Mar 12 2012

Lumps and Bumps

“It is big, black, lumpy, hard and growing on her underbelly,” states the client on the phone.

I am impressed by the description. Encouraging her to continue, I ask, “And when did you first see it?”

Dr. Saria

Dr. Saria

“It was a small bump, kinda like a black pimple, about two weeks ago. Then it got bigger very quickly. All the hair fell out and she started licking it. Then it got red around the edges and became lumpy. It is about the size of a walnut now.”

“I definately think you should make an appointment,” I tell her. “Lumps that are colored, grow quickly, are located near a mammary gland on the underbelly of a dog or cat can be quite serious. The sooner we investigate it, the better.”

This is not a rare conversation. In fact, I would say that lumps and bumps are extremely common, and they often cause stress and concern with their human companions. Here are some basic guidelines regarding them and the steps to determining the best route for diagnosis and treatment.

First, understand the word ‘mass’ is the word veterinarians use to describe a swelling. Swellings can be tumors, infections or abscesses, granulomas, reaction sites, inflammation areas, cancers, hematomas or blood blisters, parasites and many other possibilities. Therefore, most lumps or bumps are termed masses, and I am going to focus on those types of abnormalities today.

Masses should be described via several distinctive catagories. The more you know how to describe them, the better your veterinarian can assist you.

1. What is the age, breed and gender of your pet? If you have a 5yr old unspayed female labrador I will think quite differently about the lump described than I would a 13 yr old neutered male Rat Terrier.

2. What is the history of your pet? Has he or she had any masses removed before and what were they? Obviously, if your pet had malignant cancer last year, I will be much more nervous about any masses. If you pet has had three surgeries and all of them turned about to be sebaceous adenomas- a benign mass- then I would want to look at it but I would be less worried. You should also notify the veterinarian of any recent vaccines, animal encounters or recent traumas so he or she can consider whether they may be related.

3. Location- where on the body is the mass? Masses in certain areas are red flags to your veterinarian, like those on the mammary chain or near lymphnodes.

4. How long has it been there are how quickly is it growing? A mass that appeared 1 week ago and doubled in size is much more worrisome than one that has been present for 3 years and has never changed.

5. What does it look and feel like? Use your senses to describe anything you can about it. What is the color and texture? Is it round or irregular? Is is spongy or hard? Is it haired or hairless? Is it on the skin or ‘in’ the skin? What size is it (fruit and nuts seem to make good comparisons for clients or you can measure it with a ruler- use length, width and depth)? Is it hot? Sticky? Bloody?, Smelly? It is best to write these descriptions down so you can objectively tell your vet if any of the characteristics are changing and how rapid the changes are.

6. Does it bother your pet? This is very important, as it may clue me into whether it is an inflammatory, trauma or abscess site. It is also important to remember that even a benign mass may need to be addressed if it is causing pain or problems for your companion.

Once we have that information, your veterinarian will make a recommendation to be seen or to monitor it and report on any changes. If the vet wants to investigate it they will most likely do one or all of the following tests:

A. See, Palpate and Feel it. Sometimes this alone will tell us what needs to be done.
B. Clip and clean around it to see what the surrounding tissue looks like.
C. Do skin impression smears to look under the microscope and evaluate the cells. This can often be done in house but may be sent out for a specialist review.
D. Aspirate or drain fluid out of it. Unless the fluid is clearly the pus of an abscess, I will often recommend sending it to the laboratory for analysis. The cells in the fluids can be representative of inflammation, trauma or cancer. However, my personal opinion on aspiration cytology is that 75% of the time I recommend that my clients skip this step due to ambiguous answers we often get. If the cytology is conclusive for cancer, we know the mass is cancerous. However, if the results are non-conclusive, we have NOT ruled out cancer. Many times, the recommendation from the specialist at the lab is to proceed to removal anyway, making this step a waste of time and money. However, there are some cases where it is beneficial so I still mention it in a fair number of cases.
E. Recommend removal with histopathology- a laboratory test that is the most conclusive for removing the mass, potentially fixing the problem and determining what is causing it.
F. Recommend holistic approaches to getting the lump back in balance with the body. Herbs, salves, laser treatments, acupuncture and chiropratic options may be offered if appropriate.

One thing I would like to stress– no one can tell what a mass is by what it looks like. We can get a good idea of how serious it may be, what the potential it has to be cancer, what potential it has to grow, ulcerate, bleed or cause pain, but we cannot tell you what it is definatively without a microsopic examination. We can tell you the cost of removal, the risks of surgery, the risks of leaving it alone and the probablity of it resolving with medical or surgical treatment. But no one can definately tell you what it is without tests, so if you want to find out what a lump or bump is, describe it well, show it to your vet and test it.

Remember, any mass is abnormal. Don’t head to the vet expecting to be told everything is fine. In fact, if your vet doesn’t offer to investigate it further, I would become concerned. Do your own homework, and help your veterinarian by giving him or her the best information possible. Then, as a team, you and your vet can help your pet.

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