Canine Lymphosarcoma Lymphoma LSA

  Canine Lymphosarcoma (Canine Lymphoma, LSA)

  

Incidence/cause

LSA, a tumor caused by a cancerous proliferation of lymphocytes (cells that normally function in the immune system), is one of the most common tumors seen in dogs. It affects dogs of any breed and age, although most dogs will be middle-aged or older at the time of diagnosis; Golden retrievers are considered a breed at increased risk of developing LSA. The cause of LSA in dogs, as is true for most canine tumors, is not known.

What you might see/ Clinical presentation

The presentation of dogs with LSA is highly variable as lymphocytes can be found in virtually any organ in the body. Nonetheless, the most common form (referred to as stages) of LSA causes a non-painful enlargement of one or more lymph nodes that can be seen or felt from the body surface. Occasionally, a lymph node becomes large enough to impair function (obstruction of blood flow or airway, for example). Other forms of LSA can involve the liver, spleen, bone marrow and gastrointestinal tract, skin or nervous system (and other organs) and the clinical signs will reflect the organ system involved (e.g. vomiting or diarrhea with gastrointestinal forms; weakness or pale mucous membranes and others that reflect impaired production of blood cells from the bone marrow); many dogs will simply feel ill (lose appetite, become lethargic) with any of the different forms. In some dogs, lymph node enlargement is an incidental finding when an otherwise healthy-appearing dog is seen by a veterinarian for an unrelated reason (e.g. vaccination).

Lymph node staging

Stage I: single lymph node enlarged
Stage II: multiple nodes enlarged on either the front half or back half of the body
Stage III: multiple nodes enlarged on both front and back halves of body
Stage IV: involvement of the liver and/or spleen
Stage V: bone marrow involvement, or involvement of other organs (e.g. gastrointestinal, skin, nervous system)
Each numbered stage can be further divided into substages, of which there are two: a and b. Patients with substage a feel well while patients with substage b are ill.

Biological behavior of LSA

LSA is viewed as a systemic disease, and as such is not really viewed to "spread" to other organs. This tumor is not generally viewed as a curable tumor in dogs, although occasional dogs will experience what seems to be a cure with appropriate treatment (see below). A dog can start with one stage of the disease and progress over time to another (usually more advanced) stage of LSA.

Clinical staging (determination of the extent of the tumor)

Because of the organs that LSA commonly involves, staging a dog with a LSA can involve aspiration of one or more lymph nodes, thoracic radiographs abdominal radiographs or ultrasound (to look for big nodes in the abdomen and to look at the liver and spleen), or bone marrow examination. Often, obtaining blood for a complete blood count and biochemical profile, and a urinalysis will be advised as these can help assess overall health and provide information that potentially influences treatment recommendations. Sometimes, special stains to determine if the LSA is of B-cell or T-cell origin (B-cells and T-cells are specific types of lymphocytes) are recommended because of prognostic significance, although treatment recommendations are the same for either type.

There is now a new screening test (Canine Lymphoma Assay Kit) offered by Tri-Screen. It is a quick (24 hours turnabout time), non-invasive, and accurate diagnostic test that can differentiate between lymphoma and other benign problems of the lymph nodes. If lymphoma is suspected in your dog, ask your vet about this test.

Prognosis

The prognosis of dogs with LSA is highly variable, and depends on the clinical stage (ill dogs fare more poorly than dogs that feel well, and dogs with Stage V disease are generally considered to have a poorer prognosis), the type of tumor (dogs with B-cell LSA usually do better than dogs with T-cell LSA). Most dogs treated with chemotherapy will experience a remission, a period in which there is no detectable cancer and the dog feels well. Remission times are variable, but most dogs with the lymph node forms of LSA will have initial remissions lasting in the range of 6-9 months before evidence of the tumor is seen again; second remissions can be achieved in many of these dogs, but any subsequent remission is expected to be shorter in duration than the first remission. Survival times for most dogs treated with combination chemotherapy protocols are in the range of approximately 1 year. And even though an individual dog will have received a lot of chemotherapy over that year, their quality of lfe is generally very good. Statistics, while useful, can never predict how an individual dog will fare with or without specific treatment.

Treatment options

The mainstay of conventional treatment of LSA is administration of chemotherapy drugs; the best responses in terms of length of tumor control and survival are generally seen with protocols that entail administration of more than one chemotherapy drug, although there are approaches that involve administration of a single drug. Chemotherapy drugs commonly used include: doxorubicin, vincristine, cyclophosphamide, prednisone, and L-Aspariginase, but many others are also used. In some dogs with very localized disease, surgery or radiation therapy can play a role in treatment, although chemotherapy is still often recommended in these cases.
A company called PetScreen (which also offers the new diagnostic test mentioned above) provides a service called "Directed Chemotherapy Assay Service" (DCA) - a laboratory service to help veterinarians select the most effective chemotherapy drug for a dog patient. This can avoid incidences of drug resistance in which a certain drug has little or no effect on a particular dog patient. With the help of DCA, time is not wasted in picking the right drug for the patient.

If you opt for DCA, please understand that a biopsy of the cancerous tissue has to be taken. Various chemo drugs are then tested against the biopsied tissue to determine which drug(s) is the most effective.

While undergoing chemotherapy, regular blood tests should be carried out to monitor for decreased white blood cell counts (drug-induced myelosuppression).

For the same reason as surgery, radiation is not commonly recommended for lymphoma in dogs. However, relatively novel approaches have recently been adopted to treat canine lymphosarcoma. For example, the dog patient may receive half-body irradiation - each half body is treated 4 weeks apart. Also, radiation to a single lymph node or all nodes may be given to dog patients that are drug-resistant.

 Most dogs with lymphoma are rather responsive to chemotherapy. Greater than 75% of dogs with lymphoma are expected to achieve a complete remission of 6 to 11 months with chemotherapy. When a dog treated with chemotherapy comes out of remission, further chemotherapy (rescue protocol) can be given which may induce second or even third remissions. However, understand that cancer cells that have survived prior chemotherapy treatments are stronger and more resistant to being eradicated; therefore, stronger and stronger medications have to be used. Dog parents, at that stage, have to make a decision.

This alternative treatment option I found a dog that lived more than 2 years:

""Following supplements were given each day with each specific meal

Batch #1:
(2) IP-6 Celle Forte(220mg.), (1) Swiss Formula Anti-Oxidant capsule (contains 10,000IU Beta-Carotene / 500mg Vit. C / 25mcg. Selenium), (3) Reishi Mushroom capsules(1000mg each), (3) Maitake Mushroom caps(800mg each), (3) Shiitake Mushroom caps(800mg each), (2) Ester Vitamin C(600mg each), (3) Prednisone Rx, every other day(5mg each)

Batch #2:
(2) IP-6, (1) Co-Enzyme Co-Q10(30mg), 1 ounce Flor-Essence diluted with 2 ounces water (or Essiac Tea is acceptable), (1) Green Tea capsule(50mg), (2) Salmon Oil**(1000mg each), 2 teaspoons Greens+ powder

Batch #3:
(2) IP-6, (1) high quality human grade IRON FREE Multi Vitamin,  (2) Ester Vitamin C, (3) Reishi Mushroom caps, (2) Cat's Claw(670mg each), (2) Grape Seed extract capsules, (2) Moducare Sterinol tablets, (1) Salmon Oil cap**

Batch #4:
(3) Maitake Mushroom caps, (3) Shiitake Mushroom caps, 2 teaspoons Wheatgrass powder, 2 tablespoons Flax Seed Oil**

Batch #5:
(2) IP-6, (1) Selenium(100mcg), (1) Co-Enzyme Q-10, (1) Ester Vitamin C,

Liver Supplements (given twice daily):
Turmeric - 1000mg
Artichoke Leaves Extract - 1800mg
Dandelion Extract - 1500mg
SAMe - 200 mg (started in 2003)
Milk Thistle - 3000mg (<--- very important liver supplement, with SAMe being a close second)


Anti-angiogenic medication:
Doxycycline Rx 50mg / 3 times a day (150mg total per day): Doxy helps to prevent cancer spread and blood vessel growth around tumors and seems to be effective with osteosarcoma cases. Doxy appears to be beneficial for other cancers as well.

Try to give some of the above supplements between meals, especially IP-6. The more "spread out" the supplements are throughout the day and evening, the better.
**Stop excessive fatty acid/fish oil supplementation 2-3 days prior to any chemo, until 2 days after.""""

Here is another one:

"1. Chemotherapy

This is the most common, and most effective treatment for canine lymphoma.
Chemotherapy generally refers to the treatment of cancer with powerful drugs that kill cells. These drugs are used to kill the cancer cells, but can harm healthy cells as well (which causes the side effects associated with this treatment). Combination chemotherapy usually involves chemotherapy drugs in addition to radiation treatment, which is usually the most effective against canine lymphoma.

The chemotherapy process for dogs is slightly less intensive than chemotherapy in humans, since the dosage ratio of the cell-killing drugs is much lower.

The veterinarian responsible for selecting chemotherapy drugs that will best help your dog is called an oncologist. Certain chemotherapy drugs are used for each type of cancer, and an oncologist is responsible for choosing the drugs that will have the lowest toxicity rate for your dog's healthy cells.

2. Immune System Booster(w/ chemo)

Treating your dog with an immune booster in addition to chemotherapy treatments is a good way to further increase your dog's survival rate. Most immune boosters include glyconutrients, which are required for healthy immune system function in canines.

3. Proper Nutrition(w/ above)

With a systemic cancer like lymphoma, proper nutrition is extremely important in increasing your dog's odds of survival. According to veterinary studies, dog foods that are high in carbohydrates “feed” the cancer, causing visible acceleration of the tumor's progression.

Dog foods that are high in protein are said to "starve" the cancer, while providing good support for your dog's healthy systems.

Dog food that is enriched in Omega 3 fatty acids has proven especially effective against canine lymphoma.

4. Surgery

In some cases, surgery to remove the malignant lymphoma tumor is suggested for a treatment option. Surgery is usually used in combination with chemotherapy, and is generally only suggested if the tumor is extremely large or is endangering vital organs. Fatal complications can arise with a surgical removal of a tumor, especially if a portion of the endangered organ is also removed.


The life expectancy of a dog diagnosed with lymphoma is between 9 and 12 months. While this may seem discouraging, it is possible to send a dog's lymphoma into remission with constant medical care, and regular chemotherapy.
 With proper care, the survival rate of a dog diagnosed with lymphoma can be raised to 50%. With intensive chemotherapy, the average chance of remission is from 60-90%. Without any treatment/intervention whatsoever, most dogs will only survive for an average of two months."

Key points

LSA is one of the most chemotherapy-responsive tumors seen in veterinary medicine, and most dogs tolerate chemotherapy very well with minimal impact on their quality of life. If you notice fast growing lumps on your dog that seem to be in the area of the major joints (at the neck, in front of the shoulders, in the armpits, at the back of the knees or in the groin) have your dog examined soon by a veterinarian even if he feels well. Remember, lower stage disease, and dogs that feel well, will do better with treatment than dogs that are ill and/or have more advanced disease. In the case of lymphoma, I don't think you should rule out conventional measures, just look into combining conventional treatments with natural ones to support the immune system.