Lymphoma

Lymphoma is a fairly common genetic cancer in dogs generally, but seems to be especially a problem in some breeds, including Dobermanns. It is one of the two cancers listed as of most concern in the Dobermann Breed Health and Conservation Plan.

Lymphoma is a cancer of the white blood cells that control the immune system. Because these cells travel around the body, lymphoma can affect lymph nodes in a variety of places. It is generally a disease of middle aged and veteran dogs, but it can strike at any age and there are many cases of very early onset lymphoma in Dobermanns.

There are four types of lymphoma:

Multicentric (systemic) lymphoma. This is, by far, the most common type of canine lymphoma. Multicentric lymphoma accounts for approximately 80-85% of cases in dogs. In multicentric lymphoma, lymph nodes throughout the body are affected.

Alimentary lymphoma. This type of lymphoma affects the gastrointestinal tract. Alimentary lymphoma is the second most common type of lymphoma.

Mediastinal lymphoma. In this rare form of lymphoma, lymphoid organs in the chest (eg lymph nodes, thymus) are affected.

Extranodal lymphoma. This type of lymphoma targets a specific organ outside of the lymphatic system. Extranodal lymphoma is rare but may develop in the skin, eyes, kidney, lung, or nervous system.

The most common early symptom is swollen lymph glands in the neck, armpits etc (for systemic lymphoma, the commonest kind). Swollen glands are not always due to lymphoma – it could be a response to infection – but the dog should always be seen urgently by a vet and lymphoma should be one of the possible diagnoses considered.

In the case of alimentary lymphoma, the only early sign might be weight loss. The dog may well have a grumbling stomach in the morning and not want its breakfast. It may also go into a ‘downward dog’ pose and hold it. Whilst this looks cute, it is actually a sign of intestinal distress. As it progresses, the dog will be less and less able to eat and will vomit food back, and potentially vomit blood and/or pass blood. This can be misinterpreted as gastroenteritis, so if there is no increase in temperature or white blood cell count, lymphoma should be considered as a potential diagnosis.

In some of the rare cases, such as mediastinal lymphoma, this could lead to coughing and breathing difficulty.

Lymphoma is always fatal. Without treatment, dogs often die within weeks of onset of symptoms. Chemotherapy can put the disease into remission for many months with good quality of life, but it will recur eventually. Chemotherapy is usually well tolerated by dogs, with little or nothing in the way of side effects, but it is very expensive and usually involves weekly injections for 4-5 months. Some lymphomas can be treated by steroids. Steroids can also reduce the swelling of the lymph nodes. With chemo, dogs can last up to a year, sometimes longer.

There are varying degrees of lymphoma. The most common kinds follow the pattern above, with a good remission phase after chemo, but eventually recurrence. Indolent lymphoma is the name given to rarer slow-growing lymphoma, which can mean a dog needs only steroid treatment and has a longer life-expectancy, possibly up to two years or even more, although some later develop additional malignancy. Sadly, some lymphomas develop very rapidly and the dog will die within weeks, probably before there is any chance for chemo. Anecdotally, this very aggressive type seems often to be very early onset.

What to look out for:

Swollen lymph nodes
An unexplained loss of weight, particularly if not corrected when food intake is increased
Grumbling stomach in the morning and ‘downward dog’ plus inappetence in the morning
Vomiting and/or diarrhoea, especially if not accompanied by raised temperature and/or changes in blood count (ie unlikely to be caused by infection)

If a vet is investigating any of these, it is worth discussing the possibility of lymphoma.

The vet will give information on how to manage the dog through the disease. If vomiting and diarrhoea are an issue, there are anti-sickness and appetite-stimulant drugs that can be given. Dogs may be picky about what they can eat, loving things one day and refusing them the next. It is best to offer a range of tasty foods in small amounts throughout the day. Some dogs will refuse a dish of food but can be made to accept what they see as training treats, such as cocktail sausages, cheese, pieces of cooked meat, when given alongside a mock training or play session. It is probably best in this case just to get as many calories as possible into the dog without worrying about how much is junk food. If tolerated, tins of ultra-high calorie recuperation food can be a way of getting calories in, potentially mixed with soaked kibble and partly dried in a low oven.

It is tempting to wrap the dog in cotton wool and not allow energy expenditure, but it is probably best to allow short games and garden time every couple of hours with rest in between, to avoid the dog becoming depressed.