LYMPHOMA – This word itself is a terror! Every time I heard the word, it gave me goosebumps. I’m sure it did the same to everybody.
Like humans, animals can also suffer from lymphoma. For pet parents, the pet is just not a mere animal; he is a family member to them. So if one of your family members has got lymphoma, it’s hard to digest the fact. But this is the time when you need to gather yourself and give your dog the best possible support.
Sometimes, the procurable treatment might not give you the best results and leave your dog in pain. In such cases, the pain becomes unbearable gradually and you might think of euthanasia then. However, before doing this, make sure you have a proper idea about when to euthanize your dog. In case of any query, you may consult your vet or directly visit the hospital.
Today, in this article, I will give you a detailed conception about lymphoma and euthanasia which will include:
- Preliminary concept of lymphoma.
- Symptoms of lymphoma.
- Canine lymphoma stages and progression.
- Treatment cost of lymphoma.
- Basics of euthanasia.
- When and where to euthanize your dog.
What is lymphoma?
The term lymphoma means cancer of the lymphoid tissue and lymphocytes. What are lymphocytes then? These are white blood cells that protect the body from infection and acts as a part of the immune system. The presence of lymphoid tissues is generally found in lymph nodes, gastrointestinal tract, liver, spleen and bone marrow as these organs play major roles in the function of the immune system. Lymphoma generally attacks these organs though it can affect any organ virtually.
Is it common in case of dogs?
Yes, it is pretty common as it ranks third amongst all the cancers. Of all the canine neoplasias, it accounts for 24% approximately which equals 13 – 24 dogs per 100,000. Dogs of any age can suffer from lymphoma but dogs aged 6 – 9 years are more vulnerable. However, there is no gender discrimination here. Male and female dogs both have a risk of developing lymphoma. If we talk about breeds, certain breeds like Boxer, Scotties, Westies, German Shephard, pointers and Golden Retrievers may have more chances of developing this kind of cancer. Whereas Dachshund and Pomeranian dogs are less vulnerable.
Causes of lymphoma
Lymphoma occurs due to a series of genetic mutations in a lymphocyte. As a result of this, the cells grow abnormally and ultimately turns into malignant cells, which affects the organs and different functions of the body.
Is there any specific cause of lymphoma?
Like all other cancers, there might be some factors precipitating lymphoma but there is no certain cause behind it. In fact, it is unknown. Some investigations were done regarding different possible cases like chemical exposure, virus, bacteria and strong magnetic fields but the cause remains vague till now.
In case of human, immune system suppression is considered as one of the important risk factors of lymphoma. Unfortunately, in case of dogs, this theory is not clearly established. However, dogs are 2 – 5 times more prone to lymphoma.
Types of lymphoma:
Common types of lymphoma include:
- Multicentric lymphoma
- Alimentary (Gastrointestinal lymphoma)
- Mediastinal Lymphoma
- Extranodal Lymphoma
Table: Types of lymphoma and Its Characteristics
Type of Lymphoma
This is the most common canine lymphoma and results in 80 – 85 % of all cases. It is comparable to non-Hodgkin’s lymphoma in humans. Generally, it does not develop slowly rather shows a rapid onset. It mainly shows the involvement of:
May also include:
Initially, it tends to affect these organs only but can spread to other organs gradually which will end in multi organ failure.
How will we understand that our pet is suffering from lymphoma? In case of multicentric lymphoma we may notice the following symptoms:
Sometimes seizures or paralysis can also occur in advanced stages if metastasis occurs into the central nervous system.
Being the second highest, it accounts for 10% of all the lymphoma cases. From it’s name we can understand that this affects the digestive tract. As a result of this there is less external signs and difficult to diagnose.
This restriction can lead to further serious complications and increased risk of fatality.
In this case symptoms may include:
It can affect any breed but Boxer and Shar-pei are most commonly reported.
It stands third among all types of canine lymphoma and it’s rare. This lymphoma mostly involves the cardiothoracic region i,e dog’s chest region. Mediastinal lymph nodes or the thymus is seen to get enlarged in this type of case. Thymus is an organ where the T lymphocytes mature. So, many mediastinal lymphoma shows malignant T lymphocytes.
Unlike alimentary lymphoma, here the symptoms are quite visible.
However, this is more common in younger dogs.
This canine lymphoma is said to be the rarest among all. What does extra nodal mean? It refers to the other locations of the body except lymph nodes which get affected by lymphoma. Commonly these organs may include:
Others organs might be:
Symptoms of this lymphoma will differ according to the organ affected:
However, if we want to pick the most common among extra nodal lymphoma then it would be cutaneous lymphoma. It is categorized into 2 types:
The symptoms of cutaneous lymphoma shows 2 different stages:
In early stage:
This signs maybe mistaken as fungal infections and allergies.
In severe condition:
Two relevant subtypes are:
This is a positive predictor with approximately 60-80% cases of this type. It has advantage over T-cell lymphoma because:
- Dogs with this type of lymphoma show a positive response to treatment.
- Increased survival rates
- Complete remission rate is high.
- Longer remission times.
This constitutes 10 – 40% of lymphoma cases. Being opposite to B-cell lymphoma it is negative predictor because of:
- Does not respond well to treatment.
- More risk of hypercalcemia.
Diagnosis of lymphoma:
If we talk about multicentric lymphoma which the most common, then we will see that the patients will report with one clinical sign mainly I,e enlarged peripheral lymph node. Sometimes other symptoms like weight loss, lethargy or polyuria maybe present. For perfect diagnosis, proper and detailed history should be obtained.
Fine needle aspiration of the affected nodes can be done to figure out high grade lymphoma. But which test will give the confirmation? For this we should go for lymph node biopsy.
Confirmation of lymphoma is not the last thing to do. We need to know the stages of lymphoma. So, for the diagnosis of different stage, your dog needs to go through some test:
- Serum biochemical profile
- Complete blood count
- Thoracic radiography
- Bone marrow evaluation
- Abdominal ultrasonography
- Thorough cardiac evaluation should be done.
- Echocardiography should be conducted if arrhythmia is found on auscultation.
Why should we consider doing cardiac examination?
This should be done because if we find any cardiac abnormality there might be requirement of making a change in the chemotherapy plan.
There are some other abnormalities that we might come across while doing different tests. What are they? Here’s a list of some:
It may occur as a secondary case in case of bone marrow involvement.
If there is bone marrow involvement the dog can also suffer from leukopenia due to the presence of cancerous cells. Due to the circulating cancer cells, the dog may have leucocytosis.
Hypercalcemia of malignancy:
This is generally associated with the T-cell lymphoma and known as paraneoplastic syndrome. This condition can prove to be fatal if persistent. So, it is considered as a medical emergency. However, to confirm hypercalcemia certain panels of tests are required to be done.
Elevated level of liver enzymes:
When the liver is affected, it’s enzymes also show an elevated level. Many of the drugs used in the chemotherapy are metabolized in the liver. So the chemotherapy protocol highly depends on the proper liver function. If the themotherapeutics are not properly cleared out then it may add more adverse side effects or can lead to relative overdose.
Lymphoma grades, stages and progression:
Diagnosis of stage and grade is important in order to determine level of the treatment. There are mainly 2 stages in case of canine lymphoma. We should certain facts about them:
On cytology low grade or small cell lymphoma is characterized by:
- Homogenous population lymphocytes which are small but mature.
- May not show any difference with normal lymph node population.
- It progresses slowly compared to high grade or large cell lymphoma.
- Biopsy is required to determine the presence of malignancy.
On cytology high grade lymphoma is characterized by:
- Monomorphic population of lymphoblasts which are large, immature and almost the size of a neutrophil.
- If it is left untreated, may prove fatal within 6 – 8 weeks.
- As this is a systemic cancer, it is very responsive to chemotherapy.
At first the dog can be attacked by low grade lymphoma and later turn into high grade lymphoma through prognosis.
Stages of lymphoma:
Stage works as a prognostic factor.
To determine stage some certain factors needs concern. Those include:
- Degree of necrosis
- Mitotic index
- Cellular atypia
- It shows the areas where the tumour has already invaded.
Now, let’s see what different stages mean:
Only 1 lymph node is affected.
Multiple peripheral lymph nodes are affected on one side of diaphragm.
Liver and spleen are affected.
- Bone marrow
- Extranodal sites
Other than these stages, there are 2 clinical subtypes:
Clinical signs associated with the disease are absent. The dog will have normal appetite and energy level.
Systemic signs of illness associated with the disease are present.
Canine lymphoma treatment:
By providing the treatment of lymphoma what can we expect? What is our goal?
We can only expect our dogs to enter the remission stage. So before knowing the treatment we should know what does remission refers to. It is a regression condition of the dog’s cancer. We need to know that remission does not mean cure. It means the signs and symptoms of cancer has become undetectable in the screening tests but the disease is still present there. However, a dog can attain complete or partial remission.
what is the ideal treatment for lymphoma?
Chemotherapy is the base of the treatment, as lymphoma is a systemic disease. Other treatment options may include medicine like Prednisone, Tanoveoa-CA1 and bone marrow transplant. Same drugs as humans are used but comparatively at a lower dose. This keeps the side effects short term and minimal in most cases. The Madison Winsconsin Porotocol (UW-25 or CHOP) is generally used for the treatment of dogs with high grade lymphoma. 70 -90% dogs treated with CHOP obtain complete or partial remission on an average. But the remission period can vary according to the type of cells affected:
For B-cell lymphoma:
Within first month 80 – 90% patient can attain remission with median survival time upto 1 year though in 25% cases it can be 2 years.
For T-cell lymphoma:
Dogs with this lymphoma are likely to have 6 – 8 months of survival time with 70% achieving remission.
Generally, chemotherapy has 2 phases:
- Consist of weekly treatments.
- It works to place the dog into remission as soon as possible.
- Compared to consolidation phase, it is more dose intensive.
- Treatment is administered less frequently.
- Works to kill the remaining tumour cells.
How long a dog with lymphoma will survive on prednisone?
As we discussed before, if dogs with high grade lymphoma are left untreated, their survival time will be only 6 – 8 weeks. The life span can extend to 2- 3 months if treated with prednisone with an average of 50% responding. During giving prednisone, aspirins like Carprofen (Rimadyl), Etodolac (Etogesic), Deracoxib (Deramaxx) or Piraxicam (Feldane) should not be administered as this combination has a chance of causing stomach ulcer. Though prednisone kills cancer cell directly, long term use of it can lead to drug resistance. However, after administration of prednisone we can notice certain changes in the dogs:
- More urination
- More thirsty, thus will drink more
- Will pant more
- Increased appetite
He should be allowed to drink and urinate whenever he requires.
Side effects of chemotherapy
Generally the side effects are very mild in case of dogs unlike humans and last for a shorter period of time. As a matter of fact almost 75 – 80% dogs show no side effects at all. Less than a five percent may suffer severely and will need attention from vet. However, the side effects may include:
Vomiting, diarrhoea and inappetence are commonly seen as side effects. They usually begin 3 – 5 days after treatment.
If there is bone marrow involvement and the chemotherapeutics are applied there, then it may cause damage to the precursor cells present in the bone marrow. So, decreased number of platelets and neutrophils are mostly seen. As a result of these the patients are seen to have petechiae, pyrexia, pallor and weakness.
Lymphoma treatment cost:
How much can chemotherapy cost?
This is a common concern that gives pet parents a splitting headache along with heartbreak. Owners of dogs with lymphoma are likely to spend about $5,000 through which a chance maybe created of extending the dog’s life upto a year or two along with a little hope of cure. For further treatment more expenses maybe required. For example – At North Carolina State University, above 70 owners of dog having lymphoma spent $16,000 - $25,000 on bone marrow transplantation. Again, it may cost $3,500 - $4,500 at tufts. The cost can be $10,000 or higher in other clinics. So, we can see that it does not have any specific limit but we may say that it might start from 3,500 approximately.
When to euthanize a dog with lymphoma?
To understand the concept of euthanizing a dog, we need to know what euthanasia is.
What is euthanasia?
It means to end life intentionally to gain relief from pain and suffering due to any kind of disease or other causes which has no chance of recovery.
When should we euthanize a dog?
This is a very painful decision to make for a pet parent. But considering certain things we can make a peace of mind before deciding to euthanize the dog:
If the vet recommends that the sufferings of the dog cannot be eliminated by any way, then you can take a decision to euthanize your dog. It’s better to relief him from pain rather than making him suffer everyday.
Loss of appetite:
If your dog does not eat anything and keeps food down then it is one of the greatest sign that he is absolutely not having a good time anymore.
Trouble walking or standing:
If your dog cannot walk without interruption and cannot stand without help then you should understand that it’s the time to let him go.
Difficulty in breathing:
If chronic, labored, shallow and rapid is noticed in your dog then you should know that his time is near.
Sometimes, fun loving, cheerful dog maybe seen lying listlessly. His favourite things like treats, toys or car ride will hold no interest for him anymore. Then, you can understand that time has come to bid goodbye.
How and why to euthanize a dog at home:
Many people may ask if they can euthanize their dog at home or not. Or in which situation they should take this decision. Following facts might be the reason:
- One may live far away from a veterinary clinic which can be a rural area.
- Your dog may feel distressed by seeing a vet which you may not want.
- Many people want their pet to live the last days of his life with the family rather than in clinic.
- The process is expensive when done by vet at the clinic. The cost can be up to $400 which might be expensive for some people. There might be some organization which may provide the service at a low cost but not for free. So, if you plan to do it on your own then you will be able to euthanize your dog for free.
So, finally if one decides to euthanize the dog at home then he might follow any of the two ways:
Euthanasia by the pet parent himself:
If one is convinced to do euthanasia by himself then he must be careful during the process. If performed improperly then it might cause more harm and pain to the dog. The following process might be followed:
- A sedative is to be injected to the dog. He will loose his consciousness slowly and you can say goodbye to your beloved friend.
- The next phase is to administer Pentobarbital Sodium. Dose is ≥100mg/kg body weight. This can be given by injection or by the catheter. It will stop your dog from breathing and the heart will stop. It may take half an hour to become effective.
Euthanasia by the vet at home:
Vets mostly choose to sedate the dog at first and then go for further process. They also use penobarbitone solution which they administer through intravenous injection. This drug is considered the best by vets as this very rapid working, inhibits the voluntary motor activities followed by cardiac arrest.
How to euthanize a dog with Benadryl?
Benadryl can be used for mercy killing at home. This is an antihistamine and works as a sedative. Generally, used by humans as sleeping aid. But vets also use this to euthanize dogs. Following steps should be kept in mind while euthanizing your dog:
- To understand the details of the dosage from the vet.
- To take him to the favourite place in your house or to prepare a place where he feels relaxed.
- To administer the Benadryl in correct dose and keep a close eye on him.
What is the lethal dose of Benadryl? As a standard dose it can be given at a rate of 1 mg per pound body weight up to 2 – 3 times a day. If it’s given more than this dose then overdose might happen and it prove to be fatal then.
Medicines like Tylenol pm or other sleeping pills can be used for euthanizing.
FAQs’ regarding dog lymphoma:
How do you know when your dog is dying from lymphoma?
There are some signs which might indicate you that your pet does not have much time with you. Those include:
- Continuous lethargy
- Movement problems
- Bowel incontinence
- Loss of appetite
- Difficulty in breathing
- Excessive snuggliness
What is the final stage of lymphoma?
Stage 5 in considered as the final stage of lymphoma. Here we see the bone marrow involvement. In this case it is very difficult to obtain complete remission. But chemotherapy might be of some help.
What is the life expectancy of dog with lymphoma?
Generally, the survival time depends on the administration of medicines and proper treatment. Life expectancy varies according to this. So life expectancy:
1 to 2 months
Has average survival time of 12 – 14 months as 80 to 90% dogs attain remission.
However, if the lymphoma has other organ involvement or does not respond to the chemotherapy positively then there is a possibility of decreased survival time.
How to cope up with the situation after euthanizing your dog?
Losing a pet and keeping mental stability is never easy. It’s hard to start the daily routine just after their death. Grief and guilt encircles both brain and heart. But life goes on. So we need to try to get out of this sadness and start afresh. To cope up with the situation several strategies can be followed:
Engaging oneself socially:
Talking and sharing grief with the family and close friends may lighten the burden of guilt in our heart. Their support may help us to recover quickly and free us stress in a short period of time.
Engage oneself with different kind of meaningful activities:
Those who own a pet for a long time, they get a habit of having their pet around them all time. They also always remain busy in maintaing the proper health and food schedule of their dog. Inoder to distract himself from those, he might start doing different activities like:
- Work as a volunteer in any local animal shelter.
- Work for earning donation of needed items to an animal shelter.
- May consider taking therapy sessions to cope up with loss and bereavement.
- May start writing his feelings of grief and sadness in a diary.
Preserve the memory of the deceased pet:
Some photo frames and paintings of the pet can be made to keep the memory alive.
Getting a new friend:
After this huge loss, one can consider adding one new family member. This may fulfil the empty space in his life as an compensation of the deceased dog.
Reading books regarding this situation:
Some people may find peace of mind by reading books regarding their heartbreak. In this case here are some of the recommended books.