Malignant adrenal tumor

[DadofGuiness]

Hello all,
After some google searching I stumbled upon this site. My sweet boy Guiness, a pit bull that found me via a rescue in Washington DC about 9 years ago as of friday has been diagnosed with a cancerous adrenal gland tumor. Out of the blue he began panting, being short of breath, shaking, being lathargic, unmotavated, weak, trouble sleeping, so on and so forth. After around 8 visits to 2 diff vets, several tests, they found the nodule friday with an ultra sound. They determined last week through tests he did not have cushings tho he shows all the signs. My vet is contacting a surgen in Annapolis Md to get more info reguarding the options we have.
Guiness is thought to be aprox 11yrs old, cant confirm because he was found as a stray wondering the streets malnurished and pretty beat up. It was thought he was used as bait for fighting dogs due to his condition.
Im wondering if anyone can give any information about the surgery to remove the mass and or tratments without surgery. My vet, while tops in my area, has little experience with such diagnosis. From what ive read online this condition is quite rare. He began showing symptoms about 3 weeks ago this thursday. She informed me his life expectancy is only a matter of months without surgery.
Im unsure of what to do. My girlfried thinks we should just let nature take its course and allow him to pass naturally. He is already quite old for a 70lb pit bull and has had a great life. However if we could get a few more good years togeather the surgery may be worth doing. If his quality of life would be lessend by the surgery i'll choose not to do it. Any advice would be greatly appreciated.
Thanks,
Allen & Guiness

[Harley PoMMom]

Hi Allen,

Welcome to you and Guiness! I have manually approved your membership so there is no need to respond to the email that is automatically sent to you for validation.

Bless you for giving Guiness a forever home. I am sorry for the reasons that brought you here but glad you found us. We have several members whose dogs have gone through an adrenalectomy, and I am sure they will be along to share their advise and support.

In the meantime I am providing a post from one of members:


Hello and welcome. Good job of getting Rudy's diagnosis of an adrenal tumor. My dog Shiloh had a very large, mildly malignant adrenal tumor in her left gland, about 5 cm. in diameter. She had her adrenalectomy when she had just turned 12 and she lived well into her 15th year with an excellent quality of life. Prior to the surgery she was just hanging on. We had a wonderful board certified surgery team.

Tumors in the left gland are virtually always easier to remove than in the right. Rudy is only 10, that's a big plus. Shiloh only took a medicine similar to Trilostane to lower her cortisol prior to surgery. She didn't take anything like aspirin, tramadol or idezupan. But all surgeons do things a little differently.

As you know, it is a very serious surgery but I disagree with the 20-30% failure rate. I think it's more like 15% max. Prior to Shiloh's surgery my surgeon told me they have an 85% long term success rate with similar adrenalectomies. He also told me all he cares about is the size of the tumor and its involvement with area blood vessels.

Going through Shiloh's adrenalectomy was the toughest thing I've gone through in many, many years. But the surgery was successful, she recovered well (although it took a while) and she was a totally happy, healthy girl for years afterwards. I hope this helps a little.

Ken

I am also including links to a few of our members threads where their dog has had an adrenalectomy done or has an adrenal tumor:

Flynn 11 y/o Foxie Cross - Right adrenalectomy, 3rd Dec 2012 for Pheochromocytoma (http://www.k9cushings.com/forum/showthread.php?t=4242)

New here - adrenal mass questions (http://www.k9cushings.com/forum/showthread.php?t=6357)

will be testing hopefully soon (Update: Left adrenal tumor) (http://www.k9cushings.com/forum/showthread.php?t=3674)

Kira, 14 y/o Husky-Adrenal Cushing's (successful adrenal surgery) (http://www.k9cushings.com/forum/showthread.php?t=2742)

One of our dear members, Trish, has made a list of questions that should be asked when a pet parent is considering an adrenalectomy for their furbaby.



Part I - Questions to ask when considering if surgery is an option for your dog’s adrenal tumour:
1. What type of tumour do you suspect, ?functional, ?non-functional, pheochromocytoma, benign, metastatic
2. Expected life span for my dog in a normal situation. If your dog is close to, at or past his expected lifespan for his breed is surgery going to be of any benefit?
3. Prognosis for my dog if we treated medically i.e. with Cushings medications. AND if we do not proceed with surgery how long do you think it would be before the tumour started adversely affecting his quality of life?
4. If he is miserable now, does the benefit of potentially risky surgery outweigh his current quality of life?
5. Are there any other health problems that could impact on a positive surgical outcome, for example: if your dog is overweight or has heart, BP, liver, kidney or lung conditions
6. Is there any sign of tumour spread – imaging should be done, including ultrasound and on advice of specialists either CT or MRI to check whether there is local invasion around the tumour, into blood vessels including vena cava or spread further away in the body to lungs etc
7. Surgeon recommendations – would he/she do it for their own dog?
8. Psychological impact for the owner: It is important to understand this is risky surgery, sadly current guidelines indicate 1:5 dogs do not make it, and some recommendations are not even that high. Can you accept it if your dogs dies during or in the postoperative recovery period surgery? This is where it is important to weigh up whether the benefit of your dog being fully cured is worth the risk of possibly losing him.
9. Financially – can you afford it? Find out estimate of costs.
10. Hopefully this will not happen, but if your dog collapses, e.g his heart stops either during his surgery or afterwards what emergency measures should be undertaken, do you want your dog to have CPR, how far are you (the owner) willing to go for your dog to be saved in such circumstances

Part II - Surgery has been recommended as treatment for your dogs adrenal tumour, here are a few suggestions on what questions you should ask your surgeon:
1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?
2. Please explain to me how you will do the surgery, which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is their close supervision?
3. Will there be a specialist anaesthetist available for the surgery?
4. If it hasn’t been done, do we need a CT/MRI scan to look at the tumour more closely to check for vena cava involvement or any other tumour spread?
5. What are the risks associated with this surgery, including
• Bleeding (including trauma to blood vessels or other organs during surgery)
• clots
• Blood pressure or heart problems such as arrhythmias
• pancreatitis
• pneumonia
• kidney failure
• infection
• wound problems
• bowel problems
• anaesthetic risks
• adrenal insufficiency or electrolyte abnormalities
• death (sorry but you have to ask that risk too)
6. If we proceed with surgery does my dog need preoperative treatment with Cushing’s meds, antihypertensive if high blood pressure is a problem – phenoxybenzamine recommended preoperatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots postoperatively?
8. What would you do if you found anything else during the surgery i.e. nodules in other organs e.g. spleen, opposite adrenal, liver, kidney. Would you remove them and what are the risks associated when doing additional abdominal surgery together with adrenalectomy
9. How long will it take and when will you contact me so I know all is OK, when can I visit after surgery?
10. How will the postoperative period go, how long would you anticipate he would need to stay in hospital? How will we manage pain?
11. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
12. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
13. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.

Please do ask all the questions you want, we are here to help in any way we can.

Hugs, Lori

[molly muffin]

Hello and welcome to the forum. Lori covered off a lot if not all of the main points when it comes to the surgery.

So I'll ask, how big is the tumor currently, is it invading the vena cava (large blood vessel) and which side is it on.

Any surgery is risky and an adrenlectomy can be a tough surgery. It is most important to have a borad certified surgeon who has done ALOT of the surgeries, successfully I might add. Setting up a meeting with the surgeon and going through the questions is a good way to evaluate.

So glad that Guiness found a home with you and got to have a great life and someone who cares so much now that he is having some problems. I think you just have to find a good surgeon who will give you and honest evaluation of what will be best and what they think the risks are so you can make a decision

I'm sure Trish (of the Flynn adrenalectomy and liver surgeries) will be along at some point to chip in. Just not sure when as she is in a different time zone from most of us.

Sharlene and molly muffin

[Trish]

Hi Allen and Guiness, welcome to the forum!

Your dog sounds similar to my Flynn, he also had symptoms like you are describing. His snuck up over a period of months though, rather than a rapid presentation. But lethargy, weakness, panting, twitching well all symptoms he had. As well as high blood pressure. Flynn is a fox terrier mix and was also 11 when his right adrenal tumour was diagnosed, his turned out to be a pheochromocytoma which was also invading his vena cava. His was also picked up on an ultrasound. They suspected the pheo on the basis of negative cushings tests, the tumour appearing to arise from the medulla (inner part) of the adrenal gland and his hypertension. Has Guiness had his BP checked? In some dogs with this type of tumour the symptoms can be intermittent, when the tumour secretes catecholamines like adrenaline which causes BP to spike, shaking, perhaps headaches, twitchy, some are sweaty and look flushed etc. My dogs symptoms were fairly constant though. On the good news side, he did have adrenalectomy and removal of thrombus from the vena cava and here he is still doing well 18 months later!! The more usual adrenal cortical tumours do cause cushings and positive cushings tests, some benign tumours don't test positive but they can still have symptoms. So it can be a bit of mystery tying down a diagnosis of the type of tumour.

It is a hard decision for sure deciding whether surgery is the way to go, I was also told that Flynn had only a few months if we did not do anything. I considered the risks of surgery and found that scary :eek:. But for me surgery at least gave him a chance despite the associated risks was less scary than watching him decline over a period of months. I decided very quickly on the surgery based on what the IMS and surgeon discussed with me.

Just to complicate things even further they found a small nodule on his opposite adrenal around the 1cm mark. They did not think it a nasty one, it was eyeballed during his surgery and did not give the appearance of malignancy. So we have elected to watch and wait. He has regular scans and so far so good, no growth over 18 months so looks like we made the right decision there. Many dogs have various lumps and bumps, so the specialists jobs needs to be deciding on the best course of action based on the scans/tests to minimise the risk to your dog.

My local vet is also excellent, but he told me he does not see this type of thing very often at all and so referred us to specialists immediately. I whisked Flynn off to see them and it all worked out fine.

Have you got the results of the ultrasound and other tests that have been done on Guiness? It is real helpful for us to be able to read them and offer you any tips or advice. For blood tests just type out the abnormals with the laboratory reference ranges next to them so we can see whats going on. Include the cushings tests too. If you haven't got them, ask your vets for copies and keep them handy in a folder.

Hopefully you hear back from your vet when they discuss Guiness' case with the surgeon. I also saw an IMS who was very helpful dealing with the medical side of things, like hypertension.

We came up with that list after we have had a lot of people arriving here with questions on adrenal tumours so we hope it is helpful for you.

Guiness sounds like he has had a good life with you Allen, you have some big decisions to make about his ongoing care and I am sure you will make the right ones once you have all the info from the specialists. Do come back and ask us any questions and we will help you the best we can.

Trish :)

[goldengirl88]

Welcome to you and your baby. I am so sorry to hear your dog has a malignant tumor. My dog has an adrenal tumor also. Hope you can find an excellent surgeon to sit and talk with. Everyone else has already clued you in on what to look for in a surgeon and what to ask, so I will just say that I pray your dog can get rid of this tumor and does well. Blessings
Patti

[Trish]

Hi! Any news on Guiness? Hope he is feeling a bit better this week and you are coming up with a plan on how to proceed with him. :)

[jxeno13]

Hi and welcome to you and Guiness as well! I, too am just checking to see if there was any new news on Guiness and how you are doing.

[goldengirl88]

I just wondered if you have a plan going forward with your baby. I know this must be an awful time for you and I am so sorry this is happening to your Guiness. I pray all goes well for you both.
Patti

[goldengirl88]

I haven't seen you on the forum and just wondered about Guineas. How has he been? Have you made any decisions on treatment? I hope for your sake and for Guineas there is some way to help him. Blessings
Patti