Hello All, This message is primarily aimed at someone with a dog with a toe mass and/or soft tissue sarcoma. I cannot promise that I will follow-up this message, but I thought I would share our story and maybe offer some insight that will be useful to someone someday. I'm a human doc (MD) with a 10yo dear girl Emma, a yellow lab. About 2 weeks ago I noted a bump on the inside of one of her rear toes when I went to trim her nails. I'm most certain that I would have noticed this lump about 6 weeks ago, the last time I addressed her nails. The lump was a little less than a centimeter, fairly hard (not compressible), somewhat nodular/irregular (meaning not smooth and not round/oval). It was attached to the skin but was minimally mobile. The overlying hair was normal. I took a nosehair trimmer (perfect for this!) and removed the hair over the lump, showing no skin changes. At age 10 she's developed a few lipomas in the last 1-2 years (like humans, soft, squishy, round/smooth, and minimally mobile under the skin) that I never took her to the vet for (but noted at annual check-ups). This one was more firm and nodular, making me immediately concerned. We hike multiple times per week and she's given no hint that this thing was causing her symptoms (it was on the side of her toe; if it got much larger it would have pushed on her outer toe). So of course I Dr. Googled the subject, finding the study (that I won't link, but the title is "Toe Tumors in Dogs: Early Intervention is Key Robyn Elmslie, DMV). I then took Emma to the vet. On the first visit the vet did a fine needle aspiration, with the (non-oncologist) vet stating that the cells looked like a "round cell tumor" (usually meaning a plasma cell tumor, histiocytoma, or mast cell tumor). Importantly, I had expected an x-ray of the foot at the first visit (see above paper), but didn't get one. I was expected to have the toe removed (see above paper) as the initial plan of action. But I didn't bring this up, instead I accepted the option of bringing Emma back for an excision of the mass under anesthesia. So the next day the excision of the complete mass was performed under general anesthesia without issue. A few days later the path report came back showing stage 2 soft tissue sarcoma. Because of this, the best option was to go back and take the toe off with as wide a margin as possible (i.e. take off as much tissue as possible while still being able to close the wound). Frankly I am fortunate money is not an issue for me, but still going back I wish I would have asked for: a) a toe x-ray on the first visit (per the paper above, if bone involvement was present, the first surgery would have been a toe-removal...maybe even if bone involvement wasn't seen). b) the biopsy to be read by a pathologist. I didn't ask for, but could/should have, asked for these things. Instead, we had to do two surgeries (meaning two trips under anesthesia, increased cost, but most importantly a small risk that disrupting the tumor could increase "seeding" of the tumor into the bloodstream and/or adjacent tumor. Generally, in humans, for sarcomas, we cut wide the first time (and early, unless radiation is needed first to shrink things). So as it is now Emma is doing fine. Thankfully the first surgery had clean margins (albeit <1mm) while the excised toe biopsy couldn't find evidence of disease. The point of this message is to encourage other owners, maybe, to have zero guilt/concern about cutting off a toe early. Invariably it doesn't seem to cause a dog problems, it provides a less chance that the tumor can spread, and frankly it's less expensive. Because Emma had clear margins, we're not doing radiation or chemo. BUT, if chemo was desired, the "metronome cyclophosphamide and piroxicam" chemo combo is fairly inexpensive with good results in dogs with stage 1 or stage 2 tumors that don't have clear margins (studies for this online); though of course other treatments are available by the oncologist. A competent regular general vet should be willing to write prescriptions for this combo (check goodRx for prices, generally <$30 a month where I live). Again, Emma will not be taking meds, just very close surveillance. So hopefully few people will need the above information, but hopefully it helps someone. I MUST say that as a doctor who has read the heck out of this, I am so happy that soft tissue sarcoma is her diagnosis (at stage 2 or less). Toe tumors if, the entire toe is removed early, seem to routinely be a costly nuisance, NOT a life-shortening disease! Best to all of our beloved creatures!
Hi Emma Thank you for sharing that. My previous lab was four when he had a toe removed with a tumour. Fortunately it was benign and caused him no further problem. He went on to have two further lumps removed from his torso. Each time another type of tumour but always benign. Sadly not the case for my young lab who is battling Mast Cell Cancer at the moment.
