Roxy’s owner is unfortunately no stranger to cancer, and was suspicious herself on presentation; having previously had unrewarding experiences with such problems with her pets. Her cancer concerns were well founded since a hard swelling on the lower jaw bone is always of concern (regardless of the exact diagnosis). However, it may not necessarily be cancer because infection (osteomyelitis), dislocation and foreign body reaction are also differentials that may carry a much better prognosis than cancer.
We proceeded with diagnostics and sedated Roxy with a sedative that can be reversed quickly so that she is back on her feet and out of the clinic within an hour of presentation. Examination and x-rays under sedation did reveal a mid mandibular bony mass, which in itself was very concerning for cancer.
– This is where some pro’s and con’s and practicalities need to be discussed –
The biopsy carries a small chance of causing the bony lesion to fracture, leaving the patient in an awkward position as it would not be able to be fixed! On top of this, if the lesion is not cancer but an infection, the prognosis for getting this bone to heal with antibiotics is almost zero! So what are we really going to gain via going to the expense and potential complications of a biopsy in this particular situation? Although it’s still an option,for practical reasons it is reasonable to take a different approach.
Although this sounds drastic, a hemimandibulectomy (removal of half of the lower jaw entirely), is a reasonable option. It is unlikely (no matter the actual pathology), that Roxy will ever be anything but in pain with this lesion. It sounds drastic but dogs undergoing hemimandibulectomy look remarkably normal, eat with very little trouble at all, and are usually pain free soon after the removal – even if it is a nasty cancer that may return at a later date.
With all this in mind, Roxy’s owners will be given time to consider their options and think about any further questions they may have. We go to great lengths in these cases to ensure pet owners are not rushed into making hasty decisions. One option of course was to just live on pain relief until such time as it was no longer viable.
Roxy’s owners have a tough decision to make and we now allow them time to think this through. We will update you in a few days with Roxy’s Bone Cancer Journey…