Monty’s story – metastatic anal sac carcinoma

Monty, an eight-year-old Labrador, was referred to Fitzpatrick Referrals Oncology and Soft Tissue in January 2016, after surgery with his family vet on a left-sided perineal mass showed anal sac adenocarcinoma in his left anal gland, along with concurrent hypercalcaemia.

Monty and his family had an initial consultation with Professor Nick Bacon who examined Monty and identified sublumbar lymphadenopathy on rectal examination. The treatment plan started with a contrast CT scan of the thorax, abdomen and pelvis, to help with surgical planning and tumour staging.

The scan confirmed his hypogastric lymph nodes were enlarged, with additional concern over the sacral lymph nodes. A soft tissue nodule in the area of the left anal sac was also identified which was either tumour recurrence or residual scar tissue. Nick went through the CT scan with Monty’s family and they decided to proceed with a laparotomy to remove Monty’s lymph nodes and also the newly found perianal nodule.

During surgery, both his enlarged hypogastric and sacral lymph nodes were removed, and the left and right medial iliac lymph nodes were dissected free. Monty’s nodule near the left anal sac was also excised. All were submitted for histopathology, which confirmed macroscopic metastatic disease in the sacral and hypogastric lymph nodes and microscopic disease in the medial iliac nodes. The perianal nodule was a suture granuloma.

The pathology results were discussed with the family by our former Medical Oncologist, Dr Kelvin Kow, who explained the likely progression of Monty’s disease and the treatment options that were available. It was explained that all grossly detectable disease has been removed but it was likely that cancer would recur within the abdominal lymph nodes in the future. Monty’s family were keen to pursue adjuvant chemotherapy and after an original combination of carboplatin and mitoxantrone, he is currently on the tyrosine kinase inhibitor palladia three times a week.

Since 2016, we have continued to monitor for metastasis with abdominal ultrasound or CT. Monty has had two small procedures to remove positive lymph nodes in the past two years, but throughout Monty has been running around, is bright and comfortable, and enjoys playing with the grandchildren. Nobody has told Monty life should be any different.

 

Monty’s mum, Sylvia said:

Monty has the most wonderful personality. He loves lots of affection and cuddles and mostly very obedient, but can be very mischievous. I have found over the years of walking him all dogs seem to love being with him and playing. We walk with young puppies sometimes and he likes to supervise their play with the other dogs, he can be quite bossy!

Monty is doing well. If he is not feeling quite up to the mark, he will tell me, especially on walks. He will stop and not want to go any further, so we just go back home and take it very easily. I have to know all of the signs of Monty not feeling too good and we work it out together. Overall, despite his cancer diagnosis, Monty is as happy as ever and continues to enjoy life as always.

I have found Fitzpatrick Referrals to be a lovely place full of warmth and kindness. It all starts at the reception with the warm welcome and attention given to Monty. Monty loves going to see all of his friends. He is out of the car in a flash to go ‘in to see his girlfriends’… and the gravy bones of course! He is also very content to go and have his treatment upstairs and see everyone there too. I know that he is up there with very caring professionals.