Second Mast Cell Tumor Results

A week after Stella's herniated disks and tumor removal surgeries we got the pathology results of her second MCT.  Unlike the first time which was Grade 1 with clean margins this time it was Grade 2 with dirty margins.  Speaking with the surgeon, Dr. G., we asked if he was going to go back in and remove more tissue from Stella's arm as this is the protocol for MCT's with dirty margins; to remove more tissue, send it to the pathologist and hope for clean margins so that we would know it was contained.  Dr. G. told us that he could not go back in as there was "no more tissue to remove".  He said he had removed as much as he possibly could.  He stated he was very surprised that the report came back as dirty margins and that we would have been surprised if we saw how much skin he had removed.  

So where do we go from here?  Dr. G. and our regular vet, Dr. A., both said the first step was to meet with a veterinary oncologist to discuss our options.  The oncologist was the "expert" and would be the one to give us as more detailed information about this type of tumor, the grade, margins, etc.  Stella was due to have her stitches removed the following week so we made an appointment with the oncologist, Dr. F. - she is at the same facility as the orthopedic surgeon so they would be able to consult with each other.

Meanwhile we looked on the internet and from the info we gathered (and could understand) it seemed that we had 4 options:

• Radiation
• Chemotherapy
• Removal of the entire limb
• Do nothing - MCT's are usually slow growing.  Stella's re-appeared in less than a year.  What did it mean?

Meeting with the surgeon and oncologist the following week our choices came down to only one.  We were told by both that removal of Stella's arm was way too aggressive of a move at this point.  Also, if she developed another MCT in the other arm we may be screwed.  Chemo is used only as a means of sustaining a pet's life, not as a cure.  If Stella was metastatic (meaning it had spread systemically) chemo would be used to sustain her life for as long as she was meant to live.  She would never be cured.  Doing nothing would not be an option.  Dr. F. said if we did nothing this Grade 2 tumor would definitely grow back within 4 to 6 months and would be aggressive at that point.  Also, at that point, it would more than likely be too late for any kind of intervention.  If we did nothing we would cut Stella's life short significantly.  If Stella was not metastatic radiation would be the best choice.  Dr. F. explained that radiation is 90% effective that the tumor would not grow back in that same location - which is another reason why removing her arm was considered too aggressive.  She did remind us though that MCT's can grow anywhere (on the body, in the organs) at any time.

I asked Dr. F. if we should be extra concerned that this tumor grew back in less than a year and she said she was not at all surprised by this.

But here's were the snag came in.  Upon examination Dr. F. noticed that the lymph node on Stella's right side, the upper chest area near the armpit, was swollen.  She stated that this could be a sign that the disease had become systemic or it could be that her body was just reacting to the trauma of having the surgeries, causing some temporary swelling.  She would need to aspirate this lymph node and we would have to wait yet again.  Meanwhile Dr. F. did an abdominal ultrasound to see if  there were any abnormalities within Stella's organs as MCT's tend to travel to the liver, spleen, etc.  The ultrasound showed no signs of tumors - whew.

So as we waited for the aspiration results we had long discussions of what we thought would be the right thing to do in either case.  We decided that if the results came back negative, meaning Stella was not metastatic, we would do the radiation.  If Stella was, say, 12 years old the conversation may take a whole different tone.  But she is 6 (7 in July).  How could we not try to give her the best life possible?   As of today she looks and acts like she always has but if we did nothing she would become debilitated in a relatively short period of time and we would know that it was because we took no course of action.  We decided that we could not live with that decision.  If it turned out Stella was metastatic we agreed that we were willing to "start" chemo to sustain her life for the time she would have left.  If she could not handle it or it caused her to be too incapacitated from day-to-day we agreed  that we would stop the treatment and let nature take it's course.  We would decide when Baby Girl had had enough.

A few days later we got the results - negative for systemic activity!  The swollen lymph node was just a result of the surgeries.

Stella's radiation therapy treatments begin tomorrow, May 2nd.  20 sessions, Monday thru Friday, for 4 weeks straight.  We asked Dr. F. of the likelihood of another tumor showing up - a totally unfair question we know.  She stated there was no way of knowing.  Another tumor could pop up in a matter of months, or years, or never.  When we asked if she truly had ever had a case where Mast Cell Tumors never appeared again she stated "I have absolutely seen this, it does happen".