I recently euthanized a dog that greeted me at his front door with a goofy grin on his face and a wagging tail. This type of appointment just breaks my heart, yet I was fully supportive of the owner’s decision to euthanize. Why? Because the dog had been diagnosed with hemangiosarcoma of the heart. Faced with this disease, I would much rather euthanize a week "too early" than a day "too late". Read on to find out why.
What is hemangiosarcoma?
Hemangiosarcoma (HSA) is an aggressive, malignant cancer of the blood vessels that often grows as a mass in the spleen, liver, or heart, but can also be found in other parts in the body. Animals usually present to their veterinarian for sudden collapse due to internal bleeding from the mass. In most cases, by the time the animal is showing clinical signs, the cancer has spread to other areas of the body, such as the lungs. HSA can be diagnosed with X-rays, ultrasound, aspiration of abnormal fluid accumulations, and biopsy of the mass via exploratory surgery.
How is it treated?
Unfortunately, while there are treatment options available, there are no cures for this disease. Surgery may be an effective option for removing the primary tumor and temporarily stopping bleeding, but it is not capable of removing all of the metastatic disease, which is usually microscopic at the time of diagnosis. Chemotherapy is often used in conjunction with surgery to help combat the cancer cells that have spread throughout the body.
What symptoms can present as the disease progresses?
- loss of appetite
- weight loss
- exercise intolerance
- pale gums
- possible distended abdomen
- possible increased respiratory rate and effort
- persistent early stages
- reclusive behavior
- distended abdomen
- dull mentation
- difficulty breathing
- panting, gasping for breath
- possible black, tarry stool
- sudden collapse
- unable to rise
Crisis — Immediate veterinary assistance needed regardless of the disease
- Difficulty breathing
- Prolonged seizures
- Uncontrollable vomiting/diarrhea
- Sudden collapse
- Profuse bleeding — internal or external
- Crying/whining from pain*
*It should be noted that most animals will instinctually hide their pain. Vocalization of any sort that is out of the ordinary for your pet may indicate that their pain and anxiety has become too much for them to bear. If your pet vocalizes due to pain or anxiety, please consult with your tending veterinarian immediately.
What is the prognosis for hemangiosarcoma (HSA)?
A diagnosis of HSA almost always carries a poor prognosis, the only exception being HSA originating from the skin with no internal involvement. If treatment is not an option, euthanasia should be considered to prevent suffering from internal bleeding. Surgery alone to remove the primary tumor carries a median survival time of 1-4 months, while chemotherapy in addition to surgery carries a median survival time of 6-8 months.
Even with surgery and chemotherapy, the disease will progress and the cancer cells with continue to metastasize, creating masses throughout the entire body. Hemorrhages may occur from each cancer site, which may cause transient weakness until the bleeding stops. If the bleeding does not stop, the patient will start showing signs of shock and collapse. To save both the dog and owner from the horrors of this experience, I always prefer to euthanize sooner rather than later when faced with a diagnosis of hemangiosarcoma.
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Dr. Jennifer Coates