9 year old dutch with mouth cancer, radiation treatment or no?

[pkpzp228]

Hi all, I have a 9 year old Dutch named Sylow, she's been a wonderful friend since I got her at around 3-4 month of age. She was recently diagnosed with squamous cell carcinoma in the right side of her mouth, initially I noticed in relation to change in her eating habits. On recommendation of my normal vet I took her up to the CSU veterinary school to discuss what my available options were.

Surgical excision isn't viable because we feel that it would remove too much of her lip leading to more problems. Alternatively, the oncology dept felt that she was a fine candidate for radiation treatment which could be as simple as 3 fairly small inexpensive treatments or could require several much more extensive treatments. Finally another option is just to manage any pain and let the cancer run its course, possibly excising any regrowth of the cancerous tissue as it presents until it metastasizes.

Given her age I definitely don't want to put her through any long drawn out treatment process that will severely effect what time she has left. The vet stated that at 9 years old she's already outlived her expected lifespan yet I've seen so many discussions from people describing how their rabbit has lived 10 to 12 years. Sylow is still quite alert and relatively active with no outward signs of problems short of her unwillingness to eat food other than pellets. The question I'm struggling with is if few and less severe radiation treatments is a possibility, given her age is it worth it in respect to her quality of life? If treating the cancer only buys her a few more months of quality life than I'm comfortable letting her pass on naturally, on the other if this could lead to several more years of active life I want to provider her every opportunity.

Any thoughts, suggestions?

Thanks

 

[Maureen Las]

I have a Facebook friend who was a member of this website and recently had radiation done on her rabbit for a thyoma. I believe that it was the a similar protocol in that the rabbit had 3 treatments maybe spaced 1-2 weeks apart. She may be on RabbitsOnline Facebook . As far as I know her rabbit is doing well, however, the location of your rabbit's malignancy poses certain problems . I don't know how radiation will affect her ability to eat.
I hope that you can get more specifics on the effects of radiation on her ability to function comfortably

 

[carlysoup]

Wow, that is something very difficult to deal with, I'm sure. I think that people are faced with similar questions, in regard to managing their own cancer treatment. In a way, I think its harder with pets, though, because you have to make the choices for them. But, ultimately you will make the best decision for Sylow.

Is it possible to do the initial 3, small cancer treatments, then see if they help, and then move forward with decision making from there, in terms of potential excision, versus pain management, or versus more aggressive treatment? What did both of the treatments entail, exactly?

Will the treatment significantly stress your rabbit? If so, is she easily stressed? That might also be something to consider, as I noticed you are weighing your options, considering that you stated she may have months or years left to live. With cancer, it can be difficult to tell how much, if any, time a treatment might extend a life, or the quality of it. You might be able to determine this by finding out how invasive the cancer is, then deciding what to do.

How large and invasive is the carcinoma? I'm assuming its a bit large since they feel it might impair her to excise it? Perhaps it is small enough that monitoring it might be best right now, as you mentioned that was an option. After all, you said she is still eating, active and otherwise happy. Perhaps pain management and watchful waiting might be best, in that case.

Did the vet mention any complimentary treatments, in order to help improve her quality of life while she's either being monitored, or undergoing any treatment?

I apologize for having so many questions, I am just curious and also trying to consider this from all angles.

 

[pkpzp228]

Thank you both for your replies.

What did both of the treatments entail, exactly?

I'm not exactly sure, what I've gathered so far is that first treatment is a lower amount of radiation and to a smaller area, whereas the more aggressive approach entails a much wider area needed to eradicate the cancerous cells.

Will the treatment significantly stress your rabbit?

I don't believe so, she's very resilient and I've found that she tends to trust people that I demonstrate trust towards. Of course she's not generally happy with other people poking and prodding but she's done well thus far. My biggest concern isn't so much with the procedure/visit but the effect that the treatment will have on her over the recovery period.

How large and invasive is the carcinoma?

It's large enough that the vet feels that removing it would leave her with little to no lip on her right side, exposing her teeth and mouth.

In terms of complimentary treatments, I'm giving her pain meds. My overall question with the process I guess is more related to how I can expert her to bounce from the radiation. I know it's going to be specific to her but in general I'm curious how radiation has effected other rabbits in general, is it something that I can hope/expect that she would generally recover well from or would this treatment just generally make her life miserable for the foreseeable future? I know these are questions for my vet but I'm looking for anyone who has experience with this type of thing.

At this point I'm considering just managing her pain and monitoring the regrowth of the cancer, if it's quick than I may get her in to be evaluated as it becomes clear, this vs just taking her in now for the treatment. Either way, if the vet suggests that it will require the more aggressive treatment I don't think that's something that I should put through.

 

[Amy27]

I just recently went through radiation with my rabbit, LB who is also 9 years old. LB had a thymoma that she had the radiation for. Her radiation started in Feb and it was once a week for 4 weeks. I will say that my vet has done radiation on several rabbits. She stated that LB handled the radiation worse than any rabbit she had done in the past. Just want to put that out there before I tell you my experience.

I will say it was rough. She was extremely stressed during the treatments. The treatments were short, but she had to lay completely still and because it was in her upper chest, they had to tape her arms down, which I didn't know at first. She had to be put under anesthesia for 3 of the 4 treatments because she would freak out and they couldn't get her still enough to do 3 minutes worth of treatment. 3 out of the 4 treatments, she went through stasis after. She didn't eat for several days and I would just get her to start eating again, and it would be time for another treatment. I won't say it is easy. I cried a lot and wondered if I made the right decision. But after she had 2 treatments, how could I not do two more? She would have died from the thymoma and I didn't want the 2 treatments to be for nothing. So we pushed through and she completed the 4 treatments and the thymoma was gone. After that she developed a cyst that was aspirated and she had to be put under for that so we started the stasis all over again.

But today, LB is acting like she did when she was much younger. She runs around and plays. She has so much energy and a great appetite. My vet and I were both very stressed during all of it because LB was so stressed from having it done. But my vet told me several times that this is not what normally happens.

I researched it a lot and did find some other people that had radiation done for a thymoma and their rabbit didn't live 6 months after the treatment. LB hasn't made the 6 week mark from when it ended, but she has made it 5 months and she really is doing great. And I know your rabbit has a different type of cancer. But I wanted to share my story. My vet asked in the middle of the treatment if I would ever do radiation again and I said heck no!!! But now, that I see her recovered and doing so great, I am happy I did it. I can't say I would do it again. It was stressful. And when she was so ill, I worried that her last days would be full of stress. But I am so happy now she is doing so well and is so happy. I think if she could talk, she would say she was happy it was done. The thymoma slowly got bigger so it was a slow progression that she stopped doing things and I just thought it was age. Those things she is now doing. Like getting up at the top of her condo and running up and down the stairs.

I am not sure if my post helped you. Feel free to ask any questions. For me and LB, I won't say that it was easy, but it was worth it. If her thymoma came back, would I do it again? No, it was too stressful. Would I change my decision and not do it in the first place? No, I would do it again. As hard as it was, it has given her 5 months so far of a happy healthy life. Would I do it again for another rabbit? I would have to take into account how stressed out the rabbits got at the vet. How many treatments they would need. And how healthy they were otherwise. Those 4 weeks she had treatment were so stressful, though I tend to be a stressed out bunny mom! But that 4 weeks of stress, has given her 5 months of a happy life. I am just so thankful for every day I have with her and get to watch her being a normal bunny, running around and getting into trouble.

Again, Sorry if I didn't help much. I think this is a decision that only you can make. It is going to be different for every person and every bunny. My thoughts are with you. I know how hard it is to decide what to do. It seems from my research, every rabbit is different. And my vet would agree. From her experience, the average life span after radiation was 2 years.

It sounds like your rabbit doesn't get stressed easily. My LB would get bile that came out of her nose just from a regular vet visit. To the point the vet gave me meds to help her with the car ride. She was a bunny that liked her home and her mom, but nothing new at all!!!

Amy

 

[tonyshuman]

This is a tough decision. I had a bunny with thymoma who we decided not to treat with radiation. It was a few years ago and stories of successful treatments were very rare, plus he would have to go under general anesthesia for the treatments and they would make him feel quite ill. That is another side effect of radiation to think about--it can cause skin damage in the area it is applied, there are risks for general anesthesia if it is needed for your rabbit, and there is nausea/other discomfort associated directly with the radiation. If your bunny can undergo light sedation for the treatments, such as valium or light exposure to isofluorane (without intubation), that may be ok. The condition of his heart and lungs is also important to determine if he will do well under anesthesia. Our bunny had pneumonia related to the tumor pressing on his lungs, so he was already not a good anethesia candidate. While we were treating him to try to resolve the pneumonia, which we tried to treat for several months, the tumor got so large that he went into cardiac arrest and passed away. My Muffin has a slight heart murmur that I would have to consider carefully before putting her through repeated general anesthesia, and there can be age-related heart and lung issues that could complicate things. Luckily for Ben he was happy, eating, running, and cuddling with his buddy for the rest of his life. A large mouth tumor might be more frustrating, if you would have to syringe-feed him, for instance.

There are several stories of bunnies undergoing radiation on the web.
http://www.rabbit.org/health/thymoma.html

This article in particular makes me wish we had done radiation for Ben, although he was only 3-4 years old. He lived around 5 months after diagnosis. Granted, again this is not skin cancer, but it does show that cancer can successfully be treated in rabbits. Rabbits who did not die acutely during treatment lived for more than 2 years more, which is a great gain compared to what we had with Ben.
http://www.ncbi.nlm.nih.gov/pubmed/22487188

So, to recap, it is a tough tough decision that you have to make. Nobody will fault you either way. I would want to know about what kind of sedation is required, what risks come with that sedation, and how good a candidate he is for anesthesia. What is the probability of this putting the cancer into full remission? Is there a chance it has already metastasized? What will his life be like if you do not treat? Will he have to be syringe fed? How does he do with that? Does he fight it or will he take critical care willingly? Is eating the only thing he enjoys in life? Can you expect a lot of GI issues from having to do a liquid diet? You may have to do a great deal of syringe feeding after the radiation treatments as well due to the nausea and after-effects of anesthesia, so that one may come out even on the balance sheet. Will you be able to give him the supportive care at home that he needs, or are you too busy with work? What would be his eventual cause of death if you do not treat, and is it something very unpleasant? For Ben, he may have had a few moments of discomfort but it seemed that he slipped into a coma due to lack of oxygen getting to his body, and from there went into arrest and seizures that often accompany death. The scary part was all over in a few minutes. I like to think that he was already "gone" by that time. Just a few other things to think about.

edit: I'm so glad Amy posted. Her experience with Little Bunny is really helpful to know about and I think if I had known about a story like hers before, and that the mean post-rad survival time is 2 years, we would have put our own Little Bunny (nickname for Benjamin) through the treatments. However, she and LB definitely had a lot of stress to deal with through the treatment. With my current work schedule, I couldn't take the time off to deal with all the stasis, etc. Since Ben was so young and easy to handle, he probably would have done ok, although he was prone to gas and probably would have had to be force fed. Anyway, we gather stories and knowledge as the years go on.

 

[Azerane]

Personally, I think I would find it very difficult to put my rabbit through radiation treatment. Perhaps if he was a couple of years old, but at 9 years, while he may still get some life out of it, I feel like the trauma of the experience just outweighs the benefit. It's not exactly the same, but after seeing the struggles my mum went through from having radiation treatment, I would hate to put that on an animal that essentially doesn't have a choice and doesn't understand what's happening. Having said that, three treatments is very few, I just don't think I could bring myself to do it.

It really is a personal decision, the tough part about it is because it's on her mouth, it's going to be very difficult for her to eat as the radiated area can become very sensitive and feel as if it has been burned. In this case there is no right or wrong decision, both have very valid arguments. Are you willing to see your bunny possibly go through painful side-effects such as stasis, do you have the time to devote to her after each treatment? What if you go through with the treatment and it doesn't work? Are you ready to let go? Will the pain of the treatment be worth the possible small increase of life expectancy? These are all questions you need to ask yourself as at the end of the day, no one else can make this decision for you.

Best wishes.

 

[pkpzp228]

Thank you all again for your insightful responses. I've decided that it's best to manage her pain as best I can without any other aggressive treatments. Again I appreciate all of your input.