(upbeat music)
- Hi, everyone.
I'm Dr. Sue, Cancer Vet.
And I'm sorry that you're watching this video,
because if you're watching this video,
it means your dog was probably just diagnosed
with bone cancer, osteosarcoma,
or your veterinarian has told you
that they're highly suspicious
that your dog has bone cancer.
So my goal for this video is
to give you an overview of osteosarcoma.
I want you to know I have lots of other resources
on my Facebook page, and on this YouTube channel, as well.
So be sure to check out the osteosarcoma playlist.
One of the things that I think you'll find really useful
are the recordings of the live Q and As that I've done,
where I answer questions from other pet owners like you.
And I think a lot of you have very similar questions.
So be sure to check that out.
And then also check out some of the other vlogs
that I have where I've highlighted
if there was a patient that had osteosarcoma.
So you can see their experience, possibly,
as a tripawd, as a three legged dog.
So I hope you'll find that information.
But let's dive in,
'cause there's a lot to know about osteosarcoma.
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So what is osteosarcoma?
Well, as I mentioned,
it's the most common primary bone cancer
that we see in dogs.
It's estimated to be about 5%
of all cancers that we see in dogs,
and 85% of bone cancers.
So there are some other less common bone cancers
that we see in dogs.
So, things like chondrosarcoma,
which is derived of cartilage,
fibrosarcoma, which is of connective tissue,
hemangiosarcoma, which is of blood vessel,
and somewhat other less common ones as well,
like histiocytic sarcoma.
So it's not the only ones that we see,
but definitely, you know, playing the odds,
it's the most common primary bone cancer
that we see in dogs.
When I think about this cancer,
I like to think about it in two battlefronts,
and that's how we typically
are going to approach our patients.
So, it's locally aggressive.
What do we mean by that?
It means that this cancer causes lysis,
or destruction of the bone that it's growing in,
and sometimes bone production.
So it's gonna lay down new abnormal bone,
and eat away at your dog's bone,
and that's gonna be very painful.
And that also is going to cause soft tissue swelling.
So what it's doing in the bone of your dog,
whether it's a front leg, back leg,
so the limbs are the more common,
but it could be any bone in the body,
that is the local battlefront.
And then the second battlefront
is because it's highly metastatic.
So, 90% of dogs, if we don't follow up
their local battlefront, their local treatment,
which is usually going to be surgery,
90% of dogs will sadly die within the first year
if they're just treated with amputation alone.
So, that is typically why, when we talk about treatment,
we're gonna talk about dealing with the local battlefront,
and then the systemic battlefront,
which is typically gonna be chemotherapy,
and I'm gonna talk about immunotherapy as well.
Less than 10 to 15% of dogs will have detectable spread
on those tests that we do before,
which are called staging test.
But it is painful.
And I know it's really confusing
because a lot of the times the dogs that we see this in,
they're still wagging their tail, and they're still happy,
and they're still eating, but they are still painful.
And the fact that they're not
completely putting weight on it
is a sign that they're telling you that it's painful.
And some dogs, just as some people,
have different pain thresholds.
It is painful, and these dogs do need pain meds.
And again, we talked about very high spread rate.
The most common place that it's going to spread
is to the lungs.
It's why we're typically gonna wanna do
some sort of imaging of the lungs
before we go to surgery and do treatment.
The second most common place is going to be other bones.
So, you gonna wanna talk to your cancer specialist
about what test we can do about that as well.
So as I mentioned, the long bones
are the most common place that we see it.
So 75% of osteosarcoma is gonna be in the long bones.
And it's more common in the front legs than the hind legs.
We tend to see this in middle aged and older dogs,
usually about seven to nine years of age.
And there's a second peak incidence
of dogs about a year and a half to two years of age.
So we can see it in younger dogs as well.
What we know is that
there are certain breeds that are predisposed.
And there are some infographics
that we'll put a link on my Facebook page.
But what's more important is the size of the dog.
So this tends to be a cancer of large and giant breed dogs.
So dogs that are greater than about 70 pounds
are about 60 times more likely
and at greater risk for this cancer
than dogs that are about like 50 to 70 pounds.
We still do see this cancer in small dogs.
So, I'm currently treating a dog named Poppy.
It's a little terrier breed.
And I have a little pug that I've treated
the last year or so as well.
So we still do see this cancer in small breeds.
There's a little thing that you can sort of remember
about where are the most likely places
that we're going to see it.
So towards to knee, and away from the elbow.
So, away from the elbow
is gonna be down by the wrist of the dog,
that's the distal radius,
and by the shoulder, and that's the proximal humerus.
And then, towards the knee is going to be
at the end of the femur bone, at the top of the tibia bone.
And then we also see it,
that phrase is not gonna help us remember,
we do also see it by the hock, which is the ankle.
What is your dog likely to present for with this?
The most common symptoms that they are going to have
is lameness and swelling in the areas that we talked about.
Again, I will remind you
that we will often see this in other areas.
Like you can see it in the ribs.
The most common non-limb locations that we'll see it
are the jaws, the upper and lower jaw,
the mandible and the maxilla, and some of the facial bones.
Those are the most common non-limb locations
that we'll see it.
Only about 3% of dogs are actually gonna present
with a fracture of their leg,
and that's not a negative prognostic factor.
What the heck do I mean by that?
What I mean by that is those dogs don't do worse.
It is very traumatic because a family
will have to make a decision more quickly
about what to do about that.
But those dogs don't statistically do worse
than if they didn't have a fracture.
Pathologic fracture means that they fractured their leg
because of the cancer itself.
So normally, it's because
that cancer is eating away at the bone.
It makes the bone less structurally sound,
and they're likely to fracture.
So, it could be getting in and out of the car,
running to get the door.
So, just doing something pretty sort of innocent
will lead to that fracture.
Again, this is a cancer of large and giant breed dogs,
so I always remind veterinarians,
if you have a large or giant breed dog
that has lameness or swelling
in one of those high risk areas, towards the knee,
away from the elbow, in the hock, which is the ankle,
it's osteosarcoma until proven otherwise.
And I really encourage you as a pet owner,
if you know that, and again,
especially in a high risk breed,
you wanna go to your vet,
and you wanna ask for X-rays that day.
If you're not going to do it,
because they're gonna get better on pain meds,
'cause the pain meds will decrease the pain,
I really encourage you to go back in a week or two.
'Cause usually the pain and the lameness
does not completely go away,
and get radiographs really, really soon.
I see all too often that it's a month or two later,
and it can really make an impact on these cases.
Your veterinarian is gonna tell you, typically,
that they're very highly suspicious,
based on the X-rays, that your dog has osteosarcoma.
'Cause there's some pretty common features
that we get back on the radiology report.
That's typically when you are often to be referred to
a surgeon, or a board certified oncologist like myself.
A big question is do we just go ahead and do surgery,
and what test do I need to do.
So, if you guys have followed me at all,
you know that I'm a huge fan of doing aspirates.
So, that is when we stick a needle in a tumor,
and collect some cells,
and look at them under the microscope.
And so, in general, like for skin masses,
for skin lumps and bumps, again, huge advocate,
sticking that needle in, collecting some cells,
and looking at it under the microscope.
And, this is sort of an exception to the rule.
So, if I have a dog that is a classic breed,
so large and giant breed dog,
classic location, classic radiographs,
in an area where there is not much fungal disease,
I am typically comfortable with going straight to surgery
without doing cytology or biopsy.
And obviously, I want you to ideally meet with a surgeon,
and meet with a board certified radiologist.
Vetspecialist.com and vetcancersociety.org,
we'll put the links below,
are gonna help you find a board certified specialist.
So, the internet, Dr. Google, YouTube
is never meant to replace seeing a doctor
and having a specialist meet you, go over your pet,
and go over their medical records.
I'm just trying to give you an overview,
and make it a little less scary,
and give you some knowledge and information,
so you feel empowered.
'Cause I know how scary it is
to find out that your pet has cancer,
or might have osteosarcoma.
But, before you go to surgery,
what I think is not up for question, not debatable,
is to do three view chest radiographs, or a CT scan.
But practically most of the time,
we're gonna do chest X-rays before you go to surgery.
Why?
Because we wanna make sure
there is not detectable nodules in the lungs,
because that would be a reason maybe not to do amputation.
So, talk to your specialist about whether or not
you need to do an aspirate or biopsy of the leg
to confirm osteosarcoma before going to surgery.
But do those three view chest radiographs
before you go to surgery.
Because if there's detectable spread,
then it's time to pause, stop, and have a conversation.
90% of dogs have a microspread,
meaning that we know that there is microscopic cells,
microscopic osteosarcoma cells in the lungs
that we can't yet see on the chest X-rays,
and that's why we have to worry about
that second battlefront that I talked about
in the beginning of the video.
That's why surgery alone is not curative,
because those cells,
those microscopic cells are in the lungs,
and that's why chemotherapy has actually been shown
to be beneficial in extending their survival time.
And chemo's really well tolerated,
which I want you to watch my other videos,
and the watch the treatment one as well.
Of course we're gonna do some blood work.
One of the things that your vet
and your specialist are gonna talk to you,
they're gonna look at something
called an alkaline phosphatase.
If that's elevated, it's not as good as it's normal.
Would I not do surgery
if the alkaline phosphatase was elevated?
No, I still would do surgery.
So that's different than X-rays.
You can do a CT scan.
It's gonna be a little bit more sensitive.
It's gonna be able to pick up smaller nodules in the lungs.
So if you really wanna know,
you can talk to your specialist about the pros and the cons
of chest X-rays versus CT scan.
The negative of a CT scan is it requires anesthesia
and it's more expensive.
In general, ultrasound to look for spread,
not as needed as it would be for some other cancers.
But again, if I have something wrong on the blood work,
maybe some kidney values elevated,
or some of the other liver values,
I'm gonna talk to the pet parents about possibly doing that.
But again, chest X-rays, and blood work,
and urinalysis, super important.
Ultrasound, aspirates, biopsy of the bone, those are things
that you're gonna talk to your specialist about.
So that's pretty much what, you know,
the tests that we're gonna do beforehand.
The other thing that you're gonna wanna talk
to your specialist about
is possibly aspirating a draining lymph node.
If the lymph node that drains that bone
is positive for spread,
that's a negative predictor as well.
So then, we're gonna focus on treatment,
and that's gonna be our next video.
So, be sure to look for that one.
I hope you found this helpful.
Put your questions below.
Be sure to check out the osteosarcoma playlist.
There's also a ton of information, guys,
on my Facebook page as well.
Each month, you'll find that we do a different tumor.
And, so we have a whole set of information for osteosarcoma.
In addition to the graphics,
there is information below those graphics as well.
So you can find that there.
And a lot of that information
will be similar information here.
So again, you can find that information there.
Hope you found it helpful.
Thank you so much for joining.
Be sure to comment.
If you haven't yet subscribed, please do that.
I'd be super appreciative. (upbeat music)
I appreciate your time.
I hope that you found this helpful.
Let's kick cancer's butt.
And remember, tripawds rule.
Oh, guys, just in case, I'll remind you in the next video,
but I have a separate video, a separate vlog,
we'll put the link below,
all about the difficult decision of doing an amputation,
and lots of my different patients that have,
and the high satisfaction rate.
So, again, that's a huge part
of the osteosarcoma decision process.
So, again, be sure to check out
that vlog on the decision to amputation.
Again, thanks so much for watching.
Kick cancer's butt.