# Mast Cell - Excise and leave it be or full diagnostics/Oncologist



## Ladyluck (Nov 3, 2012)

Maybe an odd question, but I'm just putting some pieces together on a recent MC -G2 on my lab and finding that different vets and owners approach Mast Cells differently. I'm hoping those of you that have gone through this will share your experiences and thoughts. 

A little background, my lab had her nipple removed and the biopsy showed MC grade 2. I'm waiting on the proliferation panel results. While I'm waiting for the results, I'm researching. My vet gave me 2 options, to leave it be, or to order a proliferation panel and work with an oncologist. Seems like a pretty big gap between the two.

At this point, I'm letting the test results lead the way and hoping for the best.


For those of you who had mast cells removed, when your pet was diagnosed, did you :
A)determine surgery was sufficient and worked with your vet to keep an eye on it?
B) order a full work-up and see an oncologist?
c) seek post surgery treatment?

Prednisone?
Radiation?
Chemo Therapy?

What was your dog's age? What are you glad you did? What would you do differently?

Thanks in advance.


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## the S team (Dec 8, 2009)

So sorry you are going through this. We too are battling MCT. Scout is 9, will be 10 in June, and was diagnosed in October. He had a tumor on his face. The vet told us we needed to surgically remove it and we did. It was biopsied and identified as stage 2, high grade. They did not get clean margins in the surgery due to location. 

Because of this, we started a Benadryl, chemo, prednisone protocol. We also changed his diet and added protein and got rid of grains. The vet initially thought if we had scout 6 more months it would be great. We are at 6 months right now. 

He finished his last chemo treatment a few weeks ago and we stopped the prednisone too. He'll have bloodwork in 60 days to see where things are but we've started to see him go downhill quite a bit the last couple weeks.

I'm glad we did the surgery and love that we've had more time than I thought we would but I'm quite torn on all the rest. I'm struggling big time right now facing the inevitable but when is enough enough for treatments? We each have to answer that ourselves. I can't bare the thought of losing him so we just love him and enjoy him as much as humanly possible and treat each day as a gift. I feel immensely guilty about him being treatment free now but in my more rational moments it is the right decision. 

I'd be happy to answer any questions you might have as MCT has been a part of our lives every day since October. 

We recently had a scare where he opened up his scar and he is itching like crazy these days (not a good sign because MCT is caused from histamines) but we have started high dosage of Benadryl again. 

There is also a group on Facebook for holistic care of MCT. 


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## CITIgolden (Mar 9, 2013)

Ladyluck said:


> Maybe an odd question, but I'm just putting some pieces together on a recent MC -G2 on my lab and finding that different vets and owners approach Mast Cells differently. I'm hoping those of you that have gone through this will share your experiences and thoughts.
> 
> A little background, my lab had her nipple removed and the biopsy showed MC grade 2. I'm waiting on the proliferation panel results. While I'm waiting for the results, I'm researching. My vet gave me 2 options, to leave it be, or to order a proliferation panel and work with an oncologist. Seems like a pretty big gap between the two.
> 
> ...


Has the tumor already been removed? Completely? 

Not speaking from personal experience, but from a medical standpoint MC-type tumors, especially those histologically classified as grade II should never be left for observation. I dont mean to scare you but. Unless the dog is too old in poor health or the owner is unable to follow through the treatment. You should really not consider that as an option.

MCTIIs exhibit such a high degree or bio-inconsistency (I.e. can be benign to highly methastatic) that without more reliable prognostic indicator, you just can never be completely sure what will happen. The proliferation panel is based largely on the c-kit receptor protein expression on the mast cell but unfortunately still inconclusive, it is however highly recommended you do it.

The best treatment is surgery, radiation is recommended based on the margin determination post surgery (dirty or clean) - but is more often than not done because MCTs have a tendency of recurring in dogs that had them. Chemo consideration is really made if the surgery did not remove the entire mass, or theres suspicion of metastasis, and not needed or approrpriate in every case.

Prednisone would usually be given in conjunction with another treatment, most likely chemo. Some argue it's overused, I don't want to debate, your oncologist will know - just to play the devil's advocate ask if another less potent medicine would work, sometimes the answer is yes or doesn't hurt to try an alternative, with lymphomas and some other types of cancer, there's not much alternative and don't get me wrong prednisone works and is effective for what it's meant.


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## Ladyluck (Nov 3, 2012)

S Team, Thank you for sharing your experience. I am so sorry to hear what you're going through. My heart is breaking for you. It sounds like the the time you've had with Scout since the diagnosis, has been relatively good, aside from the treatment. Measuring quality of life is, in my mind, key to determining how far to go forward treatment. In our hearts, we tend to know when it is enough. I will keep you in my prayers. 

The biggest challenge for me, so far, has been educating myself on not only the disease, but the diagnostic options. The first 24 hours was mostly coming to terms with what I had been told. Leann is 5 years young and my heart dog. I honestly didn't understand that term until I met her and I can't imagine life without her. I haven't even begun to think about treatment options, though I think we will mostly likely end up doing radiation treatments. 

I'm finding that my vet, though competent, is not one to get heavily involved with cancer. His philosophy is that oncology is best left to the experts and he will work with them. From my perspective, I'm looking for a little more guidance. I haven't decided whether to consult with another vet in the practice, or move Leann to the practice my other dog goes to. It's hard for me to consider working with a vet who is not guiding me outside of the biopsy and panel, as I'm finding there are quite a few tests still to be performed before I meet with the oncologist.


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## Ladyluck (Nov 3, 2012)

CITIGolden, I appreciate your feedback, especially from a medical perspective. The next steps are daunting from both an educational and financial perspective. The prolif panel was quite expensive and I understand I still have x-rays, blood work and sonograms ahead of me. I am fortunate to be near a few oncologists. I am trying to determine how to keep the diagnostic test costs down, while providing her with the care she needs. 

Based on the lab report, the margins were clean. (so - yay for that). 

If the results for the proliferation panel are considered inconclusive, was it really worth the expense? Or would the money have been spent better elsewhere?

What are the most important tests at this time? Should I go ahead and make the oncology appt, before the radiology and blood work are performed? Is there a reason, the MC was not communicated to me as high or low grade? These are the questions I am struggling with at the moment. Questions I would like to pose to my vet, but not certain that he has the answers.


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## IndyBindy (Nov 4, 2011)

Hi there- from the labbie forum! This is a great forum...everyone has such great advice. Glad you found it. 

Anyway, I'll share a bit more of my experience. It was very helpful for me to go into the oncologists office with digital x-rays and ultra sound images. With that, they were able to quickly make decisions on how far the disease had progressed and what the best plan of treatment would be. Blood work doesn't matter as much, because if you start any treatment, they will be checking blood work again anyway. So helpful, yes, but be prepared to repeat it. 

I will tell you that oncologists are very helpful, because cancer is all they deal with. MCT is also a very common type of cancer so they should have lots of options for you. Your oncologist will be able to better answer all the questions you have. I'm not sure that I'd waste time and $$ consulting with another vet, because they will still most likely refer you to a specialist. 

If you have any more questions just ask. We are just a few weeks ahead of you in this whole process (although with a different cancer). It was so much to take in the first couple weeks. I feel much better now, because I've learned about all of our options and have a plan.


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## Ladyluck (Nov 3, 2012)

Hi Indy, 

Yes, it's me from the Lab forum. This is kind of how I flush things out, getting as much feedback as I can..... I'm kind of where you were a few weeks ago. More questions than answers. I do need to proceed carefully, as the financial impact will definitely be a challenge.

The issue I'm having, I guess, is that I don't feel like I'm getting the guidance I need from her vet. I have too many questions and feel I need my vet's full support to move forward wisely. I called my other dog's vet, since I already have an appt tomorrow to get my setter's stitches out, I asked them if I could include a Q&A on Leann's situation. They appear to be more knowledgeable of the process, so I may utilize them to schedule the remaining tests and help me work through this intelligently. They may also have a specific oncologist that they have a relationship with. 

It sounds like the xrays and sonogram are really all that I needed, and not so much the proliferation panel that my vet recommended. This is kind of what I feared, spending money unnecessarily on tests that will affect the outcome.


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## IndyBindy (Nov 4, 2011)

Glad you have another vet that you can work with! Some universities are also able to do phone consultations with your regular vet, to advise what tests are needed or for minor treatment. Not quite as good as getting first hand advice, but super helpful! 

Another option- when we met with our first oncologist, she suggested tests that they would need to stage the cancer, and suggested an additional surgery. I was able to take those suggestions and get them done at my regular vet, then I emailed her results. Oncologists will definitely be open to working with your regular vet.


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## CITIgolden (Mar 9, 2013)

Ladyluck said:


> CITIGolden, I appreciate your feedback, especially from a medical perspective. The next steps are daunting from both an educational and financial perspective. The prolif panel was quite expensive and I understand I still have x-rays, blood work and sonograms ahead of me. I am fortunate to be near a few oncologists. I am trying to determine how to keep the diagnostic test costs down, while providing her with the care she needs.
> 
> Based on the lab report, the margins were clean. (so - yay for that).
> 
> ...


Each case is different. I know that's not the answer you want to hear. But the really good news is that the margins were clean - so that's more than well spent money. 

The reason for getting as far as possible in making conclusions about MC is to determine where it falls on the grade range, benign or not. It's not about necessarily low or high grade, it's just about determining whether the MCTII has potential to be malignant, in which case you would consider chemo, or depending on the tests and complete evaluation another treatment or palliative care. 

Your traditional vet, and I don't want to generalize, will usually not understand the cancer. The same way people would seek a specialist is the case with dogs as well. I think you should speak with the oncologist and ask what they think would be the best course of action given your situation. You may skip some tests and they could recommend a course of treatment.

It's obviously tough and impossible to diagnose anything online. I think you've spent your money well removing the tumor and getting the tests to ensure there is no malignancy. After that point, you really need to speak to a specialist. I don;t think you need to spend money on a visit, you should be able to ask them for an opinion for free or your vet should.


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## the S team (Dec 8, 2009)

I will echo several things CITIgolden has said. Clean margins are a great sign so you did well with surgery and removal. I would also hope that an oncologist or other vet would give you an opinion or advice before you chose whether or not to work with them. For me, the next big question would be if it has metastasized elsewhere. 

For us, we didn't go overboard on lots of diagnostics minus the pathology report post surgery and full body x-rays. Scout had bloodwork every couple weeks on chemo and that's the only diagnostic we've used since surgery. But like CITI said, mast cell rumors can be quite varied so every situation and treatment plan is different. For us, had we gotten clean margins Scout would have simply been watched carefully. 

Keep posting and asking questions. I know it took us awhile to get our minds around the whole thing but once we had our initial plan it did get a bit easier. Trusting your vet and your gut is a. Of part of all of this and if you are not 100% behind this vet then I really do hope you get some other opinions. 


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## grls.volunteer (May 3, 2013)

Like many of you, I have been dealing with MCT's in my golden for the past 5 years. My Golden, Mica, is almost 11 ½. 

1st tumor: at 6 1/2 (right after we adopted her) on her flank. It was a grade 2, margins were clean. My vet and I both felt comfortable with the clean margins. No oncologist consulted. I travel a lot and our Goldens have 3 vets. All of them are well versed in MCTs and cancer. If you vet is not, I would question why.

2nd & 3rd tumors: at 10 1/2 in her hind leg. Grade 1. They presented as inflammation. We do not have an oncologist in the area we live. We went to Richmond, VA. The tumors were 1 x 4" and 1 x 3" and were attached to the muscle, therefore, surgery was not recommended. X-rays determined the cancer had not spread.

She had 8 weeks of vinblastine combined with benadryl and prednisone. One tumor disappeared completely and the other was reduced to 1/2" in diameter. One month later that we started her on kinavet ca-1, a drug that targets MCTs.

4th tumor: almost 11, on her flank. Grade 1, clean margins. We were 2500 miles away from Mica’s oncologist. Did a phone consult and both vets and I agreed to remove. No further testing done.

Because Mica is on oral chemo, we check her blood every 2 months.

A proliferation analysis (or panel) was never suggested to me. 

Although vinblastine treatment was very expensive, I am glad we did it. Mica was lethargic during the later portion of treatment and lost weight. She’s has never been a particularly active dog but her health (besides the MCTs ) is good. She has gained 6 lbs due to the kinavet ca-1 (she’s 66 lbs). She walks almost every day (about 1 mile), has good muscle tone and thoroughly enjoys life. 

Kinavet ca-1 is an experimental drug, you can research it. Palladia is another oral chemo used that specifically targets MCTs. Both are expensive. I did see one of the Universities was doing a trial with it for MCTs. Google MCTs, palladia (or kinavet ca-1) and trials. In the past we have worked with NC State and University of Colorado. 

I adopt older Goldens. Adopted one of Mica’s daughters last September (7) and another Golden (also related) in January (3 ½). Because of the cost of Mica’s treatment, I immediately got pet insurance. 

You didn’t mention where your dog’s MCT was or your dog’s general health. I do not think that age is a factor. If my dog is in good health, whether they be 4 or 12, I would treat. If money is an issue, there are sometimes clinical trials available.

Mica had 4 areas of concern 2 weeks ago. Vet aspirated, no cancer cells. I will continue to be vigilant and will treat if there is a reoccurrence.

One other resource: the Morris Animal Foundation. If you are not familiar with them, they are the leading research facility studying canine cancer. They have just started a Golden Retriever Lifetime Study that will follow dogs for 10-12 years. They may be able to provide information, suggestions. I have always found them to be helpful.

Good luck. Mica, the survivor, sends wags. Keep us posted.


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## Ladyluck (Nov 3, 2012)

Thank you for the additional replies. Very helpful information. I am relieved the margins were not only clean, but wide. The incision is healing beautifully and she is in fabulous health otherwise. 

The MC is from her top right nipple, next to her front leg. It started as an irritation, then swelled, cracked and bled a little. It responded well to anitbiotics and steriodal topical applications then came back as something just looking irritated and swollen. Since this is also where her harness rubs, I thought perhaps it was just irritated from wearing her harness so much and switched to another type. My setter's lumps (fatty) were all centered around her harness as well. I'm disappointed that it was not aspirated as part of her follow-up exams.

You make a very good point about health as opposed to age. It's interesting how our thoughts go immediately to age. I've had several conversations with friends, co-workers and family. The first thing they say is, 'if she was a few years older, you wouldn't have to worry as much.' While I understand that's where our minds automatically lead us, you're right, it isn't an age thing. Safe to say, the support I'm getting from these folks is mostly because she is young. They already know I'd do anything for her, but they can justify it because she's 5 yrs old,not a senior. 

I met with my other dog's vet this week (different practice). What a difference!!! He explained mast cell behavior, sonograms, xrays and bloodwork. Although he didn't get into the proliferation panel, he suggested it was useful in understanding the nature of her MC. He explained that though we will be doing the 3-sided xrays, the sonogram is also, if not more important, because cancer can travel to the spleen and liver, (just by the nature of the organs, and the toxins that flow through them). This is not something that I had even considered, but it makes sense. Needless to say, I will be working with him instead. I scheduled the additional tests with him and will pick up the biopsy and proliferation panels to bring with me for our next appt. 

In the meantime, I found a new lump in her neck they will need to aspirate. 

I can't say how much more relieved I am to have a knowledgeable veterinarian guiding me through the process. Her 'previous' vet is admittedly not knowledgeable. He said he focuses on what he does and does it well and leaves the complicated business of cancer to the oncologists. I get that, if that's the business model he chooses, it's just not going to work for us. I hate to switch from a good practice, (and aside from this, they have been great). In my gut though, I knew my setter's practice was better.

I will update soon.


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## Ladyluck (Nov 3, 2012)

Just a quick update. The mast cell panel results are in. C-Kit identified her cells as low proliferation, but because the mutations are "wild" and the gene mutation status was identified as Exon 11, the prognosis is low-spread, high recurrence; "chemo/targeted tyrosine kinase should be considered". Looks like this could become a regular part of her health maintenance. (not a bad thing with all things considered)

The remaining tests are scheduled for Wednesday, and I will be conferring with an Oncologist after that.


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