Ginger is a 12 year old yellow lab who came to us to evaluate a growth on her rump, which had been growing steadily for the past 6 months. In the last month, the owner noted another, smaller lump on her belly. Beyond these bumps, the owner reported some difficulty getting up and down, but otherwise she was in good shape.
On presentation, Ginger was bright and alert, especially for an old girl. The lump on her rump was about the size of a small melon! It was firm to the touch, but not painful. On her belly, we found one large mass the size of a peach, with multiple smaller masses running up and down the length of the abdomen.
Ginger had never been spayed and we found a small amount of discharge coming from her vagina.
Our differential diagnosis for the lumps on her abdomen included mammary gland tumors or metastasis from the primary rump tumor.
Whenever we are faced with a pet with tumors, particularly an elderly pet, we start our workup with a battery of blood tests and radiographs to find out if the tumor has spread internally, and if the pet is metabolically stable enough to undergo anesthesia to remove the tumors.
Ginger passed her pre op screening with flying colors. Her blood tests were perfectly normal. Radiographs of her chest did not reveal any metastases in the lungs and showed a normal heart. Abdominal radiographs did not show any gross tumors or a grossly enlarged uterus (which is common in older dogs with infection in the uterus). She had some mild arthitis in the spine, and surprisingly good looking hips for her age. We also noted that she has advanced arthritis in her knees on the films.
Given the positive news of the pre op workup, we decided to go forward with the surgery which would include
- Removing the large tumor on her rump
- Sterilizing her (removing the uterus and ovaries) to help prevent estrogen stimulation of the mammary glands as well as eliminate the chance of pyometra.
- Removing as many of the mammary tumors as possible.
Ginger was anesthetized gently using a fast acting induction agent; propofol to put her under and then she was maintained on isoflurane gas. We had an IV catheter in place to allow us access for emergencies and to administer fluids to her during surgery. She was monitored with our usual array of monitors to keep track of blood pressure, blood oxygenation, temperature, respiratory rate and electrocardiogram.
We went into the belly first to spay her, and while we were there, we checked all the internal organs for signs of tumor spread. Thankfully, we found none. We closed up the abdomen and started to work on the mammary glands. Since she had tumors on both sides of her mammary chains, we had to be careful to leave enough skin to close up the wounds without undue tension. With some extensive, and creative suture patterns, we managed to excise all of the palpable masses. Mammary tissue tends to ooze alot after surgery and so we placed drainage tubes under the skin to prevent the formation of a serum pocket. These drains were removed 5 days after surgery.
We were into the surgery for about 2 hours at this point, but Ginger was doing well, so we flipped her over and started attacking the rump mass. The mass turned out to be fatty in appearance, but was tightly adhered to the underlying muscle. An hour later, we finished closing the skin and she had the figure of a 5 year old!
Pre Op Mammary Tumors
Post Op Belly
Pre Op Rump Tumor
Intra-Op Tumor Removal
Actual Tumor Removed
Post Op Closed Wound
The tumors were sent out to the lab and the biopsies came back to us a few days later. The rump hump was simply a fatty tumor or lipoma. The mammary tumors were all benign types of mammary adenomas. These types of tumors may recur in residual mammary tissue, but tend not to spread to the rest of the body. The fact that we saw no metastases in the lungs before surgery and none in the abdomen at surgery, gives Ginger a very good prognosis to live out her days tumor free.
Ginger recovered from surgery and is running around like a new puppy with here younger sister Kaya (a Chocolate lab).
This case points out the importance of spaying your pet early in life. The incidence of mammary tumors can be reduced by seven fold by having your pet spayed before their first heat cycle. Moreover, early sterilization eliminates the possibliity of pyometra. The second lesson from this case is for you to have your pet examined at least once a year. These tumors could have been identified and removed at an earlier date with much less drastic intervention. Finally, Ginger teaches us, that age is not a disease and that we can safely perform surgery on our elderly patients with the appropriate workup and anesthetic techniques.