Few months ago, 13-year-old Milo the Maltese developed an ulcerated mass on his neck. He was having difficulty eating and started losing weight.
Complete surgical removal of the neck mass is the treatment of choice. Dr Estella Liew, Mount Pleasant Central Veterinary Clinic (Whitley), performed the surgery. However, due to its location (very adhered to the jugular vein & trachea), incomplete excision was expected.
The mass was sent for histopathological diagnosis and confirmed to be Squamous Cell Carcinoma (SCC). Due to its aggressive nature, the cancer is likely to regrow rapidly or metastasise (spread to other parts of the body).
SCC is a malignant cancer that originates in the squamous epithelium – the outermost layer of skin that is made up of scale-like cells. Tumours may appear as firm, raised, frequently ulcerated bumps on the skin. They can occur in any parts of the body but usually in areas with a lack of pigmentation or hair.
One factor associated with the development of SCC is prolonged exposure to sunlight (ultraviolet radiation). As with most forms of carcinoma, SCC is more commonly seen in older dogs.
Clinical signs of Squamous cell carcinoma include:
- drooling
- difficulty in eating
- weight loss
- halitosis (bad breath)
- facial swelling
oronasal fistula
Milo also had two oronasal fistulas, measuring 2cm x 3cm and 3cm x 0.5cm. Symptoms of oronasal fistulas include chronic nasal discharge (with or without bleeding), sneezing, bad breath. Left untreated, oronasal fistulas would cause irritation of the nose, infection and aspiration pneumonia.
An oronasal fistula is an abnormal passageway between the mouth & nasal cavity. It needs to be surgically corrected to prevent food & water from passing from the mouth into the nasal cavity. Ref: avds-online.org
Causes of oronasal fistulas include:
- Trauma
- Bite wound
- Oral cancer
- Periodontal disease
- Upper jaw overbites (canine teeth in bottom jaw pierce the hard palate/roof of mouth)
The smaller fistula was surgically repaired by creating a flap of gingival tissue on the buccal surface and suturing it over the defect. The other fistula was too large to be repaired at the same time. It was suspected that the fistulas developed due to SCC. If so, the repair will likely fail. Antibiotics are prescribed to control any possible infection.
With the presence of the large oronasal fistula, an esophageal feeding tube was surgically placed through the side of Milo’s neck to keep him nourished & prevent aspiration pneumonia.
X-Ray was done to make sure the feeding tube was correctly placed through the esophagus (not the trachea). The tube extends the length of the esophagus & terminates just before the stomach. It allows food to enter the esophagus & flow into the stomach.
Feeding tubes should be unwrapped, cleaned & re-wrapped once daily initially. After the insertion site has healed, the tube can be cared for every 48 hours to prevent infection at the insertion site.
Although prognosis for SCC patients is poor, Milo still has that sparkle in his eyes. And cancer can’t wipe that smile off his sweet face.
Towards the end of your pet’s life, I guess the best thing to do is remember the memories you have created (even the frustrating ones!) and cherish the moments you have left (yes there will be times your old friend needs to pee at 3am).
When the day comes to bid farewell, do so with a smile amidst the tears. Because he has been such a good dog.
“I’ll feed Milo in the morning & come home in the afternoon to feed him again. At night, my mom will help. Milo enjoys sitting by the door. Watching the world go by. He is a good boy. We hope he will live past this year.” ~ Maurice & Yuan
