“I found a lump, and I’m in a panic.”
I hear this all the time. I also hear a follow-up comment at times that makes me unhappy: “Just take it off, and I don’t want to know what it is,” says the worried client. Oh, boy. Now I’ve got some convincing to do.
Most growths that warrant removal also warrant analysis. This analysis is called a biopsy or pathology. It’s important to get a diagnosis on a growth, to give it a “name’ so that we know what we are dealing with, but many people balk at this idea. For the purposes of this article, assume that lump, bump, growth, mass and tumor are interchangeable terms.
What Clients Sometimes Say
“If it’s bad news, I’d rather not know.”
I hear this a lot when someone declines to send out a biopsy. Well, what if it’s good news?
- Many growths or tumors can be cured when surgical removal is complete.
- Did you know we use the term “tumor” even when describing a benign growth, such as a fatty tumor, commonly called a lipoma? Tumor means an abnormal growth of tissue. It is not synonymous with cancer. There can be benign tumors and malignant tumors.
- Some growths might look nasty and have you and your vet concerned, but the diagnosis may paint a more favorable picture.
- If you don’t get a diagnosis, you live with worry and concern. An answer stops the “What if?” syndrome.
“If it’s cancer, I won’t put my pet through chemo.”
There is so much wrong with this kind of thinking.
First of all, recommending chemotherapy following a growth removal is not all that common. If — and that’s a big if — some sort of drug therapy is recommended following surgery, we usually choose chemo drugs that have low toxicity and are tolerated well. If the drug doesn’t agree with the pet, we can always stop the drug, usually without doing lasting harm.
If a biopsy does yield bad news, many people in the “I wouldn’t do anything drastic” camp change their tune when follow-up treatment could mean a longer life or cure for their pet.
“No biopsy for my pet; it’s too expensive.”
Lab fees can be costly, pathology fees costing upward of $200. The information obtained, however, can tailor a follow-up treatment plan. Knowing the type and behavior of the tumor your pet had removed helps us make decisions in the future.
Cytology, Biopsy, Pathology
There are a number of ways to get information about a growth, both before and after removal.
Fine Needle Aspirate (FNA)
Basically, a fine needle aspirate is a fancy way of saying we stick a needle in a lump, squirt the contents of the needle on a slide, stain the slide and look at the splat! Looking at cells like this is called cytology. Hopefully, the splat (aspirate) contains cells that give us a clue about the type of growth we’re dealing with.
FNAs are quick, easy and inexpensive, but they yield limited information. Many FNAs give us an idea that a growth is probably benign or probably cancerous but tell us little about how that growth will behave or the severity of the cancer.
A biopsy usually refers to a sampling of a growth taken prior to removal of the entire growth and having it analyzed by a veterinary pathologist. Many biopsies can be done with only a local anesthetic. In an ideal world, it would be great to biopsy every growth and know the diagnosis prior to surgical removal.
The pros of doing a biopsy are many. The biopsy can suggest how much of a pre-surgical work-up should be done and tell the surgeon how conservative or radical to be at the time of surgery. Certain tumors, for example, due to their aggressive behavior, require a very wide excision to get the best chance at a cure. Having a reliable biopsy in advance prepares the client, surgeon and patient for a basic or more radical surgery.
The cons generally have to do with putting the animal through an additional procedure, the cost and the possibility that the small section of tissue submitted for biopsy may not be representative of the entire mass.
Rarely, excessive bleeding can occur.
Histopathology refers to the preparation and microscopic examination of tissue samples. Usually, we use the phrase “sending out for pathology” when we remove an entire mass and send that mass with surgical margins to the pathologist. The tissue (growth, mass, tumor, etc.) is the biopsy sample, and histopathology is the analysis.
Sending an entire mass to the lab for pathology gives us the best diagnosis and tells us if our margins are clear of tumor cells. The pathologist will also comment on the specific character of the cells in the mass, stage the tumor if applicable and often give an opinion about prognosis.
Sending Out the Biopsy
When clients understands the important medical information and prognostic factors that can be learned from pathology, they frequently agree to the added expense.
Occasionally, a client declines the biopsy, even when I strongly recommend it be done. I tell these people on the emotional or financial fence that their pet’s tumor is “fixed” in formalin. The sample is not time-sensitive and can go out to the lab next week or next month.
The bottom line: When your veterinarian recommends the pathology, please do it.
This pet health content was written by a veterinarian, Dr. Debora Lichtenberg, VMD. It was last reviewed Feb. 14, 2018.