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8-Year Old Boxer Battles Splenic Leiomyosarcoma

February 22, 2010
Boxer Dog Eyes Mop Bucket: Example of Extreme Polydipsia

Keynes Eyes the Mop Bucket for a Draught

First, We Just Had Too Much Drinking

Keynes is an eight-year-old Boxer. He slobbers, bounces, occasionally limps, had a benign leiomyoma intestinal muscle wall tumor surgically resected by yours Doc Truli four years ago, and generally loves loving everybody.

About three months ago, he started obsessively drinking water. From his bowl, the cat’s dish, the toilet, the bird bath, even the mop water. You’re thinking, “Diabetes, kidney disease, urinary tract infection, accidental poison ingestion, or crazy because of workmen doing construction on his house.” Or, at least, that’s what his mom and I were thinking.

Well, we were wrong. Normal blood and urine tests (except his urine was very dilute.)  So I thought, “Maybe mom’s mistaken. Let’s measure how much water Keynes drinks in a day.” A dog or cat can drink in the ballpark of 30mL per pound per 24 hour Earth day. (approx 65mL per kg per 24 hrs). Keynes was drinking well over 100 mL/pound/day.

Tru Tip:

A dog or cat can drink in the ballpark of 30mL per pound per 24 hour Earth day. (approx 65mL per kg per 24 hrs)

Next We Searched for an Answer Visually

and an “oh, by the way” gives the Doc a big clue!

Next we looked at chest and abdominal x-rays, really hunting for trouble. Then we performed an abdominal ultrasound. Keynes had a mass growing off of the tail of his spleen that might be cancerous or benign. He had 4 abnormal lumps in his pancreas. And his mom thought to let me know he had regurgitated and vomited water several times daily, although sometimes not for several days, for three months!

“That’s a symptom,” responded Doc Truli.

Now, some Specialists encouraged laparotomy, open abdominal surgery where I check everything and surgically remove or correct or at least biopsy everything abnormal (wonky) looking. (I’m psyched to have readers from Britain; I spent three years in Mildenhall as a child.)

Minimally Invasive Biopsies Identify a Diagnosis

The endoscope finds ugliness, but not disease

Your Doc Truli uses an endoscope. Regularly. The endoscope possesses a digital camera on the end, so I can see what’s going on. I decided Keynes needed his esophagus and stomach checked because of the news about the vomiting.

A mass on the spleen with normal complete blood count and no anemia could cause pressure on the capsule of the spleen and a feeling of nausea. Masses in the pancreas could cause pancreatitis, but his PLI snap pancreatitis screening test was perfectly normal, he had a good appetite, and did not vomit food. Only water.

Instead of going right to abdominal surgery, I scoped the Boxer. The first picture is the stomach lining. And no, it’s not supposed to look like it has a rash.

hyperrhemic (red) circles, like a stomach lining rash

Those red spots are not normal!

Magnification of metal biopsy instrument pinching a sore bit of stomach mucosal lining in a Boxer dog

Magnified Biopsy Instrument at Work

The Mucosal lining pooches upward where the biopsy sample pulled away

Seconds after the Biopsy Bite

Drops of Blood Ooze from the Gastric Mucosa Biopsy Site

Normal Drops of Blood Stream from the Biopsy Site

Smmoth Pink Normal Canine Stomach Lining with a small "fold" which is a peristaltic muscle contraction

Normal Stomach Lining in a Dog

The second picture shows the magnified biopsy instrument grabbing a piece of mucosa. (That’s all there is to that!) The next picture document a biopsy site where a piece of the stomach lining was grabbed (about 5mm, this is greatly magnified), the spot pooches out for a minute, then starts normal bleeding. A mostly visually normal area of stomach lining is pink and smooth.

Ultrasound-guided biopsies into the splenic mass

Doc Truli pointed the ultrasound at Keynes’ large spleen lump and used the images to guide a tru-cut biopsy needle into the heart of the mass.  Two diagnostic quality samples were obtained, without invasive surgery.  These ultimately brought the diagnosis to light.

Keynes woke up in good spirits. Hopefully, the minimally invasive biopsies give us the answer to his problems without the need for invasive internal surgery.

Disappointing Results; but at least we had results!

P.S. After 2 days, we had some results. The mass on the spleen was called a leiomyosarcoma. Any biopsy ending in -sarcoma is bad.  Sarcomas are tumors of the connective-tissue family of cells.  They like to spread around microscopically, but occasionally they like to stay local and can be cured with surgery.  The trouble is, you can never be 100% certain which way they will be.  (Like a relative that sometimes is thoughtful and insightful and other times just gets too drunk and all over the place.  You just can’t predict, good family holiday? or embarrassing family holiday?)  And the stomach lining was just basically irritated. Now begins the hunt for metastasis-or cancer spread to parts of the body in addition to the spleen.

In most cases, if chest radiographs (x-rays) show lumps or nodules, then the cancer us assumed to be spread already. However, chest x-rays only show lumps about one centimeter (1/2 inch) or larger. So basically, just because a dog has a “clear chest met-check” does not guarantee “no spread of cancer.”

The Drinking Water–Lump on the Spleen Connection

P.P.S. Keynes’ oncologist felt that he had no identifiable spread of the cancer.  He had hyperplastic (hyperactive) nodules of Delta-cells on his Pancreas.  The pancreas makes hormones that help regulate thirst and water intake.  Splenic Leiomyosarcomas are known to make a “fake” hormone to trigger the pancreas, which in turn makes a dog drink tons of water for no good reason.  These nodules were the homes of the hyperactive Delta cells that were responding to the inappropriate signal the cancer was sending their way.

Keynes Surgery

or, Why We Have to Remove the Whole Bloody Thing

Keynes underwent surgery to remove his spleen.  Dogs survive without their spleen.  The spleen is so bloody because its primary job is to filter blood.  IN fact, so much blood is stored in the spleen that racing greyhounds, and horses have muscular capsules on their spleens that contract and push extra oxygen-carrying blood into their circulation when they are running or racing.  As much as 30% more blood can enter the bloodstream from the spleen!   I digress.  The point is this: because of the architecture and the job of the spleen, it cannot be cut in half, or just a part f it removed without the patient bleeding to death.  That is why surgeons remove the whole thing!

Days after surgery, Keynes has gained weight, he’s eating well, and he stopped stealing water from every source he could find!

17 Comments leave one →
  1. Denise permalink
    May 25, 2016 9:53 pm

    Hello, I have a 8ish golden retriever. She was diagnosed with Leiomyosarcoma today. She was also diagnosed with Lymphoma which she is getting chemo treatment and she’s responding really well with it. The dr wanted to see a closer look to the mass around the pelvic area. He saids that the Leiomyosarcoma needs to be removed. There is no chemo treatment for that, I would want to avoid surgery but do you know of an alternative? Does it have to be removed, period. Please let me know your thoughts, this is very important because this is my baby girl’s health.
    Thank you,

    • July 1, 2016 10:18 pm

      Dear Denise,

      I am late to answer your question. I hope you were able to make a decision you felt good about. Western Medicine says surgery. There are literally 1,000’s of “cancer cures” on the internet that may or may not help your dog. My thoughts are: sometimes science and statistics and textbooks cannot tell us the correct path to take. It is your path. Your dog joined you and it is okay for you to make the best decision you can with current knowledge. When I consult in person, I can use Chinese Medical examination techniques and physical exam and intuitive techniques to help my patients.

      Consider whether your Golden has enough energy to withstand surgery. At least as far as you can intuit. Sometimes we cannot reach for surgical perfection without losing the patient. Often times we can, as long as good surgeon, good anesthetist, good pain control.

      Doc Truli

  2. Alicia permalink
    May 13, 2012 8:26 am

    Hi, I have a 13 year-old German Shepherd. He was diagnosed with leiomyosarcoma last year. Rather than drinking tons of water, though, he was eating everything he could get his mouth on….cardboard boxes, a tube of lotion, rocks….but eating a towel is what finally led to his diagnosis. One morning, he refused his food, which is extremely uncharacteristic of my 110 pound baby. Then I noticed he kept going outside to throw up. I called his vet, who came to my house to give him a quick checkup. He immediately said we had to do stomach abdominal X-rays because something didn’t feel right. The X-rays shows a mass in Griz’s stomach and spleen, so the vet went in surgically. The mass in the stomach was shredded up pieces of towel and the mass in the spleen was found to be leiomyosarcoma. Griz’s spleen was removed, and because of his age, I opted out of chemotherapy. The vet said he should live anywhere from 6-8 months. Well…it’s been a year, and I have enjoyed every day with my big boy. I’m wondering what to expect next and how I will know when it’s time to say goodbye to him. I hear that his liver may be the next organ affected. How will I know when this happens, and what should I do when it does? Griz is a fighter, and I don’t want to let him go before his time. I wish there was a handbook for the stages of this disease.

    • judyhutchinson permalink
      May 16, 2012 3:26 pm

      I would love to see a reply to this as well. My 13 year old JRT (below) had a 1 pound soft tissue sarcoma removed, inside of which was his spleen. Because of some high number having to do with the rate of the multiplication of cancer cells, Zip was given 1-3 months, hopefully 4. Like you, I opted to not do chemo, because I didn’t want him to be sick and because they weren’t optimistic about it working well. However, it’s as if he’s a new dog and, 2 months out of surgery it’s hard to envision that he’s a walking cancer patient. My vet also said it would migrate also to the liver or the lungs, and to look for breathing difficulties, going off his food, lethargy etc. Just FYI, I contacted the pet grief hotline at WSU and they were nice too–just like Doc Truli–they said to write down the top things my dog likes to do. WHen he can no longer do any of them, (eating is one, of course) then you begin to realize that his quality of life has diminished. But I wonder too, if the dog shows signs of liver or lung related suffering, are there some meds that can alleviate it and give him back his quality of life for a bit longer, or, is the battle over? Good luck with Griz. I hope my pal surpasses the odds too.

    • Brian permalink
      June 27, 2012 10:48 am

      I have an 8 year old Labrador who had his spleen and a baseball sized tumor removed just a few days ago (June 22, 2012). The pathology came back as Leiomyosarcoma and his diagnosis was 1 – 2 months to live. My vet admitted that this is the first time that he has seen this type of cancer, even though he see splenic masses at a rate of about 4-5 per month. Apparently this form of cancer is rare.

      During the procedure there were no visible signs of other tumors or metastasis, which is a very good sign. Apparently the assumption is that this cancer still exists at a microscopic level in the body and will reveal itself at some point in the future.

      I read on a National Institute of Health website that dogs with leimyosarcoma of the spleen have a positive outlook when both the organ and the tumor are removed. ( From their 5 year study, only 48% of all post surgical dogs die of metastasis. “The prognosis in dogs with leiomyosarcoma of the spleen, stomach, small intestine, and especially the cecum is good to excellent if surgery is performed.”

      Post surgery, Max is doing very well and has all appearances of being back to his normal self (after only four days!). It is hard for us to accept his diagnosis because by all appearances he is a strong and healthy dog. He showed no signs of illness before and we discovered the mass from an unrelated X-Ray.

      Finding this site is giving me hope and is strengthening what I feel to be true; Max has many more years left. Obviously time will tell.

      We have discussed chemotherapy and are very reluctant to go that route. From what I have read, the success rate is not overwhelming (adds maybe a few more months) and can take a real toll on the dog. Naturally, there are exceptions to the averages but we do not feel that it is the right thing for us. For anyone who has gone with Chemo, can you share the results?

      We have shed our tears over the news but are now shifting our focus on loving Max and making the most of the time that we have left (for however long that may be).

      • June 27, 2012 5:22 pm

        Excellent! Thank you for sharing your experience. My patient had 6 months of the chemo after removal of intestinal leiomyosarcoma. He experienced recurring infections in his prepuce, which came on 2 days after each chemo session and we used antiseptic flush. Once his chemo was over, his infection cleared. He lived 3 years after his surgery.

        Good luck. Your dog is very lucky.

  3. March 21, 2012 3:36 pm

    Hi, I realize that these comments are a few years old. I guess I’m searching for some hope. My 13 year old JRT, who was amazingly healthy until a week ago, just had a one pound mass and his spleen removed. My vet called telling me that it was a “soft tissue” sarcoma, and that she is consulting with the pathologist and oncologist about whether there can be further treatment. I am left thinking it’s a hemangiosarcoma (and all I’ve read is that there’s no hope, even though, after surgery, my dog is like a pup again and doesn’t think he’s sick), but then I read here about the leiomyosarcoma and I hold out hope that perhaps it is this. Obviously, neither is good, but it seems as if the latter gives him a bit more time whereas the former: 3 weeks to 3 months or something such as that. I’m wondering why my vet didn’t know…she’s been so good with caring for Zip, but this is frustrating.

    • March 25, 2012 9:00 am

      Dear Judy,
      “Sarcoma” is a general cancer term. “Soft Tissue” means it comes from any of the non-boney tissues of the body. Sometimes, especially in cancer, the cells of the tumor have de-differentiated, meaning they do not resemble their cells of origin and they are reverting to a more primitive state. That’s a reason why they grow out of control into a tumor; they do not have their original parts and activities. It can make an exact identification of the tissue they started out from tricky. Even board-certified pathologists may have differing opinions on what your dog’s tumors came from.

      If they can figure out what tissue type the tumors grew from (connective tissue, etc), then they can help predict how it will act in the future. They can also put it in a category and treat it like they have treated other ones in the past in the hopes you will prevent pain and extend your dog’s life. If they can’t exactly figure it out (this happens sometimes)< then your vet is doing the best thing- which is calling on the experience and intuition of oncologists who have seen hundreds of dogs in similar circumstances as your dog. They will put their minds and experience together and come up with the best plan for your dog.

      I believe the fact that they cannot tell for sure on the first go-'round is good news because hemangiosarcoma is so common, I can virtually almost diagnose it on sight. If I was a betting person, would bet it's not hemangiosarcoma or your vet would have had a diagnosis right away!

      I hope that explanation helps,
      -Doc Truli

      • Judy Hutchinson permalink
        March 25, 2012 11:09 am

        Wow, Doc, this is the first (guarded) hope I’ve had since the surgery. Old Zip doesn’t seem to know he’s sick, and I couldn’t keep up with him yesterday on our hike–after his staples were removed, but until now I felt as if he was basically a ticking time-bomb, who would fall deathly ill at any moment. My vet said she would be in touch early next week hopefully with a prognosis–somehow I thought she was just delaying the bad news in order to give me more time without worry. I am now slightly more cautiously optimistic thanks to your response–realizing that the tumor was still cancerous. Sometimes, the internet isn’t a good thing, such as when uneducated laypersons such as myself try to delve into veterinary medicine and diagnose conditions. On the other hand, I’m extremely grateful to have found your site, and I appreciate your explanation of the possibilities. Thanks so much. I plan on enjoying an afternoon of hiking with the pup and I’m not going to think about this hemangisarcoma stuff at all for today.

  4. karen permalink
    July 18, 2011 8:01 pm

    Dear Doc Truli,
    Our dog was just diagnosed with leiomyosarcoma of the spleen. She had surgery to remove the spleen and the six pound malignant mass attached to it. Her liver also had some very small nodules which are likely malignant, as well. These were biopsied but not removed because they were small and numerous. The biggest after surgery problem we are having with our dog is she is not eating. It’s been 10 days now. We’ve been trying to get some nutrition into her via oral syringe, but that’s about all she’ll take. We don’t want to do any more invasive surgery, chemo, etc. and are preparing for her departure. Any ideas you might have regarding anything that could help at this point would be greatly appreciated.

    • July 22, 2011 2:12 pm

      Dear Karen,

      Speak with your veterinarian about pain management. Be sure your doggie has the best pain control possible. Some painkillers actually suppress the appetite. So you’ll have to be in good communication with your veterinarian regarding your options, timing, dosages, etc.

      Perhaps your vet would feel an appetite stimulant would be appropriate. It doesn’t hurt to ask.

      Finally, remember that sometimes when you don’t feel well, especially after surgery, you want bland comfort foods instead of high-value yummy foods. So when you think of things to tempt your dog to eat, consider bread, rice, crackers, chicken soup. You know, bland foods. Sometimes, they are just the trick!

      As you can tell from my answers, I think you need more guidance from your veterinary team that knows your dog. That’s what a veterinary consultation is for, so be a noodge as schedule a follow-up consult again!

      Good Luck,
      Doc Truli

  5. Ann Van Dyk permalink
    November 16, 2010 11:04 am

    My Maggie had her first chemo shot last week, and amazingly, she seems to have had no side effects from it. I hope she continues to surprise us! She hasnt lost her appetite, loves her treats, is playing like a pup, and cant wait to go in the car with us…even to the vet! I can only hope this is a good indictation of a GREAT outcome.

    • November 17, 2010 8:04 pm

      OMG! I hope Maggie does great! Ann, thank you so much for sharing. You made my day!
      Doc Truli

  6. Ann Van Dyk permalink
    November 3, 2010 10:14 am

    Just wondering how these pups with the splenic leiomyosarcomas are doing. My 5 yr old cocker spaniel had surgery 3 weeks ago for this problem. She shows no sign of metastis and she recovered very well from surgery. All her tests, echocardiogram, 3 chest xrays, ultrasound and liver biopsy all clear. We changed her diet to high protein, no grain diet and we are giving her a daily multivitamin supplement. Her new treats, which she loves, are made from 90% fish, which is loaded with omegas. Her fur has come back silky smooth!! And we are having 5 treatments of chemo starting tomorrow. But I have kids and I am worrying about her getting sick. By the way, we found the lump by accident and she was showing no signs or symptoms of anything. Thank goddness she loves to get belly rubs and we found it!!!

    • November 3, 2010 12:23 pm

      Wow! You guys have good fingers to feel a splenic lump. That’s amazing! It sounds like your Cocker is doing great. My patient is doing well. He had the rounds of chemotherapy that the board certified oncologist recommended. He handled the chemo without any problems. White blood cells never plummeted, he didn’t get sick from the chemo until the last treatment. That time, he felt a little tired and did not want to eat (unusual for a Boxer).
      Your girl could get sick from the chemo. I’m sure your oncologist explained the pros and cons to you. Just remember, your decisions about whether or not to do chemo will not “save” or “kill” her. I know you’re probably worried that if you say no to chemo, and she gets metastasis, you’ll feel like you should have done the chemo. And if you do the chemo and she feels sick, that maybe she would have been fine without it and then you went and made her sick. Right? That’s pretty much the dilemma.
      Remember that she had a leiomyosarcoma. That cancer is responsible for any negative outcomes, not your decisions either way! Just do what you think is right!
      BTW – my patient had an intestinal leiomyoma successfully removed when he was 4 years old, and he was doing good until at 8 yrs, the leiomyosarcoma became apparent. The pathologist told me that sometimes the leiomyomas, which are benign, non-spreading tumors, are misidentified by the specialists. He said it was possible that was a leiomyosarcoma four years before the new cancer! That one stayed away without chemo for 4 years (we did twice a year abdominal ultrasounds, and the yearly bloodwork). At the second surgery for the bad cancer, the surgery from the first tumor looked fine!
      Good Luck, Anne. You are setting a great example for your kids and treating your dog like the family member she is. I’m sure you’ll make the decision that is right for her!
      Keep us updated on how her chemo treatments go.
      Doc Truli

  7. Rachel Garcia permalink
    March 24, 2010 9:44 am

    How is the dog doing now? My 10 yr old female foxhound mix, Bailey, just has the same thing. She had her spleen along with the tumor removed on 03-18-10 and is doing well. The Dr. said her liver, kidneys, lungs & heart all look unaffected but called me this morning & said the lab results are a splenic leiomyocarcoma & appears to have been isolated to just the mass in her spleen. We will need to keep an eye on her & do ultrasounds on a regular basis to keep an eye on possible spread. He says this cancer does not spread very aggressively but everything I’ve read says otherwise.

    • March 26, 2010 10:10 pm

      Hi Rachel,
      I hope Bailey does great for a long, long time.
      My patient is doing well. He visited the veterinary oncologist and she prescribed some chemotherapy for about 6 weeks to help decrease any potential cancer that may have spread microscopically. Apparently, many oncologists advise this chemo, but there is no solid proof that it extends life. He’s doing really well with it.
      Many specialists I’ve spoken with have leiomycosarcoma patients that live for 4-5 years after surgery. Be careful what you read! Keep positive.
      –Doc Truli

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