# Dual Cancers Make a Very Complex Situation



## WeJustLoveGoldens (May 7, 2014)

Our 12 yr old Holly has confirmed Insulinoma (islet carcinoma) as well as adrenal carcinoma (also called cortical carcinoma). Besides being very sad, we are overwhelmed by the complexity of our girl's situation. We spent hours and hours summarizing internet research to prepare for our meeting tomorrow with the surgeon (staples out too tomorrow) and with primary care vet and new oncologist later in the week.

As some here may know, insulinoma produces excess insulin resulting in low blood sugar. While the pancreas tumor was excised, there is fair chance the symptoms will return. Meanwhile, the adrenal tumor, initially producing Cushing's symptoms, now may yield to Addison's disease. The infected adrenal was removed, but one article suggested the remaining adrenal gland might have atrophied, thus cortisol production is down. 

The symptoms of Addisons (at least the low blood sugar one) are the same as the insulinoma (high insulin) so it can become a real challenge to manage diet, pills, shots. I am sure we will get this worked out, but right now, it is a little mixed around. Sorry also for this seems like complaining. Some searching we did did not show us anyone with this combination of cancers, so maybe we can add to the pool of knowledge as we travel this road with Holly.

If anyone has any thoughts on this, we would appreciate a note. Meanwhile we'll report back once we learn more from the surgeon.

Thanks much,

Ken & Betty for Holly

(more pictures coming once we get a minute to prepare them)


----------



## Rookie's Dad (Feb 19, 2014)

Sorry, I have no experience in this area, but wish you the best of luck and hope someone on the forum will know something about it. Sending positive thoughts!


----------



## JeanieBeth (Jul 13, 2013)

Wow. It sounds like you're being proactive by researching and taking Holly to specialist. I highly recommend looking at diet and ways to build up her immune system. Have you read The Dog Cancer Survival Diet.com? Dancer's oncologist highly recommend K-9 Plus through TDCSD website. I thank you for sharing Holly with us and look forward to seeing pictures of her! How old is she and how is she feeling now? You've come to the right place for support. I'm so sorry Holly is facing this terrible dilemma. Hugs and sending prayers for Holly. ?

Sent from Petguide.com Free App


----------



## hubbub (Jun 28, 2011)

Fingers, toes and paws crossed that your team is able to quickly piece together the puzzle of providing Holly the best plan. She's lucky to have you guys


----------



## hubbub (Jun 28, 2011)

How's Holly doing?


----------



## WeJustLoveGoldens (May 7, 2014)

hubbub said:


> How's Holly doing?


Yes, thanks for the followup. She is doing fine and we were waiting to post until our first visit with the oncologist this afternoon. We will post the results of that visit tomorrow.

Meanwhile, we learned some important things from the surgeon that may be of interest to you and others.

Her immediate prognosis is pretty good as the pancreas tumor was removed and the adrenal tumor was completely removed. Little overt evidence of spread but the surgeon emphasized that insulinomas can be grain-of-sand-sized tumors and will easily be carried other places in the bloodstream. So I suspect any chemo will focus on that aspect.

Meanwhile, this learning: with one adrenal gland subject to a tumor (adrenal carcinoma), excess corticosteriod is produced (leading to Cushing's), and the other gland (there are two) sort of shuts down. Once the affected gland is removed (temporarily leading to Addison's), the other one requires 5 to 10 days "to get going again". Thus they prescribe steroids (prednisone) tapering over 10 days or so.

So things are pretty normal right now. Incision healing nicely, back to normal diet, soon to start short walks. We will know more after today's visit with the new vet.

Thanks,

Ken and Betty for Holly


----------



## ang.suds (Apr 1, 2014)

Ken, Betty, and beautiful Holly...sending hugs and prayers your way!


----------



## WeJustLoveGoldens (May 7, 2014)

*Oncologist Meeting Results*

I guess we had the best result we could have hoped for from our meeting with the vet oncologist. She had very hopeful and helpful advice for us and we left very optimistic.

As a review, Holly had islet cell carcinoma (insulinoma) and adrenal carcinoma. Both masses were removed; "microscopic" cancer cells probably remain. Chemo drugs in general and the one she recommends in particular produce results in proportion to the cancer cells present. Thus, if mass is still remaining, then there are billions of cells and the chemo is less effective in achieving remission. Microscopic cancer, or smaller numbers of cells, is easier for the chemo to remove. Thus remission is possible. 

Palladia is a new class of chemo drugs which, she says, will work on islet cell as well as adrenal carcinomas. Thus, one oral (no IVs, no hospital stays ) drug will go after both cancers. Diarrhea is the main possible side effect, not present all the time. Dogs are mostly "normal" while on Palladia.

Measure of effectiveness is to monitor blood sugars and do ultrasounds. No evidence of return in 6 months = conclusion of remission. Cost, by the way, is $25 per dose or about $280 per month. Plus lab and ultrasound costs.

All in all, we are very happy and pleased with the direction recommended by the oncologist. Holly starts the pills next Wed.

Picture below is cute baby photo we like.....

Ken and Betty for Holly


----------



## hubbub (Jun 28, 2011)

I was thinking of Holly this morning and am glad to see your update (and sweet picture)! Fingers, toes and paws crossed for you guys :crossfing


----------



## JeanieBeth (Jul 13, 2013)

This sounds very promising! I would take it as good news and feel very hopeful for remission! Sending a prayer for Holly's full recovery! She was an adorable baby. I just want to kiss her face! 

Sent from Petguide.com Free App


----------



## JeanieBeth (Jul 13, 2013)

Holly! Just stopping by to say we are wondering what's new and sending you hugs~ Jeanie, Brie and Dancer

Sent from Petguide.com Free App


----------



## WeJustLoveGoldens (May 7, 2014)

*Holly's 3 Month Checkup Fine*

We are so sorry for not checking in sooner. So many things to do in the summer. We were just about to tell you and everyone that Holly just had a three month ultrasound and blood check and all results were completely normal and clear.  

The chemo regimen continues. This is the most simple, effective, and perhaps the cheapest approach. We give Palladia pills three times a week, at dinner. Any signs of diarrhea is a bad sign, controlled with some antibiotic. The choices seem grim if the Palladia is not tolerated. Next best, I was told was something that needed to be injected and was over $500 per injection. So, we root for the Palladia to continue to work and be tolerated.

Thanks for the reminder, we have to do better at checking in and seeing how others are doing.

Ken and Betty for Holly


----------



## JeanieBeth (Jul 13, 2013)

Yay Holly!! She looks great! Thanks for the update, so happy you are enjoying the summer with beautiful Holly. Please give Holly nose kisses from Jeanie, Brie and Dancer 

Sent from Petguide.com Free App


----------

