Too Old for Tumor Surgery?

Elbow sockThis is Ling Ling. She’s some kind of a Collie mix, or something.  Sweet dog.  Her picture here was taken a few years ago to illustrate her owner’s great idea for bandaging the elbow.  Who doesn’t have old socks lying around?  I use this technique all the time now.

Last summer, she came in for her checkup in July at the tender age of 15 years.  She had developed a large tumor in front of her left shoulder.  It was about 6 inches long, 3 inches wide and 1&1/2 inches thick, which is pretty big, even for a 57 pound dog.  We did a fine-needle-aspiration to get some cells for examination and it turned out to be a lipoma.  Lipomas are benign tumors of fat cells.  They aren’t usually invasive, nor do they spread to other organs.  Really, they are usually more of a cosmetic problem than a medical problem.  Unless they get big enough to be uncomfortable, that is. 

Ling Ling was so elderly and the tumor was large enough to require a fairly lengthy surgery, and it didn’t seem to be bothering her.  We decided it was something she would probably die with, instead of something that she would die from.

BeforeFast forward to May of this year.  Ling Ling doesn’t feel so well.  She has lost weight and gets around slowly. Her tumor, on the other hand, has been doing great.  It’s up to 10 inches long, 5 inches wide and 6 inches thick now.  Unfortunately, the tumor is not only making Ling Ling feel bad, it’s making the tumor feel bad.  It has grown so much that it appears to have disrupted its own blood supply. There is a rather nasty-looking bulge that looks like it will soon die and rot and burst open.  Not so good.

Well, the tumor did get a lot bigger, and Ling Ling did not get any younger.  In retrospect, it seems that we should have done surgery last July.  But… but… she was so old, and… it didn’t seem to be bothering her.

This reminds me a little of my wonderful Granny.  She developed a hernia when she was 70 years old.  They told her she was too old to have it repaired.  She lived to be 93.  Still too old to have it repaired.  My granny lived with a hernia for 23 years.  That doesn’t sound like fun, does it?

TumorLing Ling has an amazing constitution (meaning she is one tough old dog), and she has a very dedicated owner (also one tough old dog).  We did everything we knew how to do to support her, and she made it through 90 minutes of surgery like a champ.  The tumor was so big it was like delivering a baby.  It  weighed 3 pounds, and was as big as her head.  I’m not sure how that fits with the rule of “Never eat anything bigger than your head”, but there must be some kind of correlation if we think hard enough.

The mass had disrupted the attachment of some of her shoulder muscles.  I re-attached them as best I could, but this meant that she required immobilization of the leg for a couple of weeks.  With the huge pocket created by the tumor’s removal, we also had to do a lot of bandaging to deal with the fluid drainage.  Fortunately, Ling Ling is not only tough, but a complete sweetheart to work with.

Sutures outHere she is (at left) two weeks later at suture removal time, walking fairly well, but still

July 20, 2012

with a limp.  She has lost a fair amount of weight.   And here  she is (at right) at her July checkup, two months later, walking normally, and growing her hair back.  She has also gained a lot of her weight back.  She is eating better, and feeling better.  We just didn’t realize how much that tumor was bothering her. 

It’s pretty easy to dismiss an old dog’s slowing down as “just old age”, but many times it is not.  They have bad teeth, or bad arthritis, or that thing you don’t think is so important (like Ling Ling’s tumor) is bothering them a lot more than you know.

With modern anesthetic drugs and monitoring, “too old” is not a good reason to allow a dog’s problem to go un-treated.

27 thoughts on “Too Old for Tumor Surgery?

  1. Naomi says:

    Good for you, and good for Ling Ling! It’s so hard to know what our pets really need…if only they could talk. Glad to hear her recovery is going well. By the way, I work with an FDA cleared PEMF therapy device called Assisi. It uses microcurrents to reduce swelling and edema post surgery. You might want to look into it: http://www.assisianimalhealth.com

    Cheers, Naomi

  2. Doc says:

    Hello, LInda,

    This could be anything from a skin tumor to a reaction to some sort of foreign body (splinter, etc.).

    If it doesn’t go away on its own in a few days, I’d let your veterinarian look at it. If it is low on the leg, you don’t have a lot of loose skin to play with. If it is growing, you want to get it off while it’s still small and easy to remove.

  3. Linda says:

    Thank you for your quick response. I’ll definitely keep an eye on it. I haven’t noticed him licking the area yet today and it wasn’t wet when I felt the spot but there is still a small lump there. It is located on his forearm, so you are correct, there isn’t a lot of loose skin.

  4. Maria says:

    Im happy that the doggy is doing well. I have a 12yr old dobie and he had developed a tumor on his chest. Under the car of vet they advised to leave it alone till need be taken out. Well its been a few years and his tumor has gotten bigger. When we decided it maybe a good time to take it out we noticed he developed 4 more on his groin. Well we decided to wait on the surgery for the chest to see how the groin ones
    Would grow. They have grown really fast. So fast that they would have to be taken out soon too. My question is.. what do you do? These surgeries are gna be big and im thinking its gna be a hard recovery due to his age given its gna be his upper and lower body whether we do surgery one area at a time or all together. Not only that but its going to cost thousands of dollars for it to possibly grow back faster than before with or without having time to heal up. He is 12years old. Older than most dobermans we know. Im torn. Sld we let him continue to live his best and lay him to rest when it becomes bothersome or if there are any complications or do we do multiple operations?

  5. Doc says:

    Hello, Maria,

    All of those choices can be realistic. I cannot choose for you. It is certainly true that even if the surgeries go well, you’re not going to add another 12 years to his life.

    On the other hand, if the tumors are causing him pain, I would schedule surgery for the largest one, and take biopsies from the others at the same time. It is possible that there could be medicine to shrink them to a more manageable size for removal. Or you could just biopsy several of them to see if medication might help shrink them before surgery.

  6. nancy says:

    My lab is 11 years old and has several lipomas. One is bigger than a soft ball. I would love to have it removed but she has a history of seizures and the vet is hesitant to remove it. Is there anything that will shrink it?

  7. Doc says:

    There was a study published in 2011 about doing liposuction in England. Removal was considered successful in more than 90%, but about 1/3 of them re-grew (apparently not completely removed). Regular surgery has a greater success rate. I don’t know of anyone doing it in this country, and cannot find any more recent studies.

    They also noted it would not work if it wasn’t a simple lipoma, but had other strands of tissue in it.

    If this were my patient, I would be getting a consultation with an anesthesia specialist about how best to handle a patient with seizures (or on seizure meds).

  8. candice says:

    My 13 year old chihuahua has a fatty tumour on his chest the size of a tennis ball. it was tested and it is not cancerous. My concern is the size since it has tripled in size in the past 2 years. My vet was concerned with removing it because of his age than because of the anesthetic. Now I am worried that it won’t stop growing and don’t know what to do. I have read so much on the internet in favor and not in favor of surgery. If I knew the surgery would not be dangerous to do I would be doing it today. Not sure what to do . Any suggestions would be greatly appreciated

  9. Doc says:

    It sounds like the tumor has become large enough to be uncomfortable to the dog.

    If your doctor is uncomfortable with anesthetizing your dog, you might ask for referral to a surgical specialist who has more support personnel.

    Without knowing and seeing your dog, I really cannot speculate on the safety of the surgery.

    I can say that we routinely operate on dogs of this age who don’t have other serious medical problems.

  10. Rishabh singh says:

    Hello doc!
    Loved this article.
    My english cocker spaniel female, age 12 and a half in India had a tumor of a size of a tennis ball in her lower nipples.
    I was asked by the vet to do a surgery, however the other vet sais she being old, the surgery might be fatal to her.
    Now her tumor is bigger like 2 tennis balls together, and today i saw red markings on it!! I am not sure what to do here. IS it safe to get her in for a surgery? Please suggest

    • Doc says:

      Hello, Rishabh, It is certainly true that older patients are more likely to have trouble with anesthesia than are younger patients. If anesthetic drugs were good for you, you wouldn’t lose consciousness.

      I would revisit the doctor who recommended the surgery. While it is true that your older dog has more risk than when she was younger, as the tumor grows larger the risk become greater that it will outgrow its blood supply, causing part of it to die, and to break open. Then you have a big tumor that is draining and bleeding. The larger the tumor grows, the more difficult and time-consuming the surgery becomes.

      Yes, there is risk with the surgery, but with the rapid growth of the tumor there is a certainty that you will have severe problems. With the surgery, there is the possibility of keeping her comfortable for the years she has left.

  11. Milda Iliscupidez says:

    Hi Doc, I have a 15 1/2 year old Yorkie with newly onset dementia, and bad teeth. My vet is saying that surgery is not a viable option for him given his age and other ailments. Any insight on how dangerous removing a tumor can be at his age. He is 6lbs and the tumor is almost the size of my thumb in his left hindquarter.

    • Doc says:

      Hello, Milda,

      I can’t really evaluate this situation, since I haven’t seen your dog, and your veterinarian has. The surgery sounds pretty doable, but your dog’s other situations may make him a poor risk for anesthesia.

      Our goal is for the patient to have a good quality of life for as long as possible. Sometimes a slow-growing tumor doesn’t really affect the patient’s quality of life, and the risk of anesthesia makes us afraid of losing him right now.

      At other times, the tumor is really causing problems, and we just have to take the risk, even knowing that we might lose our patient. We just can’t let them suffer with something that is hurting every day.

      Each case has to be evaluated individually.

  12. Christy Blaszak says:

    So glad I came across this blog as my 10 year old hound dog has been limping for months. Her health also has declined dramatically and although on strict diet continues to gain substantial weight. 3 visits to vet, Couldn’t find any answers. We even changed vets for 2nd opinion only with same result until finally a 3rd vet finally was able to tell us she has a tumor in her paw. Then they also found a mass tumor in her chest and now looking at surgery next month. Worried to death about her age and the size of this tumor. Is this safe to go ahead and proceed with the surgery? Before all this she was overweight but otherwise healthy very active diog.

    • Doc says:

      Hello, Christy,
      If it were just the tumor in the paw, I’d have no worries. With a mass in her chest, surgery is much more invasive, and the dog will require more intra-operative support (someone has to breathe for her, like being on a ventilator, while the chest is open). So, I would have some worries.

      You need to discuss your concerns with the doctor who is seeing her. I really can’t give you meaningful answers.

  13. Andie Smith says:

    I appreciate any response given. We have a 13 year old 18 pound yorkie. He has several large growths around his body. One is just a cyst and fluid is often removed. Others are abdominal and near joints. He has been neutered years ago. He has a large hard/thick growth under his tail and circling his rectum. He has been drinking a lot, occasionally scooting. Sleeps a lot. He has never been a playful pup so we can’t comment on that. At 13 my heart tells me to let him enjoy a little time without surgery and then when it seems he is more uncomfortable to have at home euthanasia. I worry about the pain and possible issues with his defecting and being able to control his bowel movements. With Covid it is not easy to speak with vet. Just short hurried phone calls. Just don’t know what to expect. He has never seemed to be a real happy dog. Quiet and to himself though he does gravitate towards me. I love him dearly.

    • Doc says:

      Hello, Andie,
      It sounds like there are a lot of issues there. There are definitely times when we just opt for pain control to make the dog’s final months okay. Without seeing your dog and knowing all the details, I can’t really advise you. Best wishes.

  14. Cindy says:

    Thank you for this article. I have a 12 year old large mixed breed rescue (approx 65 pounds). She has a tumor on her belly that we are considering removal. My concern is post operative care. She licks it obsessively no matter what we do. We have tried cone (she rubs it against the tumor causing more damage), surgical suits, (she licks a hole into the suit) distraction toys, and nothing completely stops her. Our concern is she will undo any benefit of the surgery with her obsessive licking. She has developed several lick granulomas (bends of front legs, etc) so the licking is a chronic problem. I’m sick over the situation. She also seems so distraught, hiding to lick her tumor, and trembling with shame with I find her doing so. It’s heartbreaking. Any thoughts if there is hope for successful post operative care?

    • Doc says:

      Hello, Cindy,
      Dogs are unlikely to be feeling shame. However, since you have probably tried to correct her from this licking behavior, she knows that you don’t like it. This is more likely to be submissive behavior, hoping to defuse your anger.

      Is the dog taking any pain medication? While it sounds like she does have some compulsive behavior with the lick granulomas, I’d be concerned that the tumor is causing discomfort. I would certainly ask your veterinarian about pain meds if not already taking them. That makes a big difference post-operatively, as well. Sometimes we will also use sedatives in the immediate few days post surgery.

      Lick granulomas are usually deeply infected, requiring long-term (six weeks or more) antibiotic therapy (by mouth) in addition to topical meds. Some dogs also benefit from corticosteroids, like prednisone.

      Prednisone is NOT compatible with pain medicines like Rimadyl, Previcox, Galliprant, or other NSAIDs.

  15. Lee says:

    Hello. Thank you so much for your article. I have a 14 year old beagle that is good shape other than the fact that he has tumor all over his body that are just lipomas. The vet said that this very common in beagles. He has a very large lipomas on his left hind leg that is still growing. He is able to walk and take the stairs but the lipoma is making it hard to do those things. He also has to use his front legs to stand up because he hind leg with the lipoma gives him no help with standing and a lot of time that leg gives out on him when he’s walking. We are afraid he wont be able to eventually walk or go us the bathroom on his own.

    The vet said removing the lipomas and recovery would have some risks because of his age. We just don’t know what’s best for him. He is doing well for his age and we know that we may only have another year with him but this lipoma we may not even have that.

    Any advice would be greatly appreciated. Thank you

    • Doc says:

      Hello, Lee,
      There are always risks with anesthesia and surgery, and with older patients those risks can certainly be greater. We want to give them all the support we can: I.V. fluids, oxygen, monitoring blood pressure, being ready to assist with breathing now and then.

      The doctor seeing your dog is better able to help you assess any risks with preoperative testing: blood tests, chest X-ray (to evaluate heart and lungs), possibly an electrocardiogram.

      He/she can help you weigh the pros and cons of how much you can improve the dog’s quality of life, versus the risks involved.

  16. Julia Espinoza says:

    Hello doctor,

    I would appreciate any guidance possible. I have a 10 year old Yorkie, Shih Tzu mix who has a bump on her belly. The doctor says there’s a 70% chance it’s a tumor and 30% it’s cancer. She’s had very low energy, has been very clingy, diarrhea and I’m breaking inside curious if she’s in pain. If it is a tumor the doctor recommends her getting it removed and having her spayed at the same time. Is this worth it at her age? does she have much more life?, will it be enjoyable? My dog comes before me and I don’t want her to suffer. What is recommended? What would you do if it was yours?

    With appreciate, anything helps!

    • Doc says:

      Hello, Julie,
      Sorry I’ve gotten so far behind in answering comments. This is a situation where you would want to evaluate the rest of the dog’s health, since she seems to be feeling bad. It could just be the lump, but it could also be other illness. Ideally we would do a chest X-ray, complete blood count, and a biochemistry panel to see if there are other illnesses, and maybe an abdominal ultrasound, as well. That’s a lot of stuff, but it’s not a lot of stress on the patient (just the pocket-book). If there are no other illnesses that need to be handled, sometimes you will find that the dog’s quality of life improves quite a lot after removal of the mass.
      If there ARE other illnesses or obvious spread of the tumor, then you have to look at what you can handle and what you cannot.
      If the tumor hasn’t spread and other factors can be handled, then I would go ahead and remove the mass. Ten years old is not ancient. It is possible to have several more good years.

  17. Dora B. Zeiller says:

    Hello Dr
    We have a 14yr old, Cushings female Siberian Husky. She has been losing weight since her diagnosis 2 yrs ago (from 65lbs down to 38lbs). She is currently on Vetoryl (Trilostane) for it. She also has degenerative spinal myelopathy and Arthur’s in her legs and is on meds for that too. She can barely walk and loses her balance a lot. Just recently She has just been diagnosed with a grade 2 STS sarcoma on her front leg. We found the lump 2 months ago. Her Vet said he can remove the tumors but due to the wide margin her must take in her condition as a Cushings he is not positive that she will be able to heal effectively….that and the radiation following to ensure they get all the cancer cells. process due to her Cushings disease. We understand his concerns but we are even wandering if she’s a good candidate for this kind of surgery given her condition and age. What is her real prognosis if we pursue this path? How long does she have and will this surgery weaken her even more than she already is? He also states that if she were healthy and old she would have a better prognosis but it leaving it up to us. We are not sure and need your professional opinion on this. Please advise thank you

    • Doc says:

      Hello, Dora,
      I am not really in a position to advise you, not having seen your dog. I really think that your veterinarian is your best source of information. If you are not satisfied, then I would ask him for referral to a specialist.

      This is a very difficult situation. I know that an oncologist (cancer specialist) would start by “staging” – looking for spread of the tumor to other locations.

      Given what you have told me about your dog’s deteriorating condition, it is hard to feel that this is going to turn out well.

  18. Joan Nasser says:

    I have a twelve year old Golden Doodle with a large cyst between her shoulders about the size of a tennis ball. It doesn’t seem to bother her, but it has grown a little larger lately. I’m worried about her being anesthetized at her age. I don’t know if I should just leave it or have it operated. I’d appreciate your answer.

    • Doc says:

      Hello, Joan,
      If you haven’t already done so, talk with your veterinarian about getting a diagnosis. Often you can get enough cellular material to get a good idea about things by just putting a fairly small needle into the mass. The urgency for removal depends a lot upon what the disease process is, and how fast the mass is growing.

      In that location, we can sometimes remove a superficial mass with tranquilizer and local anesthetic.

      Many older dogs can be successfully anesthetized and recovered if you do some pre-anesthetic risk factor testing and support them during the procedure.

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