TL;DR

Milo was only 18 months old when we noticed the lump on his neck, and it took some weeks to reach a diagnosis, but it seems that he has cancer (bad), specifically lymphoma (very bad), more specifically lymphoma with Mott cell differentiation (aka Mott cell lymphoma [MCL], which is maybe less awful than other types of lymphoma). He’s started on chemotherapy, and early signs are promising.

Hi

I expect there will be two types of people reading this post:

1. People who know me, and perhaps know Milo from my daily #pupdate posts on Twitter.
2. People who’ve got a sick dog who are looking for more information. I hope this helps, but I caution that this is the story of one little dog, with his own specific set of circumstances; so please talk to your vet about your own dog’s symptoms and treatment.

Diagnosis

From first noticing that something was wrong (a lump on his neck) to a lymphoma diagnosis from a scan took 7.5 weeks. This was pretty scary when reading online that the average survival for a dog with lymphoma is 4-8 weeks. We lost a lot of sleep in the first days after the scan.

As I write this were still not 100% sure that it is lymphoma, but sure enough that we’ve started treatment, because there’s an obvious risk in waiting.

Sickness and lump

On the final Sunday of November 2022 Milo was sick late in the afternoon. By bedtime he’d been sick some more, and was looking VERY sorry for himself. He seemed better in the morning, and ate his usual breakfast kibble, so if it wasn’t for the lump that my wife found on his neck we might not have even taken him to the vet.

The vet thought it was gastroenteritis brought on by something he ate (he and his brother are prone to scavenging things when out on walks). His temperature was normal, but she suggested a bland diet (chicken and rice) for a few days. He weighed in at his normal 5.5kg.

It wasn’t clear if the lump was connected to the sickness, or something else. The vet suggested bringing him back if it wasn’t gone in a week or so. She also took time to outline all of the possibilities, including that it might be a swollen lymph node caused by lymphoma; and the diagnostics that would be associated with that – everything that followed over the next weeks. We could have gone all in right then, and done all the tests (and a specialist referral). But that would have been a lot of bother for Milo, and a lot of cost. Given his age and general wellbeing the odds of the worst case seemed very remote.

Milo came home, enjoyed his chicken and rice, and seemed to bounce back to normal. But the lump remained.

Needle biopsy

We took Milo back to the vet, and he re-examined him, culminating in taking some samples from the lump. A few days later we got the results, which confirmed that it was a lymph node, but were otherwise ‘non diagnostic’ – there was no indication of a problem.

An unwelcome Christmas present

As I was finishing up Christmas dinner I saw Milo repeatedly sitting at the garden door to go outside. He’d then go out, come back in, and then minutes later be back at the door. When he pooped on the floor I was a little cross with the rest of the family for not letting him out. But we got things cleaned up, and a day later returned to the chicken and rice diet as he seemed to have an upset tummy again, and the vets was closed for the Christmas break. He was still eating enthusiastically, and enjoying walks, so not a case for the emergency vet. But an ’emergency’ appointment for first day back to work.

The vet gave him some antibiotics, which seemed to make him bounce back. She also asked us to continue with the chicken and rice, and to collect faecal samples as she’d noticed ‘some firmness’ in his bowel. He was booked in for a blood test the following day.

Blood test

The blood tests came back pretty much clear. Everything was normal apart from excess reticulocytes (immature red blood cells), and that was explainable by the fact that there had been some blood in his poop, so of course he’d be making fresh blood cells.

Faecal test

The vet wanted 3 samples from consecutive days, but we didn’t have 3 samples as the New Year weekend approached; so it was after the long weekend before the samples went for analysis.

Giardia

The faecal tests picked up antigens for Giardia, a parasite that can cause gastroenteritis, and Milo was prescribed a course of Panacur to treat it. We also started feeding him Royal Canin gastrointestinal (GI) loaf, as he’d been eating a LOT of chicken and rice. As we were getting towards the end of the course of Panacur he was sick again, so the vet prescribed a few more days of treatment.

Scan

It was time to get a scan, of the lump, and his tummy. I called up the vets to make an appointment, and their scanner was away for servicing – for up to two weeks.

Over the weekend Milo was visibly lacking energy and losing weight, so back into the vets for an appointment on Monday morning. He’d dropped to 5.2kg, and the vet was concerned about what he was feeling. Luckily the scanning specialist was due the next day, and had time to see Milo too.

The interpretation of the scan was the worst news – signs of lymphoma. Samples had been taken for cytology. An appointment with a specialist oncologist at North Downs Specialist Referals (NDSR) was recommended.

We started reading:

• Lymphoma in Dogs: Symptoms, Diagnosis, and Treatment
• NDSR: Lymphoma in dogs: Diagnosis and treatment
• Canine Lymphoma: Risk Factors, Symptoms, Diagnosis, and Treatment

This all seemed like bad news. It had taken 7.5 weeks to get to a diagnosis, and we were reading that dogs with lymphoma usually last 4-8 weeks. It felt like we were running out of time.

NDSR called the following morning, their next available appointment was almost a week away. Milo seemed to be going downhill fast (maybe in retrospect the result of being sedated and poked around), and it felt like he might not make it that far.

Cytology

Meanwhile the report came back with an interpretation of ‘Consistent with lymphoma’ – not a definite diagnosis, but a fairly strong leaning. There was also a comment:

The two sets of slides contain similar predominant populations of intermediate round cells displaying features most consistent with lymphoid origin and lymphoma as you suspected. However, interestingly there are areas in which Mott cells appear over-represented and given the young age of this patient and breed, lymphoma with Mott cell differentiation is a possibility. To further the diagnosis and confirm the exact type of lymphoma will require histopathology and likely immunohistochemistry.

Veterinary Clinical Pathologist

This lead us to Clinical characteristics and outcomes of Mott cell lymphoma in nine miniature dachshunds, which was cause for some hope – MCL is less bad than other varieties, and one of the dogs in the study was still alive after over 1500 days.

Specialist

Milo had picked up a little in the days before we visited the specialist, so as he was taken in to the consulting room he didn’t appear too bad. A little thin, but otherwise OK.

Although there were strong indications of lymphoma, the specialist still wasn’t sure. He offered three possible course of action:

1. Treat the symptoms, using steroids. But don’t start cancer treatment.
2. Further tests to confirm cancer (and what type), but wait for confirmation before starting treatment. The range of possible tests included:
   • A PCR for Antigen Receptor Rearrangements (PARR) test on the samples taken during his scan.
   • Flow cytometry, which would require another scan and associated sedation.
   • A surgical biopsy, which would require general anesthetic.
3. Start chemotherapy, and run a PARR test in parallel (and perhaps further tests if the PARR wasn’t definitive).

I picked option 3. NDSR could start the chemotherapy straight away, and then my local vet could pick things up. Or we could do it all with our local vet. In the end our vet wasn’t able to start right away, and also wasn’t able to get some of the drugs. So we were back at NDSR the next day to start there.

It was also good that we’d got the scan done by a specialist, as those results were trusted, meaning that there wasn’t any push to redo tests that had already been done.

Chemotherapy

Doggy chemo isn’t the same as with humans. Firstly only certain breeds suffer from hair loss, but also the severity of treatment is much less. The aim is to get an extended quality of life rather than to ‘cure’ the cancer. A good friend who’d lost a dog to lymphoma put it something like this:

With people you can hit them so hard with chemo that they might feels like they want to die, but ultimately they get better. If you do that to a dog they lose the will to live and they do die.

Milo is on a CHOP protocol, which consists of giving him a doses of three different drugs in a rotation:

• Vincristine (injection)
• Cyclophosphamide (tablets)
• Vincristine again
• Doxorubicin (intravenous infusion)

For the first month he gets one of those weekly, along with daily steroids. For the second month the weekly doses continue, but without the steroids. After that the pace eases a little, with treatments every 2 weeks for another 4 months. All being well, he’ll be done in time for our summer holiday in the Lake District.

Each time he goes for a treatment he needs a blood test, to confirm that his white blood cell count is normal; and along the way other tests (and scans) might be needed.

It could just be the steroids, but Milo has bounced back pretty quickly. Within a couple of days his poop was back to normal, and a day later he was back to play fighting with Max. He still needs to put some weight back on, but the early signs are promising.