begging for food are exhausting tasks, and when she's completed them, it's time to curl up and catch a few zzz's.

Me, I was glued to the computer. Sinead has a big appointment coming up next week, and I wanted to prepare for it.

A few weeks ago, Sinead had a biopsy for a very small mast cell tumor located right above her left eye. (If you missed it, the original post is here.) I waited anxiously for the pathology report, and when it came, I had some reasons to celebrate. The whole tumor was gone, and it ranked right in the middle of the grading scale.

But after losing my first Boston terrier to cancer, I didn't want to take any chances. So I took Sinead to a veterinary oncologist for a second opinion. And I got some bad news.

Mast cell tumors in the Grade II realm (like Sinead's) can be really unpredictable. Some behave like completely benign bumps, and they go away without a lot of treatment. Even bumps that only come part-way out sometimes never cause problems. But some Grade II tumors do come back. And some come back in a dangerous way, spreading to the lymph nodes and the organs.

One way around that: Surgery. But the cut around the tumor needs to be huge at 2cm. Sinead's cuts were only 1mm all the way around. Here's a visual. That pencil tip is 1mm. The stamp is 2cm. See the difference?

A pencil tip and a stamp used to describe mast cell tumor margins

And that amount of tissue would need to come out all the way around the tumor. So she'd have 2mm cuts all around that tumor, if it was done with the right margins. So her entire incision would be 4cm all the way around.

That's really bad news, as I can't do that sort of surgery on Sinead's head. Why? Because her eye is just 1cm away from that tumor. If we did a surgery with margins, she'd lose her eye.

Sinead the Boston terrier in closeup

Thankfully, there is another option.

Next week, Sinead will head up to a clinic in Seattle for an innovative form of chemotherapy. The team drills chemotherapy agents into the tissues using a spark of electricity. The whole procedure takes about 10 minutes, but she'll be sedated for the process. Her stay will be longer. But she only needs one appointment to get the whole thing done.

Electrochemotherapy like this is expensive, so I am thankful Sinead has insurance. But even though I don't have to worry about the finances, I do have other things to fret about. For example, I'm told her eyelid will swell up quite a bit after the process, and I'm not sure how that will feel for her. I'm also not sure about scarring on her eyelid. Will she keep her hair? I'm not sure.

But there is one thing I'm sure of: This provides the best way to ensure that the nasty tumor doesn't come back to end her life. To me, that's the priority. This treatment will help, and I'm glad it's an option.

But am I worried? You bet.

I'll keep everyone apprised of her progress in surgery. She'll be in Seattle overnight on the 21st, so I won't have an update until the 22nd. But check back, and I'll be sure to tell you how it went. And I appreciate any kind thoughts you can spare. We both need the reassurance!

1 comment:

  1. We are certainly sending lots of prayers and well wishes to Sinead! One thing is certain, though, and that's that you're doing absolutely everything you can for her. She has the perfect mom, that's for sure. Both you and Sinead will be in our thoughts.