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Hepatocellular carcinoma


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Please keep Celt in your thoughts and prayers. He will be having surgery tomorrow to remove a tumor from his liver. He has massive (versus nodular or diffuse, both worse scenarios) hepatocellular carcinoma.

 

When his annual blood work was done last month, one of the liver values (ALP) was elevated, which it had never been before. Our local vet who does ultrasound did so expecting to find something other than this tumor. High values of ALT are more indicative of a big liver problem and elevated values of ALP are more indicative of either a gallbladder issue or possibly an adrenal issue (like Cushing's). So the tumor was found while looking for something else.

 

Today was the earliest we could see the specialist and so I took Celt up to PVSEC to see Dr. Compton (who actually had seen him previously in 2009 when his CCL damage first appeared). We actually spent most of our time with the resident surgeon, Dr. Ogden, whom I liked very much. She took plenty of time to examine Celt and talk to me, as did Dr. Compton when she came in to visit with us.

 

Because the DVDs that I brought from my vet with ultrasound and x-rays would not open on four different computers and using different software, these tests had to be redone. Fortunately, the clinic's top ultrasound expert had an opening right while we were there and Celt had a very thorough ultrasound, and then the x-rays as well.

 

The good news is that this tumor is encapsulated and no signs of metastasis were found. It is a type of malignant tumor that tends to metastasize slowly and so we may have found it in time. The other two forms (nodular and diffuse) are not readily removed with surgery and have much higher rates of metastasis. This type of cancer is treated with surgery as it does not respond to chemo, although chemo is an option as a follow-up to reduce the likelihood of additional masses developing. In addition, the biopsy that was done last month (four samples, which were very consistent) did not show evidence of mitosis, so this is likely a very slow-growing tumor. Who knows how long it's been developing? Maybe for years, or maybe just for months.

 

The not-so-good news is that the ultrasound revealed a very small (about the size of a pinhead) anomaly on one of the adrenals. I asked if it could be removed during the surgery but the vets said that that was not likely at all as, apparently, adrenal surgery is not a good option. The other less-desirable news is that the tumor is located in the middle lobe of the liver, right by the gallbladder, which will probably complicate removal compared to it being located in an area away from "other things" like the gallbladder and the vascular tissues located in that area (major blood vessels are located nearby, too).

 

Looking at all the information, I had to choose between two viable options - to do nothing but to monitor the tumor, going back about every three months for another ultrasound and x-ray panel, or have surgery done with the hopes that it could be removed with good margins, that there would be no complications, and that there has been no undiscovered (so far) metastasis.

 

I opted for surgery. Celt is 13 years and 5 months old, and doing nothing would be a very sensible choice, particularly if this is truly a very slow-growing tumor. But my worry would be that if it looked like he needed surgery on a recheck, he'd be that much older. He does have a very excellent quality of life right now, happy and active and cheerful. And maybe it's selfish of me to want to do everything I can to extend his life and health, even at his age.

 

I have heard anecdotes about dogs who have had this same type of cancer and surgery, and who went on to live a very good life for several years after. I hope I am making the right choice. We would appreciate your good thoughts and prayers on Celt's behalf.

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Wow. I'm so sorry, Sue.

 

I can totally understand your instinct to do surgery now rather than take the risk of his needing it later when he's older and possibly less able to withstand it.

 

Me heart goes out to you, Celt and the rest of your family and you have my very best wishes for the best possible outcome.

 

roxanne

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It breaks my heart to read this, Sue - I know Celt means the world to you. I'm confident you have and will continue to make the very best choices for Celt and you have my support and good thoughts and mojo for a happy, healthy outcome! Hugs to you and Celt!

 

Amy

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He's in surgery now. They called a few minutes ago to let me know. I truly feel this is the right choice but I'm still so scared that there could be problems.

 

Thank you all, for your thoughts and support.

 

Amy, yes, he is very special to me. I have loved many good dogs and other animals in my life but I think he is the one who has touched my heart the most. And I know that no matter how this turns out, our time together is limited as he is quite the senior already.

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Dr. Compton called just now - the surgery done and the mass removed. We'll know more about it after testing. Due to location, she is concerned about clean margins but took what she could without causing damage, and the alternative would have been to leave it alone.

 

The anomaly on the adrenal gland was not identifiable but possibly the beginning of Cushing's. Testing for that will not be possible for a couple of months because trauma, like this surgery, can cause false results.

 

He did well with the anesthesia and I'll get a call later after he's woken up and evaluated.

 

Pickup might be later tomorrow or else Friday but they won't know until seeing how he is tomorrow morning.

 

I'm worried about the margins issue but they did the best that could be done under the circumstances. He's now sporting a cool summer bare midriff so he'll be ready for warm weather, when it gets here.

 

Again and again, thank you all! I'll let you know his progress as I hear it.

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I was able to talk to a technician/caregiver at suppertime. She told me Celt was well awake and standing in his pen/crate in the "fluids room", just watching the activity and seeming to be quite comfortable and steady on his feet. I think she said he'd been out to potty but had not yet shown any interest in food or water (which is odd for my little vacuum cleaner of an eater but she said this was not at all unusual at this stage). He'll be offered something to eat (I brought his food so he has his regular diet with him) and drink in a bit, and taken out again. They closely monitor all night and give the dogs that get up and are restless at all the chance to go potty, etc., as they want to.

 

It looks like, if all goes well and the vet gives the go-ahead to release him tomorrow afternoon, that I will be picking him up tomorrow in the second half of the day sometime. I'll go into work, get to talk to her on the phone, and then drive up there from work around lunchtime, or whatever will work best for him and a release time appointment.

 

I was going to work tomorrow and pick him up on Friday as the admitting tech said she thought it would only be about $30 or so to keep him an extra night, but this tech corrected that - it's $130 for another night as he would be in a recovery room (versus just a "sleeping room") overnight, and that is much more expensive due to the intensive care.

 

I can't wait to get him home. I've got his "confinement" figured out - and x-pen with a variety of comfy surfaces to walk/rest on so he can pick what feels best. And it will be in the kitchen or living room, away from the other dogs, so it is more restful. And I'll get to spend several days with him before I have to go back to work.

 

Thank you all!

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