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HEMANGIOSARCOMA
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The following information is simply
informational. It's intent is not to replace the advice of a
veterinarian nor to assist you in making a diagnosis
of your pet. Please consult with your own veterinary physician for
confirmation of any diagnosis. Your pets life may depend on
it.
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OVERVIEW:*
Hemangiosarcoma is a very aggressive, high-grade soft
tissue sarcoma with the most common areas affected being the spleen
and heart. A highly malignant cancer which preys on blood vessels,
it can spread rapidly, causing tumors almost anywhere in the body.
Hemangiosarcoma is insidious, as it attempts to build it's own
blood vessel network, making blood blister like formations which
disrupts normal organ function. It is commonly in the advanced stage
before detection, making it virtually a silent
killer.
A common form of cancer, hemangiosarcoma affects
mostly older, large breed dogs though all dogs, including
young, can be affected. Males tend to have a higher rate of
diagnosis than females, with German Shepards and Golden Retrievers
more affected than other breeds.
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TYPES OF
HEMANGIOSARCOMA:***
There are three
basics forms of Hemangiosarcoma: dermal (skin), hypodermal (under the skin), and visceral (splenic or cardiac).
While the visceral form is most common, dermal and hypodermal have
been recently studied in detail. Hemangiosarcoma is highly
metastatic, and most forms of the disease are associated with a poor
prognosis. The dermal form can potentially be cured with
surgery alone, and many dogs may have a fair to excellent long-term
prognosis. Dermal and Hypodermal Hemangiosarcoma account for
14% of all reported Hemangiosarcoma
cases
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DERMAL:
Dermal Hemangiosarcoma often appears
as a dark to purple skin lesion, which may be raised and appear on
non-haired areas like the abdomen. 30% of all dogs with dermal
Hemangiosarcoma develop metastatic
disease.
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HYPODERMAL:
Hypodermal Hemangiosarcoma can occur anywhere on the
body and may appear as a soft mass or be a firm invasive mass with
ulceration. 60% of dogs with hypodermal Hemangiosarcoma develop
metastatic disease.
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VISERAL:
Visceral Hemangiosarcoma accounts
for 2% of all reported malignancies and up to 5% of all noncutaneous
tumors in dogs. Although these numbers seem small, they have a
significant impact on dogs, since this form of cancer kills.
The spleen and the right atrium of the heart are the most common
sites of occurrence of visceral Hemangiosarcoma. Dogs may have
nonspecific signs such as lethargy, loss of appetite, weight loss or
more specific signs such as difficulty breathing, pallor, or
abdominal fluid. Regardless of the site of origin, visceral
Hemangiosarcoma is locally invasive and highly metastatic. Up
to 25% of dogs with splenic Hemangiosarcoma have cardiac
Hemangiosarcoma and up to 63% of dogs with atrial Hemangiosarcoma
have metastatic disease. Metastases commonly affect the lower,
mesentery, lungs, and brain.
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DIAGNOSIS/INITAL
EVALUATION:****
Because these tumors arise in
internal organs there is often little warning that they are present
prior to time they cause severe clinical signs of disease. A common
estimate of the average time from discovery of the tumor until death
occurs in affected dogs is six to eight weeks but death occurs more
rapidly than this in a number of cases.
Visible bleeding, usually in the
form of nosebleeds, and signs associated with blood loss, such as
tiring easily, episodes of unexplained weakness, pale color to the
mucous membranes of the mouth and eyes, increased respiratory rates,
abdominal swelling and depression are the most common presenting
signs for patients with hemangiosarcoma. A few dogs just suddenly
die with no clinical signs having been noted by their families prior
to death. Bleeding disorders associated with hemangiosarcoma
are sometimes confused with immune mediated hemolytic anemia (IMHA)
because the type of anemia caused by the two conditions is very
similar and early clinical signs are often very similar, as
well. Hemangiosarcomas can cause very large tumors, sometimes
as large as ten or more pounds, when they affect the spleen.
In most instances tumors of this
size in this location are found on physical exam. In other
cases the tumor affects the heart and is hard to find on a physical
exam and even easy to miss or X-rays. Sometimes there are hundreds
of small tumors spread throughout the body and surgical exploration
or an autopsy are the only ways to identify the problem.
The blood disorder that most
commonly accompanies the presence of hemangiosarcoma tumors is
disseminated intravascular coagulation (DIC). This is blood clotting
that is occurring inappropriately inside the blood vessels. It
uses up all of the blood clotting elements rapidly and dogs with
this condition usually have platelet deficiencies, increased blood
clotting times, decrease in fibrin content in the blood and an
increase in fibrin degradation products (FDPs). This is
probably the cause of death in most dogs affected with
hemangiosarcoma.
Diagnosis of hemangiosarcoma can
be accomplished in a number of ways. Identification of a tumor in
the spleen or heart raises a high degree of suspicion for this
tumor. Abdominal swelling is also highly suggestive in an older
large breed dog. If fluid is aspirated from the abdomen and it looks
like blood it is even more suggestive of hemangiosarcoma. If
blood is drawn and will not clot when left in the syringe it is
another sign that a dog may have this tumor. In some cases
careful evaluation of the type of bleeding disorder present is
necessary to raise the suspicion of
hemangiosarcoma.
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TREATMENT:*****
Treatment and
prognosis for Hemangiosarcoma vary by location. Cutaneous
Hemangiosarcoma is often curable with surgery alone, provided the
lesion is small and confined to the dermis. Cutaneous
Hemangiosarcoma often occur in areas of glabrous skin on lightly
pigmented dogs and arise as a result of sunlight exposure.Lesions
that are larger or deeper may be either primary or metastatic
lesions and warrant more aggressive treatment. Treatment of splenic,
atrial, or subcutaneous Hemangiosarcoma consists of surgical
excision of the primary tumor and adjuvant chemotherapy. Recommended
chemotherapy for Hemangiosarcoma is single-agent doxorubicin,
intravenously given every 3 weeks. Use of an indwelling catheter is
important because of the catastrophic tissue slough that occurs
after doxorubicin extravasation. Owners should be warned of the
potential of cardiotoxicity. A total of 4-6 doses of doxorubicin are
recommended. Median survival time after surgery alone is reported to
be 2-3 months, with the addition of chemotherapy increasing the
median survival time to 4-6 months. The VAC protocol may be useful;
however it has a higher morbidity rate with no increase in survival
time. Dogs with splenic Hemangiosarcoma that have ruptured may have
a poorer prognosis than those not ruptured. Currently several drugs
are being investigated for their antiangiogenic properties, and may
be useful for treatment of Hemangiosarcoma in the future. Follow-up
for Hemangiosarcoma should include monthly thoracic radiographs and
physical examinations.
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CURRENT CLINICAL TRIALS FOR
HEMANGIOSARCOMA:
The Animal Cancer Center at
Colorado State University has the following ongoing clinical trial
for Hemangiosarcoma:
Patient
Disease:
Canine
Hemangiosarcoma
Study
Name:
Hemangiosarcoma Vaccine
Study
Purpose of the
study:
The purpose of this study is two-fold. First: to determine
if stimulating a patient's immune system in a very specific way with
one of two new vaccines will prolong survival times in dogs with
hemangiosarcoma. Both of the investigational vaccines contain potent
immune stimulating factors. Also, the study is intended to determine
if this specific immune system stimulation will inhibit new blood
vessel formation in the tumor environment. One of the two
investigational vaccines contains cells designed to activate the
patient's immune system against newly forming tumor blood vessels.
Patient Entry
Criteria:
In
general, these studies are available to qualifying patients living
within 100 miles of the Animal Cancer Center at Colorado Sate
University. The patient must have the disease of hemangiosarcoma,
which has been confirmed by biopsy. The disease may not have spread
to any other area of the body. In order to qualify for this study,
treatment prior to presentation to the Animal Cancer Center must
have been very limited. The patient is not to have received
radiation therapy, any chemotherapy, or any holistic medical
treatment for hemangiosarcoma prior to entry into the study. The
patient must not have received steroids (like prednisone) for three
weeks before presentation. No other medical conditions may be
present that might limit the patient’s life. And no
additional medication may be given once the patient is enrolled into
the study. For more information regarding entry criteria, please
contact our Consult Coordinator at
970-297-4195.
Owner
Responsibilities:
After the initial diagnostic visit, the client
is required to bring the patient to regularly scheduled visits for
treatment and evaluation for up to a year. The client must allow a
total of three skin biopsies to be taken (one pre-treatment and two
during treatment) to assess the patient’s response to the
vaccination treatment. The patient will receive Adriamycin®
chemotherapy every two weeks for a course of five treatments.
Additionally, the patient will receive a total of eight vaccine
injections; one injection at each chemotherapy treatment, and
monthly injections after the completed course of chemotherapy for
three consecutive months. No additional medication may be given once
the patient is enrolled into the study.
Financial
Incentives:
The owner pays for the initial diagnostic work up,
usually $400 to $500. The study pays for all treatment visits and
for all evaluation recheck visits for a period of one year. For more
information regarding financial incentives, please contact our
Consult Coordinator at 970-297-4195.
The University of Pennsylvania,
Department of Clinical Studies has this
available:
Canine Hemangiosarcoma
Efficacy and toxicity of
intracavitary Doxil in canine hemangiosarcoma:
The purpose of
this study is to evaluate the effectiveness of and toxicities
associated with intracavitary administration of Doxil chemotherapy
following surgery to dogs with splenic hemangiosarcoma.
Hemangiosarcoma is an aggressive malignancy and the spleen is the
most common primary site for this tumor to occur. Most dogs present
initially with acute signs associated with tumor rupture, seeding
and bleeding into the abdominal cavity. Furthermore, the abdominal
cavity is also the main site of tumor recurrence, and most dogs will
die or be euthanized due to complications associated with
progressive tumor growth within the abdominal cavity. Current
standard treatment for dogs with hemangiosarcoma is surgery and
systemic (intravenous) doxorubicin-based chemotherapy. Despite the
most effective available treatments for this disease, most dogs will
succumb to their tumor, and the average survival is approximately 6
months.
Owners of dogs that have been
diagnosed with stage 2 or 3 splenic hemangiosarcomas are eligible to
enroll their pets in this study after their pets have had their
spleens removed surgically (splenectomy). Enrollment of pets
must be completed within 3 weeks of surgery. Only
splenectomized dogs that have had no prior chemotherapy, including
doxorubicin, and those without medical problems that contraindicate
the use of doxorubicin-based chemotherapy will be
eligible.
Please make an appointment with
the oncology service or contact the oncology service for
further information if your dog is eligible to participate in this
study.
Department of Clinical
Studies, Philadelphia
215.898.6678 Office Phone / Voice Mail
215.573.8183 Office Fax
csphil-info@vet.upenn.edu General Information
Email
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CLINICAL TRIAL
RESULTS:**
| 1. J Vet Intern
Med. 2000 Sep-Oct;14(5):479-85. |
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Treatment of
canine hemangiosarcoma: 2000 and
beyond
Clifford CA,
Mackin AJ, Henry CJ.
University of Pennsylvania, Veterinary Teaching Hospital,
School of Veterinary Medicine, Philadelphia, PA,
USA.
Canine
hemangiosarcoma (HSA) is an aggressive and malignant neoplasia with
a grave prognosis. Surgery and chemotherapy have limited success in
prolonging survival times and increasing quality of life in dogs
with HSA. Advances in medical oncology are resulting in increased
survival rates and a better quality of life for veterinary cancer
patients. An understanding of mechanisms of metastasis has led to
the development of new treatments designed to delay or inhibit tumor
spread. Promising new treatment options include novel delivery
systems (inhalation or intracavitary chemotherapy); use of
immunomodulators such as liposome-encapsulated muramyl
tripeptide-phosphatidylethanolamine; antimetastatic agents such as
inhibitors of angiogenesis (interferons, thalidomide), matrix
metalloproteinase inhibitors, and minocycline; dietary
modifications; and gene therapy. Inhibitors of angiogenesis seem to
be safe and, unlike conventional chemotherapy, do not induce drug
resistance. Although many of the newer approaches are still under
development and review, the use of multimodality therapy
incorporating innovative treatment modalities may offer the best
therapeutic option for dogs affected with HSA.
Publication
Types:
PMID: 11012108 [PubMed - indexed for MEDLINE]
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