# Gingival Fibrosarcoma Tumor



## Graywings (Aug 14, 2017)

*December 10, 2017 *It has been exactly one month since my Tucker went to the bridge. I kept a diary of his disease because there is little information available about this disease and its progression from a dog owner’s perspective. I hope that someone who is searching for information will find this helpful. 

*October 28, 2017* My beautiful 13 year old Golden Retriever is dying. He has a gingival fibrosarcoma tumor on the right side of his mandible. He had surgery to remove it in May, 2017, and it has returned and is growing. I will try to leave out as much emotion as I can and focus on his physical progression. I want this to be a layman’s report of the disease. But make no mistake, I love this dog. He is my heart dog.

Tucker has been a healthy, happy, athletic dog throughout his life. He never got sick, just some ear infections, flea infestations, etc. He developed a mast cell tumor on his belly in 2012, found early and removed. As he grew older, arthritis developed in his spine, and his hind legs became weaker. Early stage kidney disease was detected in August 2016, and I changed his diet and added more supplements.. Still, it was all manageable.

Tucker has been swimming twice a week in a pool at a local dog training facility since January 2016. It was there one day in April 2017 that his swim coach, Jackie, noticed swelling and roughness on his gum line below one of his teeth. He had begun drooling months before that, but I didn’t think much of it. Tucker is a big dog with jowls, and I thought it was just part of his aging. I now realize the drooling was possibly an early symptom of his fibrosarcoma. 

Tucker has been seen fairly regularly by the same local veterinary office for the last six years. I waited a couple weeks - much to my regret - then finally took him in to have the vet look at his mouth. She said the tooth at that site needed to be removed, and they could clean his teeth at the same time. I asked whether I should take him to a veterinary dentist. The reply was that they could easily handle it and it would be less expensive. So we went forward with the surgery on 5/5/17.

Following the surgery, the vet phoned me and said she was concerned. The tooth was removed, the jaw looked suspicious. A biopsy was taken. We would receive the biopsy results in a week.

The vet called with the biopsy results: a gingival fibrosarcoma tumor. She quietly said our choices were limited: make him comfortable and let him die or have surgery done on his jaw. The report:Source / History: Gingival swelling around lower P2 3 P4 with decreased bone density on dental radiographs and tooth displacement dorsally. Fragmented pieces of gingiva and bone. Bone difficult to obtain because soft and friable.

Microscopic Description: The submitted sections of gingiva and tissue contain a proliferation of neoplastic spindle cells proliferating in interwoven bundles and occasional storiform pattern. There is a supportive collagenous stroma. In some sections the overlying mucosa is identified and appears intact. In other samples small residual fragments of mineralized bone are embedded within the proliferation. Individual cells have oval to elongate nuclei, fine chromatin, small nucleoli and fibular eosinophilic cytoplasm. There is mild nuclear pleomorphism. Two per 10 high power fields. Very few scattered inflammatory cells are present.

Microscopic Interpretation (Biopsy)
Fibrosarcoma
Margin assessment: Incisional biopsies.

Comments: The microscopic findings are characteristic for a gingival fibrosarcoma. The cellular morphology and mitotic activity is consistent with a well-differentiated low grade tumor. Fibrosarcoma is a locally aggressive and invasive neoplasm. There is often lysis of bone leading to malpositioned or loose teeth. These tumors typically have low metastatic potential. Complete excision is often recommended if possible, but may be difficult depending on the location in the oral cavity and the degree of invasive behavior. The prognosis is guarded.​My ex-husband and I talked about what to do. We had had this conversation on a theoretical level for a few years. We felt it unfair to put a dog through a grueling medical treatment program he could not understand, especially an older dog. Still, I wanted more information. At the time, I believed I could get a more unbiased assessment from a veterinary school versus a veterinary dental surgeon in private practice, who would have a financial interest in doing surgery. I called the University of Pennsylvania and Virginia Tech on a Friday afternoon. With both veterinary schools I got caught up in phone trees and could never reach a person. I then called a veterinary dental surgeon in Virginia who referred me to another practice in Maryland, since his schedule was full.

I called the Maryland dental practice and explained the situation. My call was routed to the owner of the practice, who spoke with me at length. Without seeing Tucker, he urged me to go forward with surgical removal of the fibrosarcoma. He said not doing so would lead to a painful death, and he said that surgery could give him “a year, a good year.” I made a tentative appointment for a surgery consult with his partner - since he was leaving town - and sent them Tucker’s blood work, the biopsy report, and three photos of Tucker’s mouth. My ex-husband also spoke with him by phone. 

I later found medical research that is less optimistic than the “a year, a good year” prognosis of the dental surgeon: 
*When will I know if the fibrosarcoma is permanently cured?*
In dogs, survival after local surgical removal is sometimes as short as one month before recurrence necessitates euthanasia. Major, radical surgery can result in tumor-free time as long as 32 months but the median survival is only seven months, and only about one half of cases will survive beyond one year. Fibrosarcomas located closer to the front of the mouth are usually easier to treat so have a better prognosis.

Relapses are frequent (occurring in up to 60% of cases) and the 1-year survival rate in affected dogs is 40-50%.1 Local control of the disease often requires adjuvant radiotherapy; in such cases median survival is 18-26 months and the 1-year survival rate is 76%.​We met with the surgeon on 5/17/17, and the surgery would be performed the same day. Part of his right mandible was removed, and as a precaution, his right lymph nodes were removed. The surgeon explained they would need to cut down his canine tooth on the opposite side so he would not injure himself as he chewed. Tucker was there all day and was very woozy when we picked him up that evening. Apparently their surgical schedule was delayed that day, possibly due to a delay in arrival of the anesthesiologist. 

We were told we could stop there or we could consider having radiation therapy. They were very non-committal about which was the right thing to do.

Tucker came home that night and slowly recovered. I was pleasantly surprised that his jaw was not deformed. He looked amazingly normal. He was able to eat soft food, but it was messy. No problem for me.

The biopsy report came a week later. The cancer was removed but the margins were very thin, some less than 1mm. 

Tucker recovered, but the surgery had weakened him. His stitches were removed by his regular vet two weeks later, 5/30/17. I started him swimming again on 6/26/17 as I felt he was strong enough.

I wanted to know what was involved with the radiation treatment, so we had a consultation on 8/2/17 with a radiation specialist in Richmond. She examined Tucker and spent a long time explaining what radiation treatment would involve. We were fairly certain going in that we were not going to do the radiation, and the consult confirmed it. The travel and the radiation treatments and the repeated sedations would have been too much for Tucker. She mentioned palliative radiation for when the tumor returned. I found that consult very helpful and was glad we went, even though we decided against proceeding with it.

On 9/17/17, I ran my hand over his jaw and found a lump. I described it at the time as the size of half a golf ball. I was able to get an appointment at the vet’s office the next morning. One of the very experienced vets there saw him, and she immediately confirmed the tumor had returned. I asked questions through my tears - how long does he have, what’s going to happen. She had no answers for me.

So now I am watching the tumor grow that I know will take his life. I’m most concerned about his level of pain. He is a stoic dog. His teeth sometimes chatter, which the radiation specialist said can be a sign of pain. After meals mostly, he will rub his face against the sofa. He will bark to make me come to him; he wants someone with him. 

He had been on pain medication for months, 200 mg Tramadol per day even before the surgery for his arthritis. I had recently gotten a prescription for Gabapentin for the arthritis, but had not been giving it to him. The radiologist recommended giving the Gabapentin which would work with the Tramadol and help with neurological issues, and might help with the teeth chattering. The radiologist was right, the teeth chattering subsided with the start of the Gabapentin. 

He is able to eat and drink, breathe and swallow, and I assume that when one of those becomes difficult, we will have to say goodbye to him. Or if the pain becomes evident.

*October 29, 2017.* The tumor grows. I described it the other day as rounded, about the size of ⅓ of a baseball. Today, it feels like I was cupping it in my hand, egg-shaped. 

I’m seeing spots of blood on the carpet in the bedroom where he sleeps.

I called the surgeon’s office the other day, hoping to get some information on the progression of the disease. The man who answered the phone was kind but not helpful. He gave me the usual platitudes about making Tucker comfortable and to give him anything he wants. 

I search the internet for forums that have any information on canine gingival fibrosarcoma. Generally you can find someone who has been through the disease with their dog. But I can’t find any personal experiences with this disease, even in a Golden Retriever forum. Goldens are heavily represented in clinical research reporting. 
*Are fibrosarcomas common?*
In dogs, oral fibrosarcomas represent between 17 percent and 26 percent of all mouth tumors. A quarter of these tumors are recorded in dogs less than five years of age, with some even occurring in dogs less than a year of age. Larger dogs, particularly Golden Retrievers, are more predisposed to develop fibrosarcomas than smaller breeds. Tumors are also more common in male dogs and can occur on the palate (roof of the mouth) and, occasionally, in the tongue. 

*Histologically low-grade, yet biologically high-grade, fibrosarcomas of the mandible and maxilla in dogs: 25 cases (1982-1991).*
Abstract. Medical records of 25 dogs with histologically low-grade fibrous masses of the maxilla and mandible were reviewed. Most of the dogs had extensive clinical histories and had had previous biopsies of the affected regions, from which specimens were often interpreted as benign fibrous connective tissue. The most common breed represented was Golden Retriever (13/25 dogs, 52%). ​He is getting weaker. When Tucker resumed swimming in June after his surgery, he was swimming the regular 15 minute period. Last week he wanted out of the pool on Monday 10/23/17 at 9 minutes, and on Thursday 10/26/17 at 6 minutes. The length of his walks around town vary, sometimes a mile and sometimes around the block or just down the street to do his business. 

When Tucker developed kidney disease, I switched him from his dry food to a canned lower phosphorus food plus Honest Kitchen dehydrated food. He is now on the dehydrated food with whatever mix-in I have around; right now it is canned green tripe. The dehydrated food enables me to make his food soupy. However he still seems to like hard dog biscuits. Or maybe he just wants more food in any form. His weight has gone up to 94 pounds from the 90 pounds I try to maintain him at. 

*November 1, 2017 *On Monday, 10/30, Tucker walked out of the pool after four minutes. Jackie, his swim coach, coaxed him back in and he did another couple of laps and got out again. Until recently, he would swim the entire 15 minute session.

Last night, he wanted to get up on the bed, something he has not done in months and months. I manhandled him up and he stayed until morning, It was so great having him there again. There were blood stains on the duvet. It doesn’t matter.

Today I called a local holistic vet and was able to get him in for an appointment. She recommended several supplements that I began using this evening - a mushroom blend powder, b-complex supplement, canna-pet biscuits, bone broth, and a vitamin-like substance known as IP-6, inositol hexaphosphate, which possibly could slow tumor growth. She also suggested goat’s milk and a frankincense diffuser. She said the canned green tripe I am adding to the Honest Kitchen Keen is good, but dehydrated or fresh frozen are thought to be better. And some occasional beef would be good for his muscles. 

The vet said I will know when it is time; Tucker will let me know. 

*November 4, 2017* Saturday. Tucker is repeatedly forcing his jaw open, like you would do when you yawn. His dog license renewal for 2018 came in the mail today from the city. His rabies vaccine expired in July and I didn’t have him re-vaccinated.

*November 5, 2017* Sunday. I’m having difficulty separating out what is caused by the cancer versus what is happening to him due to old age and arthritis. The last two days have been dreary and rainy. Tucker has not wanted to walk or even move much in the house, and I of course am looking into his eyes thinking the worst. 

*November 6, 2017 *Monday. Last night he lay by the side of the bed, and in the middle of the night got restless and I petted him for a long time. This morning, he seems better. We went for a walk and went farther than we have gone in some time - about six blocks in a circle. He is napping out on the side porch, alone. I assume that when he does that, he is feeling less needy.

Today turned out to be a really good day. I took him swimming, and he swam for 10 minutes, in addition to the walk in the morning He seemed to want to get out of the pool at four minutes but I coaxed him to stay in the water. He was doing so well that I called my ex-husband Ray and suggested he visit. I placed a large order for dog food and supplements. 

*November 8, 2017* Wednesday. The rains came on Monday night and it has been dreary ever since. Tucker has been zonked out with no energy to do anything. Ray walked into the room on Tuesday and Tucker lifted his head slightly but did not wag his tail. So Ray saw him at his worst, not his best. Tucker’s eyes look empty. There is an odor from his mouth. The tumor cups in my hand. 

Last night I took Tucker outside but he did not do his routine nighttime poop. We went inside and he slowly climbed the stairs with me as usual at 9 PM. He went to sleep, then became restless around 11 PM and wanted to go downstairs. He went outside and pooped, then would not climb the stairs again. He slept downstairs with Ray beside him. He was fidgety at times in the night, wanting help to get up so he could reposition himself. That’s not unusual. For months now in the night, he gives a bark and I put a sling under him to help his back legs up so he can reposition and go back to sleep. That’s usually once or twice a night.

I raised his Tramadol to 300 mg per day, given over three doses. According to PetMD, he could take even more of the Tramadol. With it, I give the Gabapentin, 600 mg per day, divided over the three doses. I’m going to add some pumpkin to his diet. 

He ate breakfast today, but did not fish around to get the very last pieces of the food in the bowl. For a dog that has been a chowhound all his life, that’s concerning.

As he is right now, I can’t help but think that maybe it is time to let him go. But I don’t want a series of bad weather days to make me misjudge. The overcast weather will be here until Friday. I don’t know whether I will take him swimming tomorrow or not.

Now it looks like the tumor is growing upwards on his face.

Writing this today, combined with Ray’s visit, is making me focus on the inevitable. I just called Ray and said that I would likely not take Tucker swimming tomorrow (Thursday) if he continues as he is today. At most, I may try to get him in the car and drive to McDonald’s for a hamburger. I will test my theory of the weather affecting Tucker. If he improves somewhat on Friday when the weather is better and sun shining, then we can keep on going. But if he doesn’t improve Friday and through the weekend, then I think it’s time to let him go. Ray and I have our doubts that Tucker will give us a sign. He is a stoic dog. Ray watched him slowly walk down the stairs yesterday. Tucker had to have been in pain and scared of falling but he managed to come down (I have been supporting him with a sling for safety for months). Depending on how things go today, I may not ask him to go upstairs tonight.

*November 9, 2017* Thursday. Another dreary, rainy day today. Tucker did not do a nighttime poop last night and then didn’t want to go upstairs to bed. So we slept downstairs. He was restless a couple times in the night, even though I gave his pain meds later than usual. He is unsteady on his feet and only walking when he needs to. He is pausing a long time before going up one step between the hall and the kitchen. But he is still eating. Two friends told me yesterday that this weather is bothering them, so I am still holding out hope that Tucker will rebound tomorrow. It’s going to be cold but clear, or so they say. I’ve cancelled his swim for today. The odor from his mouth is more pronounced.

*November 9, 2017* 5 PM After breakfast and his morning poop, Tucker settled in to sleep and did not move for hours. I lifted him up around noon to coax him to go outside. His back legs would not hold him up. So I let him down and into what I hoped was a comfortable position and let him sleep some more. Later I tried again, and he was able to get up and go out and pee. I fed dinner early tonight because I am going out for a couple of hours. For the first time in his life, Tucker did not finish his meal. After eating, he went outside and pooped. I was hoping he would return to his food bowl, but he didn’t. I will move him into the foyer where he prefers to be when I leave the house, and can be monitored by camera. At this point, I’m not sure he could get himself up without help. 

*November 10, 2017 *Friday, 7 AM I called the vet’s office just now and made the appointment I have been dreading. Tucker’s back legs won’t hold him up. Last night when he went out to poop, his back legs collapsed and I had to support them to get him back into the house. He’s on his dog bed near the back door, awake but not wanting to move, not able to move.

*November 11, 2017* Tucker had to be carried on a stretcher into the vet’s office yesterday. He went peacefully. I could go on and on about what a wonderful dog he was, but this is about his disease progression. On Monday he swam and walked. On Tuesday and Wednesday and into Thursday he was slow, not wanting to walk, but able to get outside enough to do his business. He essentially crashed on Thursday night. 

Gingival fibrosarcoma is said to be locally contained, so I don’t believe it spread to the rest of his body. But I believe it weakened his overall health and strength. And for Tucker, that meant that his already weak legs could no longer support him.

The tumor grew rapidly, just as the medical information indicates. In mid-September when I could feel the tumor had returned, it was the size of a half golf ball. On Tucker’s deathbed, the tumor filled my hand.

Good night, sweet prince,​ And flights of angels sing thee to thy rest.​


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## CAROLINA MOM (May 12, 2009)

I am so sorry for your loss of Tucker. I can't even begin to imagine how difficult posting this info must be for you but I know it will help many others, thank you.


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## Peri29 (Aug 5, 2017)

Thank you for this post . It must be really hard for you to say goodbye to Prince Tucker. I am going through a similar case with a cocker spaniel we rescued. He is said to havemaxilla ( upper jaw) melanoma including the upper palate which is the worst. We had biopsy 2 weeks ago and waiting these days the final patology report.It can be also fibrosarcoma . They are very similar . They say he won't make the surgery because they do not have enough margin. He is adorable, very soft personality, sleeping attached to me. My hands are tied. I am just watching an animal abandoned to shelter after 13 -14 years for being sick and we could rescue only months after we found out. Timing was bad. He wants to live. He even has appetit but all we can hand feed him at the moment is very soft meatballs. He has difficulty breathing & swalling due to enlarged lymph node. I am trying to go as ketogenic as possible , using lots of supplements such as antioxidants. The oncologists said it is even useless to give chemo and will have to give the decision of euthanize soon. As a volunteer, I never like to give up before trying every possibility. There must be a reason we found out about him. We will try to give him every comfort but it hurts so much to say goodbye to a dog who wants spend his every minute with us as if he has been together with us since years. The vet was very harsh and direct with me. Me, praying for miracles he said that he does not believe into miracles but coincidences. HOWEVER, a real miracle happened after a couple days with a dog diagnosed with hemangiosarcoma. So, I won't stop praying for miracles. I would very much if you can share with me in detail the holistic receipt that you used for your dear Tucker. I will have to of course change the dosages since this old cocker man is dropping each day pounds . Many many thanks


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## Graywings (Aug 14, 2017)

Peri29, the holistic vet gave me several products, but I believe she knew there was little to be done at that point. Most of the supplements were aimed at boosting Tucker's immunity, such as bone broth, a mushroom blend from a company called Veterinary Botanicals, and - at my request - a B-complex liquid. The only anti-cancer agent was the IP6 (inositol hexaphosphate), and I believe it came much too late in the progression of Tucker's disease. 

If your little guy is having trouble breathing and swallowing due to the enlarged lymph nodes, it must be terrifying and very uncomfortable for him. 

You can look at the idea of miracles in different ways. Maybe the miracle in your case is that this little guy ended up with you so that you could be with him at his end. You have the ability to enable him to pass peacefully at the vet's office instead of leaving him to suffer as his original owners apparently did.


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## cwag (Apr 25, 2017)

I'm very sorry for your loss. It is a sad recollection to read and some of it reminds me of when my Tawny died. She was 12 and got the back leg weakness too but didn't have cancer. It is clear you loved him and gave him a great life. I wish you peace.


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## Peri29 (Aug 5, 2017)

Dear Graywings,

Thank you for your kindly message.
In the meantime, we just received the patology report of the cocker. He does not have melanoma as suspected but fibrosarcoma. However, they say it's too late. I am in a really desperate situation. This old boy loved us, lives at home like a velcro, appearantly not willing to leave us yet. We use at the moment antibiotics, vitamins, antioxidants and since a week we started ketogenic diet eventhough in this country they do not much know about it. 
My cousin and a friend will be flying for Christmas to NY ( bringing also 2 golden retrievers to be homed to two US families) and they can bring back to Turkey any supplement & anti-cancer medicine you can suggest us. He has appetit but has difficulty to eat. Only one of his lymph node is really swollen which seems to get decreased after we started using heavy antibiotics. Fibrosarcoma rarely does meta to other organs and they say it's due to infection. 
I thank you very much for any feedback I can receive from you in advance.
Many many thanks



Graywings said:


> Peri29, the holistic vet gave me several products, but I believe she knew there was little to be done at that point. Most of the supplements were aimed at boosting Tucker's immunity, such as bone broth, a mushroom blend from a company called Veterinary Botanicals, and - at my request - a B-complex liquid. The only anti-cancer agent was the IP6 (inositol hexaphosphate), and I believe it came much too late in the progression of Tucker's disease.
> 
> If your little guy is having trouble breathing and swallowing due to the enlarged lymph nodes, it must be terrifying and very uncomfortable for him.
> 
> You can look at the idea of miracles in different ways. Maybe the miracle in your case is that this little guy ended up with you so that you could be with him at his end. You have the ability to enable him to pass peacefully at the vet's office instead of leaving him to suffer as his original owners apparently did.


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## Graywings (Aug 14, 2017)

Peri, I am so sorry your cocker spaniel is going through this. If I knew of anything that would help, I would certainly tell you. According to the specialists who saw Tucker, the only options were surgery and/or palliative radiation treatment.


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