Classic Lymphoma Diagnosis in a Dog
Fuzzy Does Not Feel Well
“Doc, Fuzzy just doesn’t seem right. He’s been sleeping a lot lately and he doesn’t walk as far as he should when we go out. He just sits down and refuses to go further until I turn around and face home, then he miraculously has enough energy to go the direction he wants to go! I can’t imagine what could be wrong with him,” said Antoinette, Fuzzy’s human mom. Antoinette is no dummy. She brings her pets yearly for check-ups, asks smart questions, like, “Do we really need all of these vaccines,” and her dogs are always happy and well-adjusted.
You would think Fuzzy, the 20 pound-long-haired muttzit mix would have arthritis, or heart disease, or an infection slowing him down. Maybe you would think he has a behavioral problem in which he manipulates his mom into doing what he wants for no humanly-discernable reason. You might think these things until you learn that Fuzzy is only 2 years old! Two?! And he cannot walk more than a block, sleeps all day, and generally looks like a washed-out version of a dog.
Physical Exam Reveals Swollen Lymph Nodes
Doc ran her hands over Fuzzy’s fuzzy forehead. He barely looked up. Then she tickled under his chin and around the side of his jaw (most dogs like that!) This is not mere entertainment, the submandibular lymph nodes live just under the back curve of the jaw where it meets the throat. Normally, you can feel these lymph nodes as robin-egg sized roundish things. Both of Fuzzy’s were severely enlarged.
Next Doc Truli checked his ears. After all, the normal job of the lymph nodes is to help drain and clear infections from their assigned regions of the body.
“The lymph node nearest and toward the heart from an infection should be a little enlarged as it activates to handle the extra work of cleaning up the infection,” says Doc Truli.
Fuzzy’s ears were perfect. His teeth were beautiful. His skin was clear. Doc went on high alert.
Doc Truli systematically checked all of Fuzzy’s external lymph nodes. The submandibular, the pre-scapular, the axillary (in the
armpits), the inguinal (in the groin), the popliteal (back of the knees) and an abdominal feel revealed lumps in the abdomen. A rectal exam revealed enlarged sub-aortic lymph nodes (under the spine, above the colon). Fuzzy had generalized lymphatomegaly.
Locations of common lymph nodes your veterinarian can check on physical
- submandibular (can be felt in a normal dog, cat, or ferret, too)
- popliteal (can be felt in a normal dog, cat or ferret, too)
What Causes Swollen Lymph Nodes
Infection, typically by viruses or bacteria, and cancer, cause enlarged, swollen lymph nodes. If one or a few lymph nodes are large, then usually, we think of a bacterial infection activating them to do their job. This is overwhelmingly likely in any given pet. When all or many of the peripheral lymph nodes are swollen, we get concerned about an infection that is traveling in the body, like ehrlichia canis and many others. Your veterinarian will know what is common in your geographical area and advise you what tests may be needed.
When all the lymph nodes are suddenly enlarged in a young dog like Fuzzy, you would think he would be safe from cancer. Unfortunately, lymphoma is a cancer of the lymph tissue (the stuff that makes up lymph nodes), and can arise in any age pet. In Fuzzy’s case, we opted for a biopsy of a lymph node in order to confirm the diagnosis and to type the lymphoma, as different types respond to different medications.
Why Is Biopsy (Usually) Better Than Needle Aspirate Cytology?
Many lumps on the body can be diagnosed with a needle aspirate. For lymph nodes, this is frustrating, and usually a waste of time and money. Why? Because a “busy” lymph node fighting infection looks the same as a cancerous lymph node growing large for no good reason at all. They are almost indistinguishable on needle aspirate cytology. A biopsy is superior because the cells and their “business” of what they are doing can be preserved in relation to one another.
Think of it this way- if you see a teen-ager wearing black, smoking, and hanging outside a club, you do not know if you have an artsy future Harvard graduate going through a “phase,” or a juvenile delinquent headed for prison-unless you see that individual at work with friends in her typical environment. Then you have a better picture of what is going on – not perfect, but better. This is the difference between a cytology which looks at each cell out of context and a biopsy look at tissues in their biological strata.
Please note Sharon’s comment at the end of the story. She rightfully points out the fact that ultrasound guided fine needle aspirate of an internal organ can be an excellent method for diagnosing lymphoma. Doc Truli explains more about peripheral lymph node fine needle aspirates versus internal organ aspirates.
Lymphoma Diagnosis Leads to Proper Treatment
Fuzzy’s biopsy confirmed lymphoma. We selected a cancer treatment protocol and holistic protocol for whole-body support which he tolerated very well, with very few side effects. His energy picked up and he enjoyed himself immensely during baby squirrel season. Fuzzy remained happy and disease-free for about 6 months, then he started to grow new tumors and feel sluggish again. After a year, it was the end of the journey for this awesome dog. Rest in peace, Fuzzy.
Editor’s Note: Many dogs go into remission or live for years with lymphoma treatment. Fuzzy’s results were a little disappointing.