Lumps and bumps part 2: lump-be-gone

In part one I talked mostly about benign lumps such as lipomas, fatty tumors, that can often be left alone unless they are causing a specific problem.  This blog is dedicated to lumps that should not be left alone.  As a veterinarian, it makes me sad when I see a pet brought into the clinic with a tumor that has grown too large to be removed.  Usually the history given to me is that the growth showed up about a year ago and didn't look too bad.  Then it suddenly started to grow over the last week or two and by the time the pet is brought in for an exam it is either too late to do anything or if surgery is possible it would be so extensive that a referral to a board certified surgeon is necessary.  This is especially true of lumps and bumps on legs.  Remember that when a surgeon cuts a lump off an animal almost always they will have to remove the skin over the lump as well.  On legs especially, there is just not enough loose skin available to cover the surgical wound at least without using some special techniques. It is so much easier to just remove a leg lump when it is small.

As I mentioned in Part 1, I think part of the hesitation about bringing a pet in for an exam to have a lump checked is that we as humans are all afraid of getting a bad diagnosis.  But the good thing about lumps on the outside of the body where they can be seen is that we can do something about them early and that can lead to a good outcome.  Within the past year, I said goodbye to two of patients that will always remind me of what is possible by taking care of cancerous lumps earlier rather than later.  Both patients were diagnosed with cancer.  Buddy had a fairly aggressive mast cell tumor diagnosed in 2008.  Buddy actually had two surgeries to remove his cancer.  Daisy Mae had mammary gland (breast) cancer in 2007 and had a partial mastectomy.  Buddy and Daisy Mae both lived to around 16 years of age which is a fine lifetime for a dog.  I have no doubt that both their lives would have been considerably shorter if they had not had surgery early on to remove their cancerous tumors.

Buddy at age 16  

Gosh I love old dogs.

Unfortunately I don't have a picture of Daisy Mae, but I do want to discuss mammary cancer in dogs for just a bit.  There are many things unknown in our lives, but one thing that has been proven is that if you get a dog spayed before she is two years old, you can really decrease the risk of mammary cancer later in life.  Because of a dog's anatomy, a female dog has on average 10 mammary glands or a chain of 5 on each side, plus or minus.  Sometimes dogs will develop mammary cancer in multiple glands and when that happens, a complete mastectomy is done.  First one side and then the other if appropriate.  A female dog's mammary chain runs from the "armpit" area under the front leg all the back to the groin under the rear leg.  That means to get all the cancer, a surgeon has to make a VERY long incision.  It looks like this.

This little dog was 8 years old, not spayed and never used for breeding.  All this pain and suffering, and nearly always preventable by spaying while young.  Fortunately for this dog, she had an owner that was willing to treat her disease before it became inoperable.  If she makes it one year, she has a very good chance of her mammary cancer being gone for good.

The moral of Part 1 and Part 2 of the lumps and bumps blog?  If your pet  has a lump and you don't know what it is, please have it checked out sooner rather than later.  Time is ticking.

Lumps and bumps part 1: Do you want to see a one pound lipoma?

I have learned a couple of things from blogging.  Number one, the first picture contained in a blog post is often the thumbnail that is used by other web sites when a linked back to the blog.  Number two is that some people don't enjoy looking at gross pictures of tumors and body parts.  I can't quite figure out why someone wouldn't want to look at something as fascinating as a one pound lipoma, but I accept that some people really do feel that way whenever I show someone a recently removed tumor and they turn white as a ghost and leave the room.  Oh well.  I guess the fact that I am fascinated by how things look underneath that covering of skin makes me well suited to being a surgeon.  And so to kick off this blog about tumors and lumps and bumps, I give you a picture of my dog Buddy.  He is lot cuter than a one pound lipoma anyway.

Onward to the blog about lumps.  I decided to write this blog because I have seen a few tumors lately where owners ignored a lump on their dog until the lump was so big or so aggressive that nothing could be done to save the dog's life.  I don't know quite why people wait so long, but it is not uncommon.  Sometimes it is money, but many times it is not.  Maybe it's that we all get busy with other things in our lives or there is some underlying fear that the lump may be something bad, but it is a common human reaction to put things off until they jump up and bite us.  So I thought I would share some examples of when lumps can be ignored and when they can't and how some lumps can be prevented and how some cancers in our pets can truly be cured.  Part 1 will be dedicated to benign lumps that can sometimes be left alone except when they are in bad locations or get really large.

Lumps and bumps are really common especially in dogs.  Lumps can be caused by infections (e.g. abscesses) or irritations (e.g. lick granulomas - that's a good one to type into a Google Image search) or lumps can be caused by abnormal growth of cells (tumors).  Tumors can be either benign or cancerous.

The case of the one pound lipoma

definition of lipoma = a benign tumor made of fatty tissue

Lipomas are one of the most common tumors we see in dogs.  They are benign although there is a cancerous counterpart called a liposarcoma, but those are relatively rare.  Most lipomas occur along the side or the lower part of the chest or the belly, but I have seen them on legs or the head on occasion.  One time I removed a lipoma from the side of a Labrador Retriever's head that was literally as big as the lab's head.  It looked like the dog had two heads.  This dog had been adopted from the local shelter with this growth and his new owners were kind enough to have this monstrous growth removed.  I just want to give people a big hug when they take on a senior dog from a shelter with a problem.

Some dogs get so many lipomas during their middle age to senior years that it would be impossible to remove them all.  Retrievers are especially noted for getting lots of lots of these growths as they get older. These growths are not painful, but if they grow in a bad spot, they can cause difficulty walking or moving.  Because lipomas are common growths that don't bother dogs very much, they are one type of tumor that is often left alone.  They can however get quite large.  My personal record was an 11 pound lipoma that I removed off the side of the flank of a dog.  The dog weighed (after surgery) 17 pounds.  That tumor was nearly 2/3rds of the dog's post-surgery weight.  Holy lipoma batman!

Some lipomas are soft and others have a more firm feel to them.  Some of them are quite easy to determine where they stop and where normal tissue starts.  Others "infiltrate" into normal surrounding body fat.  Through experience, most veterinarians can tell you whether they think a lump is a lipoma or not and most of the time they will be right.  But the truth is that none of us can truly know what kind of lump your pet may have without a biopsy (taking a sample of the cells from a growth and looking at them under a microscope).  And the other truth is that there are some cancerous growths that can feel identical to lipomas.  Hemangiopericytomas and mast cell tumors are two examples and those two growths can be very difficult to deal with especially if you let them get big.  I will say that I don't necessarily recommend a biopsy of every single "lipoma-like" lump, but there are times when I think it is a very good idea.

Teddy was a retriever that came to see me because his owners noticed a swelling in his upper thigh on the inside.  By feeling it I could tell it was a mass of some sort so the next step was to do a needle biopsy.  A needle biopsy (fine needle aspirate) is done by sticking a small needle into the lump and sucking out some of the cells with a syringe.  The cells can then be put on a slide and looked at under a microscope.  Needle biopsies are not nearly as accurate as taking a whole slice out of  a lump, but the nice thing is that most dogs don't need any sedation to get a needle biopsy sample.   Some tumors are really hard to diagnose with a needle biopsy but lipomas are pretty easy most of the time.  I did a needle biopsy on Teddy's lump and the report came back it was a lipoma. We decided to leave it alone for several reasons.  It was in kind of a bad spot to remove, it wasn't causing him any symptoms and because I knew it was a lipoma, I also knew that if it got a little bigger it would not be much harder to remove than it already was.

Teddy did just fine, but about 10 months later, his owners noticed that the lipoma was getting bigger and it was starting to affect how Teddy was using his rear leg.  We decided to remove the lipoma.  I was happy that this lipoma was one of the non-invasive kind and even though it was in a really bad location, it came out relatively easily.  As is typical of growths that are a little larger than average, I like to get them weighed and photographed.  And so here is a one pound lipoma hanging out next to a regular sized Sharpie for size comparison.

Even though lipomas are abnormal growths of fat cells, they are fat cells none the less. If you are carrying a little extra weight, just think about 10, 20, 30 or more of these little buggers hiding out under your skin.  I know I think about it every time I have that extra slice (or two or three) of pizza on a Saturday night.  Certainly gives me some motivation to get out and ride my bike.

Enough about lipomas.  Next blog is part 2 about lumps that should not be left alone.