Hemangiosarcoma is a
malignant cancer of the cells that form blood
vessels. Because these tumors start
in blood vessels, they are
frequently filled with blood. Consequently, when a blood-filled tumor
ruptures, it can cause problems with internal or external bleeding.
Hemangiosarcoma is considered to be a very aggressive tumor and can
spread rapidly to other organs.
|Pale gums of a dog with
abdominal bleeding from a ruptured tumor.
click on image for larger view
Hemangiosarcoma is more common in dogs than in cats. It usually occurs
in middle-aged to older dogs 9 to 11 years of age, and German shepherds
appear to be predisposed to developing this cancer.
The most common primary location of this cancer in dogs is the spleen.
Other primary locations include the heart, liver, skin, and bone;
however, it can start in any location where blood vessels are present.
These tumors usually spread to the lungs, liver, spleen and heart.
Signs of this disease are usually the result of the tumor rupturing,
which causes bleeding.
This may occur without any warning, and the symptoms will depend upon
where the tumor is located.
When the tumor is located in the spleen or liver, the signs are usually
due to rupture of the tumor and subsequent bleeding into the abdomen.
This causes anemia, weakness and if the bleeding is severe, collapse.
The gums may appear to be pale or white. In relatively few animals the
is made before the tumor ruptures.
When this type of tumor occurs in the heart, it can cause symptoms,
such as weakness, collapse, difficulty breathing, exercise intolerance
and fluid build-up in the abdomen. This is usually due to the
of fluid around the heart, called pericardial effusion. A thin sack,
the pericardium, normally surrounds the heart. In pericardial effusion
the sack fills up with fluid and prevents the heart from beating
With hemangiosarcoma, the pericardium fills up with blood due to
of the tumor.
When the tumor occurs in the skin, a mass or lump can usually be felt
in or under the skin. The mass may become ulcerated and bleed. When the
tumor occurs in a bone, it can cause pain and discomfort. In some
such as a rib, the tumor can be felt as a firm swelling in the bone.
What to Watch For
Anemia, weakness and collapse
Pale or white gums
Fluid build-up of the abdomen
Mass or lump under the skin
Swelling in the bone
Pain in the bones
Diagnostic tests that may be needed to recognize hemangiosarcoma and
to direct treatment include:
Complete blood count (CBC) including platelet numbers
|An abdominal tap or abdominocentesis may
be needed to recognize hemangiosarcoma.
click on image for larger view
Serum chemistry panel and urinalysis
Abdominal radiographs (X-rays) and/or ultrasound
Ultrasound of the heart
The treatment and prognosis depends upon the location of the tumor.
When the tumor occurs in an internal organ such as the spleen or heart,
chances of long-term survival are poor. Treatment is more successful
this cancer occurs in the skin. Exposure to the sun may play a role in
the development of this type of skin cancer. Dogs with poorly-pigmented
skin and sparse hair coats, such as the whippet, saluki, bloodhound and
English pointer, are more likely to develop this form of
is no known cause of hemangiosarcoma in other locations. In humans,
to certain chemicals such as vinyl chloride has been implicated as a
Treatment for hemangiosarcoma may include the following:
Home Care and Prevention
Seek veterinary attention promptly if your pet develops pale gums,
signs of weakness or collapse. Have any new lumps on your pet evaluated
by your veterinarian.
Minimize your pet's exposure to the sun, especially dogs that are
poorly pigmented and have a sparse hair coat.
Hemangiosarcoma must be differentiated from other diseases that might
cause similar clinical signs. For example, diseases of the heart such
as an irregular heart rhythm can cause pets to show signs of weakness
or collapse. There are several other malignant tumors that can appear
as a mass in the spleen including:
Malignant fibrous histiocytomas
These tumors can also rupture leading to bleeding from the spleen and
the development of anemia. Some systemic cancers may involve the spleen
either in addition to other sites or as the primary site. The two most
common cancers where this occurs are lymphosarcoma and mast cell tumor.
Although not common, other tumors can spread or metastasize to the
spleen causing similar signs as hemangiosarcoma.
Other diseases that can cause similar signs include:
Hemangioma, which is the benign counterpart of
hemangiosarcoma.This tumor can cause the same clinical signs as
hemangiosarcoma but does not
spread to other areas of the body. This tumor type is rare.
Splenic torsion. The spleen can become twisted, which can lead
to enlargement of the spleen and possible rupture.
Hematoma of the spleen. A blood clot can form in the spleen
causing anemia and/or a mass in the spleen. Although generally there is
a history of trauma, this can also occur without any known injury.
Aortic body tumor, which is the most common other tumor of the
heart. This can occur in the same location as hemangiosarcoma and cause
signs. Ultrasound of the heart may not be able to differentiate between
hemangiosarcoma and other tumor types such as an aortic body tumor.
Idiopathic pericardial effusion. This condition in dogs causes
fluid build-up around the heart. The cause is unknown but it can be
managed by periodic removal of the fluid or surgery. Other types of
tumors can also cause pericardial effusion.
Veterinary Care In-depth
A complete blood count (CBC), including evaluating platelet numbers,
will allow your veterinarian to check
whether anemia (a low red blood cell count) is present or not. In
addition to causing anemia, hemangiosarcoma can also cause a low
Platelets are needed in order for clotting to occur, so when the
count is low, there is an increased risk of bleeding.
Dogs with hemangiosarcoma can also have changes in other clotting
tests. The risk of bleeding may be increased when the clotting tests
are abnormal. This information is important for your veterinarian when
surgery is being considered.
Serum chemistry panel and urinalysis tests are run to identify
any underlying diseases such as kidney or liver disease.
Abdominal radiographs (X-rays) or ultrasound are sometimes
performed to identify if there is a mass present in the
abdomen.However, when there has been bleeding into the abdomen, X-rays
become difficult to evaluate. An ultrasound of the abdomen will allow
the liver and spleen to be evaluated in greater detail than X-rays. It
should be kept in mind that older dogs frequently have nodules in the
liver and spleen that are considered aging changes and this does not
mean that cancer is present.
An abdominal tap may be performed to confirm the presence of
free blood in the abdomen. Unlike blood in blood vessels, free blood in
abdomen does not clot. The blood can also be examined under a
for the presence of cancerous cells in the fluid. However, the absence
cancerous cells does not preclude the diagnosis of hemangiosarcoma.
Pericardial tap When there is free fluid around the heart, it
is often possible to remove a portion of this fluid using a needle and
syringe. This is called a pericardial tap. A pericardial tap is often
done with the assistance of an ultrasound so that there is less risk of
puncturing the heart.
Chest X-rays may be routinely taken in any dog suspected of
having cancer. The lungs are one of the most common sites of spread of
hemangiosarcoma. In addition, the size and shape of the heart can be
evaluated to see if
there are signs of either a mass in the heart or pericardial effusion.
An ultrasound of the heart may be performed to allow
identification of either a mass in the heart or fluid around the heart.
However, ultrasound may not be able to identify small masses in the
heart. An ultrasound of
the heart also allows evaluation of heart function, which is important
chemotherapy is planned.
An EKG allows for identification of any irregular heart rhythms
(arrhythmias) that may be secondary to hemangiosarcoma in the heart.
Arrhythmias are common in dogs that have tumors in the spleen or that
have just undergone removal of the spleen.
A biopsy may be necessary to make a definite diagnosis. If only a small
sample is taken or if the tumor is very abnormal, it may not be
possible to confirm that it is hemangiosarcoma. In the case where only
a small sample is submitted, additional biopsies may be needed. In the
case where the tumor is abnormal, special stains can be used to confirm
that it is hemangiosarcoma. The type of biopsy depends upon the
location of the tumor.
When the tumor occurs in the spleen, the entire spleen is usually
removed and submitted for biopsy. In addition, all other organs in the
are usually examined and biopsies taken of any tissue that looks
The liver is usually examined carefully since it is common for
hemangiosarcoma to spread to this site.
It is more difficult to obtain a diagnosis when the tumor occurs in the
heart than in the spleen. Generally the only way to get a biopsy in
this location is to enter the chest cavity surgically.
When the tumor occurs in the skin or in the tissues directly below the
skin, several types of biopsies can be obtained. A small piece of the
tumor can be obtained to confirm the diagnosis prior to any further
treatment. It is also possible in some cases to remove the entire tumor
When the tumor occurs in a bone, generally only a small sample of the
bone is taken to obtain a diagnosis.
Stabilization is usually needed when the tumor causes internal bleeding
or a build-up of fluid around the heart. The symptoms can be life
threatening; pets that have bleeding into the abdomen can go into shock
emergency care. Dogs that have a build-up of fluid around the heart can
show signs of heart failure and collapse.
Intravenous fluids may be administered. This usually involves placement
of a catheter and rapid administration of intravenous fluids.
Transfusions may be performed. If a dog is very anemic, a blood
transfusion may be required to stabilize the patient. A transfusion can
either whole blood or just red blood cells.
When the tumor causes pericardial effusion, it may be necessary to
remove the fluid around the heart to allow the heart to beat more
A pericardial tap is the procedure by which fluid is removed from
the heart.Generally, once the fluid is removed, the patient improves,
although he must be monitored for recurrence of the fluid. Periodic
removal of the fluid may be needed.
Surgery may be performed, and the type will depend upon the location
of the tumor. In some cases emergency surgery is required to stabilize
patient when the tumor is bleeding.
When the tumor occurs in the spleen, a splenectomy is performed. This
involves removing the entire spleen. The spleen can be removed without
having an adverse effect on health. At the time of surgery other
organs, particularly the liver, should be examined and a biopsy taken
of any abnormal tissue. By removing the spleen, the source of bleeding
is removed and the patient stabilized. Potential complications
following removal of the spleen include: infection, continued bleeding,
failure of the incision to heal and an abnormal heart rhythm.
When the tumor occurs in the heart, it is almost always found on only
one chamber of the heart, the right atrium. It may be possible to
remove the tumor surgically. The outer covering of the heart, the
pericardium, can also be removed to prevent future build-up of fluid
around the heart.
Potential complications of this surgery include bleeding, infection,
failure of the surgery site to heal, introduction of air into the chest
cavity causing difficulty breathing and an abnormal heart rhythm.
When the tumor occurs in the skin or in the tissues immediately below
the skin, surgery is required. It is important that normal tissue
surrounding the tumor be removed, along with the mass, because cells
from this tumor frequently infiltrate the surrounding tissues. Failure
to remove these cells will result in the tumor regrowing.
When the tumor occurs in the bone, it may be possible to remove the
tumor by removing the bone itself. This is possible only in certain
such as a leg or a rib. In some cases, it is only possible to get a
of the tumor.
Due to the early spread of this tumor, chemotherapy is frequently
recommended in addition to other treatments. The only exception to this
is when the
tumor is localized to the very uppermost layer of the skin. Then
removal of the tumor may be all that is required.
The most commonly used chemotherapy drug is doxorubicin. This drug is
administered intravenously once every three weeks. Dogs handle this
drug well and the risk of serious side effects is low, between 5 to 10
percent. Potential side effects include gastrointestinal problems,
including nausea, vomiting, diarrhea or loss of appetite, and a drop in
the white blood cell count, leaving a pet susceptible to infection. If
multiple treatments of this
drug are given, cumulative side effects include heart problems. In
prevent the cumulative side effects, the number of treatments is
six or less.
In dogs, a heart evaluation (ultrasound and EKG) is recommended prior
to giving the drug and before the fifth and sixth treatment.
Other drugs that are used in the treatment of hemangiosarcoma are
cyclophosphamide and ifosphamide. Cyclophosphamide is frequently given
either with doxorubicin or immediately after. When ifosphamide is used,
it is alternated with doxorubicin. Both of these drugs can cause
gastrointestinal side effects and a drop
in the white blood cell count. In addition, they can cause an
in the lining of the bladder causing blood in the urine and straining
urinate. If the drug irritates the bladder the signs will usually
in a few days to a few weeks.
Radiation therapy may be performed and involve the following:
Full course radiation therapy. This type of radiation therapy
is used when a tumor involving the skin or underlying tissues cannot be
completely removed. In order for full course radiation to be effective,
all visible evidence of the tumor must be removed first with surgery.
this situation, 16 to 19 treatments of radiation may be given over a
to six week period of time. The side effects include hair loss and
and ulceration of the skin. These side effects are present only for a
to four week period of time and can be managed with medications.
Palliative radiation therapy. This type of radiation therapy
can be used to control symptoms such as pain when the tumor cannot be
entirely removed with surgery. It involves giving a few large doses of
radiation therapy to the tumor over a two to three week period of
time.Side effects are very few and is most commonly used when the tumor
occurs in the bone.
Prognosis may vary. The recommended course of treatment and outcome
depends upon the location of the tumor.
Hemangiosarcoma of the spleen is aggressive. The recommended treatment
is surgery (to remove the spleen) and chemotherapy. If the only
treatment is removal of the spleen, the survival time is short (between
one to two months). If chemotherapy is given after surgery the survival
time is improved and is about six months.
When the hemangiosarcoma is in the liver, the treatment recommendations
and outcome are similar to that of the spleen.
When the hemangiosarcoma is in the heart, the recommended treatment is
to remove the tumor if possible and follow-up with chemotherapy. With
surgery alone, the survival time is less than four months. With
chemotherapy, the survival time is extended to six months or more.
If the tumor occurs in only the upper layer of the skin the outcome is
excellent. In that situation, the only required treatment is complete
removal of the tumor with surgery. When the tumor involves the deeper
the skin or the underlying tissues, there is a greater potential for
of the tumor to other organs. The recommended treatment is to remove
entire tumor with surgery and to follow-up with chemotherapy. If the
tumor cannot be removed with surgery but is reduced to the level where
tumor cannot be felt, radiation therapy is recommended in addition to
surgery and chemotherapy. In this situation, survival times are between
to 12 months with treatment.
Hemangiosarcoma of the bone is an aggressive tumor. The most common
bones affected are the ribs, forelimbs and vertebrae. The recommended
treatment is removal of the affected bone if possible followed by
chemotherapy. In situations where the affected bone cannot be removed,
palliative radiation therapy can be given to control pain. The survival
time for hemangiosarcoma of the bone with treatment is around six
Seek veterinary attention promptly if your pet develops pale gums or
signs of weakness or collapse. These may be symptoms of hemangiosarcoma
or other potentially serious conditions.
Have any new lumps on your pet evaluated by your veterinarian.
Hemangiosarcoma of the skin or underlying tissues can be difficult to
less serious skin tumors. Early detection may increase the possibility
of successful treatment.
Restrict your pet's activity after surgery until suture removal.
Monitor the incision for any signs of redness, swelling or discharge.
pet from chewing or scratching at the incision.
If your pet receives chemotherapy monitor him for changes in appetite
and activity. The most common side effects of chemotherapy are appetite
loss, vomiting and/or diarrhea. Mild signs can frequently be managed at
home with diet changes.Anti-nausea or anti-diarrhea medications can
also be prescribed. Your veterinarian should be notified if the signs
are severe or last longer than a few days. Rarely, your veterinarian
may recommend hospitalization
to prevent dehydration.
Signs of infection include loss of appetite, fever and extreme
tiredness. Infections in patients with low white blood counts are
serious and require intravenous antibiotics.
Minimize your pet's exposure to the sun, especially for dogs that are
poorly pigmented and have a sparse haircoat. Hemangiosarcoma of the
skin can be caused by excessive exposure to the sun.
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The above information is simply
informational. It's intent is not to replace the advice of a
veterinarian nor to assist you in making a diagnosis of your pet.
Please consult with your own veterinarian for confirmation of any
diagnosis. Your pets life may depend on it.