- Find these lumps and bumps early.
Find out what they are before you go to surgery,
so that first surgery is the only surgery
that your pet needs so we can find out if it's benign,
find out it's malignant.
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Hi, welcome back to the vlog.
This is all about treatment options for dogs
with soft tissue sarcomas.
Be sure to check out the last vlog.
There'll be a link below where I give you five things
that you need to know about soft tissue sarcomas.
But today we're gonna be focusing on
the main treatment options
including surgery, radiation, and chemotherapy.
Don't worry, not every dog will need all three
but we're gonna highlight those.
There are some other treatment options as well
like electrochemotherapy.
So just a quick reminder that it is really important
that you talk to your veterinarian,
often a medical oncologist
and in many cases a surgeon as well,
who is gonna be involved in your dogs' care.
And they're going to be the ones to best be able to give you
specific recommendations about your dog.
This video is to give you an overview,
hopefully, just give you some information.
If you haven't yet gone to see the specialist
or you just wanna hear some information
about soft tissue sarcoma treatment options in general.
Let's break it down.
We're gonna start with surgery because that
is the most common treatment option for dogs
with soft tissue sarcomas.
As we talked about in the last video,
what's really important with dogs with soft tissue sarcomas
is that we know they have a soft tissue sarcoma
before they go to surgery,
that maybe with an aspart or may be with a biopsy.
And why that's so important is then we can plan
and do a wide surgical resection.
Depending on where that is on the dog,
that surgery may be done by your veterinarian
or they may recommend that you go see
a board-certified surgeon.
Some of these tumors depending on the size,
the location of your dog.
Do you have a large breed dog,
a small breed dog over the wrist, things like that
they may recommend if it's a challenging surgery
that you go see a board-certified surgeon.
So we'll have some links below
and where you can find a medical oncologist
and a board-certified surgeon as well.
So surgery is often gonna be the main way
that we remove these.
How big does a surgery be?
One of the main guidelines and I did mention this
in the last video as well is three centimeters
around the tumor, and a tissue plane
what's called a fascicle plane deep.
And I gave this example last time,
but here we'll just do a two-centimeter tumor.
And again, so three centimeters on each side
would bring that incision up to eight centimeters.
So, pretty big.
So, think about, that's gonna be different
if you have a golden retriever or Labrador
and it's over their side, as opposed to over their wrists.
And so why the importance of finding these tumors
when they're small.
So we have to think about the size of the tumor,
how big the dog is, the patient size, the location.
Is it over the face?
Is it over the limbs?
Is it over the trunk of the body?
And then the tumor characteristics.
Is it soft?
Is it freely movable?
Is it deeply attached to underlying structures?
Is it between pop heads and things like that.
So, on the neck area?
Are there vessels, other nerves that they're worried about
that could be involved anatomically at that area?
So those are all things that are going to play
into the decision for surgery.
The different types of surgery, the way that we often
will break it down as a marginal surgery,
which is often not going to get those wide margins
that we need to prevent recurrence.
A wide surgery, which is often the goal
to get those wide surgical margins to prevent recurrence.
And then a radical surgery and that would be something like
doing an amputation.
So those are the sort of three main categories
that we think about and that you're really talking about
with your veterinarian, the medical oncologist
and or the surgeon.
So typically the goal with surgery
when we get back our report is that
we get wide clean margin.
So my job and the surgeon's job and your veterinarian's job
is to look at that biopsy report.
We don't wanna see just one millimeter,
we wanna see multiple wide margin.
So, definitely there is some shrinkage
when the mass is taken out of the dog
and dropped into what's called formalin,
which is the liquid that we use to fix the tissue.
So even if they measure three centimeters,
we don't often see three centimeters
measured on the biopsy report.
But we don't want one millimeter
so we're looking for wide and clean margins.
So on that biopsy report, we're looking for grade
as I talked about in part one.
Please go watch that.
We often will get a tumor subtype,
but a grade is very important, mitotic index
and the depth of margins,
or the size of the margins are really important.
And that is really gonna help me make
additional recommendations.
If I have a lower intermediate grade soft tissue sarcoma
with clean and wide margins, that may be all the dog needs.
And those dogs will have a wonderful prognosis
and can go on and live years
and not need any additional surgery.
I usually will see those dogs back every three months
from monitoring, which we're gonna feel the area.
I always will have the owners be feeling the area
where the scar was.
And we'll usually do chest x-rays.
I personally do chest x-rays every three months
for the first year.
And then I start spreading them out to every four months
and then ultimately every six months.
But these dogs can have a really good prognosis,
very low metastatic rate.
I think I mentioned in part one, for grade one,
it's about 10%.
For grade two intermediate grade about 10% to 20%
and then high grade about 20% to 45%
depending on what study you look at.
So those five grade ones are gonna be the ones
that we're gonna recommend chemo.
So why clean margins?
We are not gonna recommend additional therapy for the low
and intermediate grade.
For a higher grade one with widened clean margins,
we're gonna recommend chemotherapy.
In the next section we'll talk about what do we do
if the margins were not clean for those low
and intermediate grade soft tissue sarcomas.
All right, so what do we do if the margins
were a couple of different phrases.
Dirty, incomplete or narrow for those
low and intermediate grade soft tissue sarcomas.
First thing is what is the location.
If it was over the side of the chest
and there's a lot of skin there
and the surgeon and I think that it's reasonable to go back,
often we'll do a second surgery.
Another term for that would be a scar revision.
The alternative option to that if they can't go back,
this will often be the case if it's over the wrist
or over the end of the leg, the distal leg,
front and hind leg, there's just no more.
There's no more tissue left,
they can't remove any more tissue,
is to do radiation after surgery.
So post operative radiation.
And this has very good success rates
for dogs with soft tissue sarcomas.
Going back to what I said in the first video,
dogs with low and intermediate grade
soft tissue sarcomas that have good local control,
even with surgery with radiation
have very good long term survival.
So ideally, if we can get clean wide margins with surgery,
that would be great.
But surgery plus radiation, so you need to do surgery
to get down to what we call microscopic disease.
Then follow up with daily radiation usually given daily,
over four weeks with the weekends off.
If you look at those dogs for the first couple of years
90% still have good local control.
And then in one study by one of my mentors,
on my residency, 75% local control five years after.
And five years is a really long time
when you think about the dog life, right?
How many years that would be for you or me
when we're talking tumor control.
So just really good long term control.
Yes, you still need to do surgery first to get them down
to microscopic disease.
In general radiation is less effective for bulky disease.
You'll hear the word gross disease, macroscopic disease.
So in general, ideally you wanna remove as much tumor
get them down to scar microscopic disease,
we usually let that heal.
At usually around the two week mark
is when they're gonna start radiation.
So if you have a dog that has incompletely resected
soft tissue sarcoma, post operative radiation
is a great way to prevent the tumor from coming back.
An alternative option would be the wait-and-see approach.
I don't really love that.
When do these tumors usually grow back
is a question I often get.
They're usually pretty slow growing,
so often it's gonna be around the six month mark.
Could be in three months could be in nine months.
There's always ranges around those numbers.
But ideally, I would wanna be thinking about
something like post operative radiation.
There's gonna be lots of different variations.
Some people will talk about for one on a leg
doing an amputation.
That's gonna be a radical approach to this.
I would personally rather do surgery
with post operative radiation,
but there's gonna be a lot more expense there.
You're gonna need to go to a radiation facility,
but it saves the dog's leg.
So I want you to know that this is a general overview.
But again, talk to your veterinarian,
talk to your medical oncologist, talk to your surgeon,
talk to the radiation, oncologist as well
and see what the different options are for your dog.
But in general surgery, wide clean margins.
If you can't get wide clean margins,
we can follow up with radiation.
Radiation is most commonly gonna be done after surgery
in some cases they can do before but in general,
we're gonna be doing after.
There is a newer type of radiation
called stereotactic radiation for bulky disease.
Again, if it is deemed to be non surgical,
that would be something you could potentially
talk to a radiation oncologist about.
We do that for some other tumors like nose tumors,
brain tumors, bone tumors and things like that.
But soft tissue sarcomas usually we're doing the combination
of surgery first and then radiation most commonly.
There are some newer studies
looking at stereotactic radiation, but again,
talk to your radiation oncologist about that as an option.
So which dogs with the soft tissue sarcomas
need chemotherapy.
In general, the dogs with soft tissue sarcomas
I'm gonna recommend chemotherapy
are gonna be the high grade ones.
So we get back our biopsy report.
Still going to remove them.
We still wanna get local control
so that we wanna get those one clean margins.
Potentially if we didn't incomplete,
if we had incomplete margins or dirty margins,
we would do, we would still recommend radiation
if they had a positive lymph node
for metastasis or high grade.
Those would be the dogs that
I would be recommending chemotherapy.
Usually a doxorubicin based chemotherapy protocol.
If they had metastases to the lungs,
we could potentially be considered chemotherapy.
I'll put a link below.
I have a couple of videos on what do I recommend
for dogs with metastases.
It's what I recommend, please talk to your oncologist,
your veterinarian about what they recommend.
I usually do not use a doxorubicin-based protocol
for dogs with detectable metastasis in the lungs.
But please talk to your specialist
about their individual protocol.
I do wanna make a note about metronomic chemotherapy
and I'm gonna put a link below as well
because I have a video about that.
So metronomic, is low dose oral chemotherapy.
And there was a study which used this type of chemotherapy
for dogs with soft tissue sarcomas
that were incompletely resected,
so the low and intermediate to prevent working recurrence.
And that was a very new way to think about using metronomic
or using chemotherapy in general,
because when I was a resident we were really taught that
if a dog had an incompletely resected soft tissue sarcoma,
especially going up the example over the wrist
over the ankle, or the end of the legs
where you can't usually go back and do more surgery,
radiation was really just the standard of care
to prevent those tumors from coming back.
But metronomic, low dose oral chemotherapy has been shown
to delay recurrence.
Not as good as radiation but can delay recurrence
and that usually combines a nonsteroidal anti-inflammatory
with low dose cyclophosphamide.
So that is a potential option.
Those dogs are usually on that oral chemotherapy long term,
and there are side effects with that.
Cyclophosphamide can cause sterile hemorrhagic cystitis.
I'm not gonna go through all that.
We're gonna put a link below
so you can check out that video.
But in general, most dogs with a low and intermediate grade
soft tissues sarcoma with complete margins
don't need chemotherapy.
Again, this highlights the importance
of finding these tumor early.
Please do your lump and bump check on all your dogs,
all your cats.
It is so important.
Check out vlog number 73 where we show you
how to do that lump and bump exam from nose to tail,
skin maps, calipers.
All the things that you need to make sure
that you are finding these lumps and bumps early.
Find out what they are before you go to surgery,
so that first surgery is the only surgery
that your pet needs so we can find out if it's benign,
find out it's malignant.
And if your dog has had a soft tissue sarcoma,
include in that monthly lump and bump exam,
feeling their scar, feeling for recurrence,
and just make sure.
Because, some dogs with a clean resection,
with a clean wide margins, their tumors can still grow back.
And I'll be honest,
I've had dogs that have had incomplete margins
and their tumors do not grow back.
So nothing is a guarantee in the world of cancer.
We just have to do our best to be diligent
and stay on top of it.
That's it guys.
Thank you so much for watching.
I hope that you found this helpful.
Please remember to talk to your veterinarian.
Please meet with a cancer specialist
and please talk to a surgeon as well.
Find out what's gonna be best for your dog.
Please don't forget to subscribe
and I'll see you at the next video.
Thanks so much for watching.
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