By Dr. Alison Book, DACVIM Oncology
The word amputation can elicit strong negative emotional responses. The first time you heard this mentioned as an option for the treatment of your dog or cat’s cancer, you may have felt shocked, scared, saddened or even angry. You may have wondered how you could possibly do that to your beloved family member.
Rest assured, you are not alone. Most owners faced with this choice struggle with the decision to amputate. However, for those who decide to move forward with amputation, the vast majority are very happy with their decision.
My hope in this article is to define the goals of limb amputation as a treatment for cancer, clarify some myths surrounding amputation, provide support in the decision making process, and prepare you for what to expect if you decide to move forward.
What are the common cancers for which limb amputation is a consideration?
Bone cancer: osteosarcoma, chondrosarcoma and others
Vaccine-associated soft tissue sarcoma of the limb
Soft tissue sarcoma of the limb (fibrosarcoma and others)
Localized histiocytic sarcoma
Mast cell tumor on the limb (usually because the tumor is large and/or other treatments haven’t worked)
Why would limb amputation be recommended for my pet’s cancer?
Your veterinary oncologist or surgeon will likely recommend amputation for your pet’s cancer in order to achieve specific treatment goals:
1- Completely remove the primary tumor.
One of the primary goals of surgical oncology is to remove the primary cancer in its entirety. In order to achieve this, margins of normal tissue surrounding the cancer are required. If a tumor located on the limb is large or invades deeply into tissues such as bone, amputation is often the only surgical procedure that will result in complete removal. This is usually the primary treatment goal in cases where prognosis following amputation is anticipated to be good.
2- Relieve pain and discomfort.
In some cases, amputation is not expected to be a curative treatment. Rather, the goal is for improved quality of life and prolonged life. In these cases some might wonder, “what’s the point?” However, this goal can be especially important in many situations, particularly with bone cancer.
It is important to remember that dogs and cats are stoic and particularly good at hiding their pain. But don’t be fooled. Bone cancer hurts! It is very painful because the tumor is destroying normal bone and stretching the tissue that lines the bone. When a dog or cat is reluctant to bear weight on a limb, they are showing you that they are painful. Sometimes, in advanced cases, the limb might not be serving a useful function any longer.
Although it may sound radical, removal of the tumor (the source of the pain) is the single most effective way to relieve bone cancer pain and prevent fracture. Thus, amputation is often the procedure that most improves your pet’s quality of life.
Making the decision to amputate.
It is important to remember that there is no right or wrong answer, only the best decision for your pet and family. We know the decision making process is difficult and your oncologist and surgeon is here to answer your questions. Some other helpful resources:
Online resources: Many families say it was helpful to watch videos of other three legged pets doing the things they loved most. You can also check out www.tripawds.com and www.bonecancerdogs.org.
Other pet owners who have been in your situation: Ask your oncologist if they can connect you with another client whose dog or cat has had an amputation.
What to expect with an amputation surgery?
Immediately following amputation:
Your pet will have a large shaved area and an incision. Just following surgery, there can be some swelling or redness to the area, and visually, this can be shocking for families. Remember that the visual appearance will improve as the surgical site heals and the fur grows back. You might consider bringing a T-shirt for your pet to wear when you first see him/her following amputation. Ask your surgeon to put it on before your pet is brought out to you.
The initial recovery/ healing period is typically 10-14 days. For some pets, there is a period of learning in the first few days to a week where you might want to support them as they move around. You will also be asked to give your pet medications to prevent pain.
For some pets, they will want to resume normal activity before it is medically advised! It will be important for you to keep your pet quiet during the first 2 weeks so the surgical site can heal completely, without complications. Your surgical team should discuss with you how to limit activity during this period.
We hear many of the same concerns regarding amputation so let’s talk about a few myths that are out there.
The amputation surgery and recovery is too difficult/painful for me to put my pet through.
The typical recovery period from surgery is about 10-14 days. However, most dogs and cats will be mobile on three legs much faster than this. Adequate pain control is achieved both during and after your pets surgery through the use of local analgesia, intravenous and oral pain medications. These medications keep your pet very comfortable. You would be surprised how quickly most pets are back to normal activity and out doing the things they love!!
My dog or cat is too big or too arthritic to tolerate amputation.
The truth is that most large pets and pets with moderate arthritis get around quite well on three legs. If you are concerned about these particular factors, it is best to have a consultation with an orthopedic surgeon prior to amputation to discuss factors particular to your pet.
My dog or cat will have a worse quality of life following amputation.
Most dogs and cats have improved quality of life following amputation. Discuss your pet’s particular situation with your oncologist. However, chances are we would not recommend amputation if we believed it would lessen quality of life.
What are my alternative options?
If you’ve decided that amputation is not the best option for your dog or cat, talk with your oncologist about alternatives for your pet’s particular situation.