What is a chemodectoma?

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A chemodectoma is a type of tumor made up of chemoreceptor cells. Chemoreceptorcells detect chemical changes (such as oxygen content and pH levels) in the body and respond by regulating chemical or physical processes. A chemodectoma involves abnormal growth of these chemoreceptor cells in an uncontrolled way that causes the formation of a tumor.

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The most common regions these tumors are seen are along one of the carotid arteries and the aorta. Two carotid arteries sit within your pet’s neck; one on each side of the trachea. The aorta is the large blood vessel that leaves the heart to deliver oxygenated blood to the body. These tumors are rare and may be found when your pet has a wellness examination or if your pet is exhibiting signs associated with these tumors.

What causes this type of tumor?

The reason why a particular pet may develop this, or any tumor or cancer, is not straightforward. Very few tumors and cancers have a single known cause. Most seem to be caused by a complex mix of risk factors, some environmental and some genetic or hereditary.

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In the case of chemodectomas, short-nosed breeds (brachycephalic breeds), are more predisposed to these types of tumors (e.g., Boston Terriers and English Bulldogs). Because these breeds have chronic low oxygen levels due to the structure of their face, jaw, and airway, it is thought that the chemoreceptors are overworked, and tumor development occurs. German Shepherds and Boxer Dogs, as well as male dogs tend to be more predisposed to aortic body tumors.

What are the signs of chemodectomas?

Clinical signs of chemodectomas depend on the location of the tumor. The most common clinical signs associated with aortic tumors (located on the aortic artery) and the resulting pericardial effusion (fluid within the sac around the heart) include weakness/wobbliness, lethargy, collapse, exercise intolerance, increased respiratory rate and effort, cough, vomiting, and sudden death.

The most common signs associated with a carotid artery tumor (located in the neck) are swelling in the neck region, regurgitation, lethargy, difficulty breathing, weakness, and collapse.

How is this cancer diagnosed?

Your veterinarian may notice changes in your pet during a wellness examination such as increased breathing rate and effort, and swelling in the neck region. Your veterinarian may recommend radiographs (X-rays) or ultrasound of the chest, which may show evidence of a tumor in front of or around the heart, or fluid within the sac around the heart (called pericardial effusion). More commonly though, ultrasound or a CT scan of the chest and neck will show evidence of tumors.

Once a diagnosis of a mass on the carotid artery or aorta is made, your veterinarian may discuss performing an ultrasound-guided fine needle aspiration. Other techniques involving specialized equipment to obtain samples of carotid tumors and may be discussed. These techniques use an ultrasound probe to guide a small needle into the tumor to retrieve cells. The cells are placed on a microscope slide which is examined by a veterinary pathologist.

If the mass is close to the heart, these diagnostic techniques have significant risk of complications including bleeding. Because of these risks, once a mass has been diagnosed, surgical removal of the tumor may be recommended. Samples of the tumor will be examined under the microscope by a pathologist who will confirm the tumor type.

How does this tumor typically progress?

Carotid and aortic body tumors are commonly locally aggressive. This means that they penetrate the local tissues directly surrounding the area where they form. However, there are rare cases of metastasis (spread) to other organs including the lungs, lymph nodes, and bone.

What are the treatments for this type of tumor?

The most commonly pursued treatment is surgical removal of the tumor, regardless of location.

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Your veterinarian may discuss with you the options for a pericardectomy. This involves removing the tumor as well as a part of sac that surrounds the heart (the pericardium). Pets that have a pericardectomy have improved recovery and live significantly longer.

Hemangiosarcoma is a rapidly growing, highly invasive variety of cancer that occurs almost exclusively in dogs, and only rarely in cats, horses, mice,^[1] or humans (vinyl chloride toxicity). It is a sarcoma arising from the lining of blood vessels; that is, blood-filled channels and spaces are commonly observed microscopically. A frequent cause of death is the rupturing of this tumor, causing the patient to rapidly bleed to death.

The term 'angiosarcoma', when used without a modifier, usually refers to hemangiosarcoma.^[2] However, glomangiosarcoma (8710/3) and lymphangiosarcoma (9170/3) are distinct conditions [in humans]. Hemangiosarcomas are commonly associated with toxic exposure to thorium dioxide (Thorotrast), vinyl chloride, and arsenic.^{[citation needed]}

Dogs[edit]

Hemangiosarcoma is quite common in dogs, and more so in certain breeds including German Shepherd Dogs and Golden Retrievers.^[3] It also occurs in cats, but much more rarely. Dogs with hemangiosarcoma rarely show clinical signs until the tumor has become very large and has metastasized. Typically, clinical signs are due to hypovolemia after the tumor ruptures, causing extensive bleeding. Owners of the affected dogs often discover that the dog has hemangiosarcoma only after the dog collapses.

The tumor most often appears on the spleen, right heart base, or liver, although varieties also appear on or under the skin or in other locations. It is the most common tumor of the heart, and occurs in the right atrium or right auricular appendage. Here it can cause right-sided heart failure, arrhythmias, pericardial effusion, and cardiac tamponade. Hemangiosarcoma of the spleen or liver is the most common tumor to cause hemorrhage in the abdomen.^[4] Hemorrhage secondary to splenic and hepatic tumors can also cause ventricular arrythmias. Hemangiosarcoma of the skin usually appears as a small red or bluish-black lump. It can also occur under the skin. It is suspected that in the skin, hemangiosarcoma is caused by sun exposure.^[4] Occasionally, hemangiosarcoma of the skin can be a metastasis from visceral hemangiosarcoma. Other sites the tumor may occur include bone, kidneys, the bladder, muscle, the mouth, and the central nervous system.

Clinical features[edit]

Presenting complaints and clinical signs are usually related to the site of origin of the primary tumor or to the presence of metastases, spontaneous tumor rupture, coagulopathies, or cardiac arrhythmias. More than 50% of patients are presented because of acute collapse after spontaneous rupture of the primary tumor or its metastases. Some episodes of collapse are a result of ventricular arrhythmias, which are relatively common in dogs with splenic or cardiac HSA.^[5]

Most common clinical signs of visceral hemangiosarcoma include loss of appetite, arrhythmias, weight loss, weakness, lethargy, collapse, pale mucous membranes, and/or sudden death. An enlarged abdomen is often seen due to hemorrhage. Metastasis is most commonly to the liver, omentum, lungs, or brain.

A retrospective study published in 1999 by Ware, et al., found a 5 times greater risk of cardiac hemangiosarcoma in spayed vs. intact female dogs and a 2.4 times greater risk of hemangiosarcoma in neutered dogs as compared to intact males.^{[citation needed]}. The validity of this study is in dispute. (Personal communication; Modiano, Sackmann)

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Clinicopathologic findings[edit]

Hemangiosarcoma can cause a wide variety of hematologic and hemostatic abnormalities, including anemia, thrombocytopenia (low platelet count), disseminated intravascular coagulation (DIC); presence of nRBC, schistocytes, and acanthocytes in the blood smear; and leukocytosis with neutrophilia, left shift, and monocytosis.

A definitive diagnosis requires biopsy and histopathology. Cytologic aspirates are usually not recommended, as the accuracy rate for a positive diagnosis of malignant splenic disease is approximately 50%. This is because of frequent blood contamination and poor exfoliation. Surgical biopsy is the typical approach in veterinary medicine.

Symptoms[edit]

Dogs rarely show symptoms of hemangiosarcoma until after the tumor ruptures, causing extensive bleeding. Then symptoms can include short-term lethargy, loss of appetite, enlarged abdomen, weakness in the back legs, paled colored tongue and gums, rapid heart rate, and a weak pulse.^[6]

Treatments[edit]

Treatment includes chemotherapy and, where practical, removal of the tumor with the affected organ, such as with a splenectomy. Splenectomy alone gives an average survival time of 1–3 months. The addition of chemotherapy, primarily comprising the drug doxorubicin, alone or in combination with other drugs, can increase the average survival time by 2–4 months beyond splenectomy alone.

A more favorable outcome has been demonstrated in recent research conducted at University of Pennsylvania Veterinary School, in dogs treated with a compound derived from the Coriolus versicolor (commonly known as 'Turkey Tail') mushroom:^[7]

“We were shocked,” Cimino Brown said. “Prior to this, the longest reported median survival time of dogs with hemangiosarcoma of the spleen that underwent no further treatment was 86 days. We had dogs that lived beyond a year with nothing other than this mushroom as treatment.”There were not statistically significant differences in survival between the three dosage groups, though the longest survival time was highest in the 100 mg group, at 199 days, eclipsing the previously reported survival time.

The results were so surprising, in fact, that the researchers asked Penn Vet pathologists to recheck the dogs’ tissue biopsies to make sure that the dogs really had the disease.“They reread the samples and said, yes, it’s really hemangiosarcoma,” Cimino Brown said.Chemotherapy is available for treating hemangiosarcoma, but many owners opt not to pursue that treatment once their dog is diagnosed.

“It doesn’t hugely increase survival, it’s expensive and it means a lot of back and forth to the vet for the dog,” Cimino Brown said. “So you have to figure in quality of life.”

This treatment does not always work. So, one should always be prepared for their pet to have the same survival time as a dog who is untreated. Visceral hemangiosarcoma is usually fatal even with treatment, and usually within weeks or, at best, months. In the skin, it can be cured in most cases with complete surgical removal as long as there is not visceral involvement.^[4]

References[edit]

1. ^https://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+893
2. ^'Hemangiosarcoma - an overview ScienceDirect Topics'. www.sciencedirect.com. Retrieved 2020-01-03.
3. ^Ettinger, Stephen J.; Feldman, Edward C. (1995). Textbook of Veterinary Internal Medicine (4th ed.). W.B. Saunders Company. ISBN0-7216-6795-3.
4. ^ ^abcMorrison, Wallace B. (1998). Cancer in Dogs and Cats (1st ed.). Williams and Wilkins. ISBN0-683-06105-4.
5. ^Nelson; et al. (2005). Manual of Small Animal Internal Medicine. St. Louis, Missouri: Elsevier Mosby.
6. ^Farricelli, Adrienne. 'The Silent Killer: Hemangiosarcomas or a Ruptured, Bleeding Spleen in Dogs'. PetHelpful. Retrieved 23 March 2019.
7. ^'Compound Derived From a Mushroom Lengthens Survival Time in Dogs With Cancer, Penn Vet Study Finds'. University of Pennsylvania.

External links[edit]

• 'Flat-Coated Retriever Hemangiosarcoma'. AKC.org.
• 'Heart hemangiosarcoma in Cats and Dogs'. Pet Cancer Center.
• 'Hemangiosarcoma'. Canine Cancer Awareness. - includes links to current studies
• 'Hemangiosarcoma'. Cure Hemangiosarcoma. - includes links to current and past studies of hemangiosarcoma
• 'Hemangiosarcoma'. Mar Vista Animal Medical Center. Archived from the original on 2004-02-03. Retrieved 2004-01-27.
• 'Hemangiosarcoma'. Vetinfo.
• 'Hemangiosarcoma in Cats and Dogs'. Pet Cancer Center.
• 'Hemangiosarcoma research'. Modiano Lab of the Univ. of Minnesota. - includes links to other canine cancer research
• 'Vet Corner: Hemangiosarcoma'. Adopt a Golden Retriever. Archived from the original on 2003-12-15. Retrieved 2004-01-27.