Hemangiosarcoma

Hemangiosarcoma is a malignant,^[1] rare, rapidly growing, highly invasive variety of cancer. It is a blood-fed sarcoma; that is, blood vessels grow directly into the tumor and it is typically filled with blood. A frequent cause of death is the rupturing of this tumor, causing the victim to rapidly bleed to death.

The term angiosarcoma, when used without modifier, usually refers to hemangiosarcoma. However, glomangiosarcoma (8710/3) and lymphangiosarcoma (9170/3) are distinct conditions. Hemangiosarcomas are commonly associated with toxic exposure to thorium dioxide (Thorotrast), vinyl chloride, and arsenic.

Stewart-Treves syndrome is a form of hemangiosarcoma due to lymphedema, usually following mastectomy and radiotherapy for breast cancer.

Hemangiosarcoma of the skin in a dog

Hemangiosarcoma of the spleen in a dog

Hemangiosarcoma in dogs

Hemangiosarcoma is quite common in dogs, and more so in certain breeds of dogs including German Shepherds and Golden Retrievers.^[2] It also occurs in cats, but is much more rare. Dogs with hemangiosarcoma rarely show clinical signs until the tumor has become very large and has metastasized. Typically, clinical signs are due to hypovolaemia after the tumor ruptures, causing extensive bleeding. Owners of the affected dogs often discover that the dog has hemangiosarcoma only after the dog collapses.

The tumor most often appears on the spleen, right heart base, or liver, although varieties also appear on the skin or in other locations. It is the most common tumor of the heart, and occurs in the right atrium. Here it can cause right-sided heart failure, arrhythmias, pericardial effusion, and cardiac tamponade. Hemangiosarcoma of the spleen or liver is the most common tumor to cause hemorrhage in the abdomen.^[3] Hemangiosarcoma of the skin usually appears as a small red or bluish-black lump. It can also occur under the skin. It is suspected that in the skin, hemangiosarcoma is caused by sun exposure.^[3] Occasionally, hemangiosarcoma of the skin can be a metastasis from visceral hemangiosarcoma. Other sites the tumor may occur include bone, the kidney, the bladder, muscle, the mouth, and the central nervous system.

Clinical Features Presenting complaints and clinical signs are usually related to the site of origin of the primary tumor or to the presence of metastases, spontaneous tumor rupture, coagulopathies, or cardiac arrhythmias. More than 50% of patients are presented because of acute collapse after spontaneous rupture of the primary tumor or its metastases. Some episodes of collapse are a result of ventricular arrhythmias, which are relatively common in dogs with splenic or cardiac HSA. ^[4]

Most common clinical signs of visceral hemangiosarcoma include loss of appetite, arrhythmias, weight loss, weakness, lethargy, collapse, pale mucous membranes, and/or sudden death. An enlarged abdomen is often seen due to hemorrhage. Metastasis is most commonly to the liver, omentum, lungs, or brain.

Clinicopathologic findings Hemangiosarcoma can cause anemia, thrombocytopenia (low platelet count), and disseminated intravascular coagulation (DIC).

HSAs usually cause a wide variety of hematologic and hemostatic abnormalities, including anemia; thrombocytopenia; presence of nRBC, schistocytes, and acanthocytes in the blood smear; and leukocytosis with neutrophilia, left shift, and monocytosis.

Diagnosis are based on findings from cytology, imaging, and staging from FNA or biopsies.

Treatments Treatment includes chemotherapy and, where practical, removal of the tumor with the affected organ, such as with a splenectomy. Splenectomy alone gives an average survival time of 1-3 months. The addition of chemotherapy, primarily consisting of the drug doxorubicin, alone or in combination with other drugs, can increase the average survival time to 5-7 months.

Visceral hemangiosarcoma is usually fatal even with treatment, and usually within weeks or, at best, months. In the skin, it can be cured in most cases with complete surgical removal as long as there is not visceral involvement.^[3]

Experimental Laser Procedure Autologous patient specific tumor antigen response: apSTAR Veterinary Cancer Laser: The use of a laser combined with a polymer has been shown to enhance tumor immunity and improve the rate of primary and metastatic tumor regression in laboratory models of tumors. Veterinary Cancer Therapeutics, LLC, a division of IMULAN BioTherapeutics, LLC, has recently started examining the use of this laser device, termed apSTAR, for canine sarcomas and other tumor types [1]

References

1. ^ hemangiosarcoma at Dorland's Medical Dictionary
2. ^ Ettinger, Stephen J.;Feldman, Edward C. (1995). Textbook of Veterinary Internal Medicine (4th ed. ed.). W.B. Saunders Company. ISBN 0-7216-6795-3. 
3. ^ ^{a b c} Morrison, Wallace B. (1998). Cancer in Dogs and Cats (1st ed. ed.). Williams and Wilkins. ISBN 0-683-06105-4. 
4. ^ Nelson et al. Manual of Small Animal Internal Medicine. Elsevier Mosby: St. Louis, Missouri (2005)

External links

• Hemangiosarcoma research at the Modiano Lab of the Univ. of Minnesota - includes links to other canine cancer research
• Vetinfo on Hemangiosarcoma
• Canine Cancer Awareness on Hemangiosarcoma, including more links to current studies
• Flat-Coated Retriever Hemangiosarcoma page
• Vet Corner on Hemangiosarcoma
• Mar Vista Animal Medical Center on Hemangiosarcoma
• Hemangiosarcoma in Cats and Dogs from Pet Cancer Center
• Heart hemangiosarcoma in Cats and Dogs from Pet Cancer Center