Types of lung tumors
- Metastatic lung tumors are those that spread from a primary tumor else where in the body
- example is a dog that has a bone tumor which has spread to the lungs
- metastatic lung tumors generally are usually multiple
- if your dog has multiple lung masses these also could be caused by a fungal infection and not cancer
- Primary lung tumors originate in the lung tissue
- the most common primary lung tumor is bronchoalveolar carcinoma
- the most common place that these tumors can spread to is the lung
Clinical signs of lung tumors
- Cough which may also produce phlegm or blood
- Loss of appetite
- Weight loss
- In the early stages, there may be no clinical signs, but your veterinarian may detect this tumor on chest radiographs
Testing done for patients in preparation for surgery
- Complete Blood cell count
- Chemistry profile
- Chest radiographs - left side, right side and front-back views
- tumors located in the right lung are seen best when the pet is lying on the left side and visa versa
- If fungal infections are suspected, fungal titers may be indicated
- In selected cases in which infection is suspected a scope (camera) may be placed down the wind pipe and into the lungs in order for samples to be collected for microscopic analysis and/or bacterial culture
- Fine needle biopsy of the lung mass is occasionally recommended
Typical findings on radiographs
- Primary lung tumors frequently are located in the caudal (towards the hind end of the pet) lung lobes, however can be located in any lung lobe; they are usually a single mass in the lungs, unless the tumor has spread
- Metastatic lung tumors frequently are multiple and found in a variety of lung lobes; occasionally a metastatic tumor spread from else where in the body may appear as a single mass in the lungs; if your pet has a fever and has been traveling to southern United States, the masses in the lungs could be due to fungal infection and may be treated with medication
- In the radiograph below left, take note of the multiple round masses in the lungs representing metastatic disease (only three of the many tumors were labeled T in this photo)
- In the radiograph below right, take note of the single mass located in one of the lung lobes; this is typical of a primary lung tumor
Metastatic lung tumors
- A diagnosis of cancer can only be definitively be made with a lung biopsy and histopathology
- If there is no evidence of a primary tumor in the body and multiple nodules are found in the lungs, a minimally invasive lung biopsy can be done by placing a thoroscope (camera) into the chest and obtaining a sample of lung; animals that have this done can usually go home the same day after the procedure; this test will confirm a diagnosis of fungal or cancer
- If there is a known tumor somewhere on the body and the lungs are full of nodules, it is presumed that these are metastatic tumors
- If there are three or fewer lung nodules, surgery can be done to remove these in order to increase the lifespan of your pet; this is most commonly done with osteosarcoma metastatic disease
Primary lung tumors
- Surgery is recommended for these cases if there is no evidence of metastatic disease
- If needed, the entire left lung can be removed at one time, as the right lung will take over for the left
- Your pet may not do as well if the entire right lung (all lobes) need to be removed
- Usually the tumor is removed through the side of the chest cavity (lateral thoracotomy)
- In some cases the breast bone must be divided (median sternotomy) so that both left and right lungs can be accessed
Aftercare following thoracotomy and lung tumor removal
- IN HOSPITAL
- Your pet is initially given oxygen via a nasal catheter
- Pain medication is given to your pet either by injection or via an epidural catheter, or through the intravenous as a constant rate infusion
- Antibiotics are usually just given at the time of surgery and not given in the postop period
- Intravenous fluids are given to keep your pet hydrated
- A bandage may be placed on the chest
- AT HOME
- Limit exercise to short leash walks for 3 weeks if a lateral thoracotomy was performed; limit exercise for 6 weeks if a median sternotomy was performed
- Administer oral pain medications as needed
- Monitor respirations to make sure that these are not labored
- Monitor gums and tongue to make sure that these are pink
- Encourage eating
- Monitor the incision for signs of infection
- Do not allow licking or scratching of the incision
- Put a tee shirt on your pet to help prevent this
- Chemotherapy may be recommended by an oncologist, pending the tumor type
- Anesthetic death - uncommon
- Seroma formation at the incision - fluid accumulation which will resolve within about 3 to 4 weeks
- Infection - uncommon
- Internal hemorrhage - uncommon
- Spread of tumor - dependant on type and stage of tumor
- Pneumothorax - air leaking from lung after surgery - uncommon, but requires that a chest tube be kept in place for a longer period of time
Frequently Asked Questions After Surgery
When should my dog have the first bowel movement after surgery?
- Many dogs will not have a bowel movement for the first 4 to 5 days after surgery
- Reasons that a dog will not have regular bowel movements after surgery include:
- The dog has been fasted prior to surgery
- Dogs do not eat well during the hospital stay
- They frequently do not eat well when they go home
- They are fed highly digestible food that produces little stool
- Pain medication that contain narcotics (such as morphine, fentanyl patches, and tramadol) can be constipating
- If a pet does not have a bowel movement on the 5th day of being home, a stool softener such as metamucil can be fed
- Dose of metamucil is 1 tsp per 25 Kg mixed in with each meal (canned dog food); feed immediately after mixing, as the metamucil will gel the food and may make it less palatable
My pet had surgery and will not eat. What can be done?
- Most pets will not eat their regular dog food after surgery, especially if it is kibble.
- Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source. The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low in fat and should be cooked (drain off all fat after the meat has been cooked). The carbohydrate can be pasta, potato or white rice.
- Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth (Chicken-in-a- MugTM or Beef-in-a-MugTM products)
- Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal
- Try Hill's A/D diet available at most veterinary hospitals
- Hand feeding: place a small amount of food in the mouth so that your dog gets the flavor
- Warm the food slightly in a microwave, as the food will be more aromatic; stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
- Remember that most pets will not eat the first day or two after they get home from surgery
- Offer smelly foods that contain fish such as tuna or smelly cat foods
- Try Gerber strained meats for babies such as the chicken, beef, turkey or veal
- Hand feeding: with your finger place a small amount of food on the roof of your cat's mouth; use a syringe to get soft food into the mouth
- Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature; it should be only luke-warm
- Some cats will only eat dry food, try kibble if your cat normally has been fed that food
- Petting and stroking your cat frequently will help to stimulate appetite
- Remember that most pets will not eat the first day or two after they get home from surgery
- Appetite stimulants such as cyproheptadine may be helpful
- If your cat refuses to eat anything for 7 days a stomach tube or nasogastric tube should be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop
My pet is vomiting. What can be done?
- The first thing for you to discern is whether your pet is vomiting or regurgitating. Both will result in fluid or food being brought up. Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus. Regurgitation is not associated with heaving and the pet usually just opens the mouth and fluid or food will be expelled. Usually the regurgited material will be clear or brown colored fluid.
- Next is to identify the cause of the vomiting or regurgitation.
- Causes and treatment of vomiting after surgery
- When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be the case, the water should be limited to frequent smaller amounts.
- Medications such as antibiotics, narcotics or nonsteroidal anti-inflammatory medication commonly cause vomiting after surgery. In order to see which medication is causing the problem, the administration of each drug should be separated 2 hours apart. Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to. The antibiotic in some cases may be changed to a different one, or may be discontinued.
- Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days.
- An uncommon cause of vomiting after surgery is internal organ failure. Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
- If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present. Do not ignore this sign.
- Symptomatic treatment of vomiting involves withholding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then gradually wean him/her back onto the regular diet after 3 days. In order to decrease the acidity of the stomach, Pepcid AC 0.5 mg/kg can be given by mouth twice daily for 5 days. Metoclopramide and Cerenia are good anti-vomiting medications for dogs and cats. You should always consult a veterinary healthcare professional before administering medication.
- Causes and treatment of regurgitation after surgery
- The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia. Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, called esophagitis. This results in poor motility of the esophagus, therefore water and food will accumulate in this structure. In most cases, esphagitis is self-eliminating and will resolve within two or three days.
- If the esophagitis is severe the esophagus may develop one or more strictures. A stricture is a narrowing or stenosis of the esophagus and does not allow passage of food down the esophagus, in regurgitation that lasts longer than one week. This problem should be brought to the attention of your pet's doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure, as it is done with the aide of an endoscope). If an esophageal stricture is chronic surgery is needed.
- Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent (sucralfate) and an acid blocker (omeprazole or other). Consult a veterinary health care professional if the regurgitation continues for more than a couple of days.
How do I know that my dog is in pain following surgery?
- Signs of pain include
- biting if you get near the surgical site
- grimacing (lips are pulled back and the the dog looks anxious)
- tragic facial expression
- restlessness and unable to sleep; pacing
- if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
- the worst pain will be for the first 2 to 3 days after surgery
What can I do to control my dog's pain?
- Narcotic medications that control pain: tramadol, butorphanol, Duragesic (fentanyl patch)
- Anti-inflammatories used to control pain: Deramaxx, Rimadyl, Previcox, or Etogesic
- If an orthopedic surgery has been done cold packing the surgical site may be helpful
- A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack. An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out. Cool the surgical site around the incision by rubbing the exposed ice directly on the skin in a circular pattern. Cooling the surgical site helps to numb the area.
How do I know that my cat is in pain following surgery?
- Pain is more difficult to assess in cats versus dogs, as signs can be more subtle and they usually do not vocalize when in pain
- Signs of pain in a cat include the following:
- biting if you get near the surgical site
- growling or deep cry
- not wanting to eat
- hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)
What can be done for pain at home for my cat?
- Pain medication such as buprenorphine or a Duragesic (fentanyl) patch
- Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver
- Anti-inflammatories can be used, but the dose is much less than dogs
Is it okay for my pet to lick the incision?
- If a dog licks the incision, the healing process may be delayed.
- Licking can remove stitches and cause the incision to open
- Licking can become a severe habit that is difficult to break
- Licking can cause infection as the mouth has many bacteria
- Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.
- To stop your pet from licking the following can be tried:
- Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
- Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
- A tee shirt can be used to cover an incision on the chest or front part of the abdomen; gather the waist of the shirt up over the dog's back and wrap an elastic band around this part of the shirt.
- A bandage or sock can be used to cover an incision on a limb; fasten the top of the sock to the dog's limb with tape.
- Bitter apple can be applied around the incision; many dogs will continue to lick after application of this topical
- Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
- Antipsychotic medication in some cases is needed