Our Dog’s Experience with Soft Tissue Sarcoma, TPLO, and Meniscectomy
Our 8 year old pitbull Harper was diagnosed with a Soft Tissue Sarcoma in February 2022. Shortly before, she tore her right cranial cruciate ligament. About 8 months after, her right meniscus tore and she underwent a Meniscectomy. Another 5 months later, she ruptured her left CCL and completed her second TPLO surgery.
At the time, I wasn’t able to find many helpful resources online. Here is Harper’s story from start to finish. Hopefully this can help someone and their dog!
January — Month 0
Harper tore her CCL/ACL playing in the snow. After a few weeks of thinking her limping was due to arthritis (the first vet failed to do the “drawer slide test,” the simplest way to identify a CCL tear), we got a proper diagnosis and scheduled her for a Tibial Plateau Leveling Osteotomy (TPLO) surgery at a vet in Las Vegas.
We woke up a week before the surgery to find a rather large (1cm) bump on her front leg, just above her hock. It seemed to appear overnight. It was very hard and did not feel like her fatty tumors (lipomas).
It was Sunday, so all the vets were closed. We were a panic and spent the entire day online making ourselves sick. When you Google “dog lump front leg,” the first thing that comes up is bone cancer (Osteosarcoma), which can look similar to a Soft Tissue Sarcoma but has a very poor prognosis.
On Monday, we got her to the same vet who accurately diagnosed her CCL tear. He took a fine needle aspirate and looked at the sample under the microscope. He said yes, it probably is cancer, but almost certainly not Osteosarcoma. Even though the lump was hard, it wasn’t hard as a rock or firmly attached to the bone.
As we waited for the initial results, we looked back through photos over the last few months. Even though it seemed to appear overnight, it actually had been presenting for a few weeks. We think because it was near her hock and because we were so focused on her hind leg injury, we just didn’t notice it.
The initial pathology report of the fine needle aspirate said the following:
HISTORY: Right front leg, lateral aspect just proximal to carpus. About 1 x 1 x 1 cm. Inflammatory vs neoplasia.
DESCRIPTION: The slides range from poorly to moderately cellular with marked blood. Nucleated cells consist of predominantly individualized to often aggregated spindle cells that exhibit mild to occasionally moderate anisocytosis and anisokaryosis with round to oval, paracentral to eccentric nuclei containing stippled to coarse chromatin and 0–2 indistinct nucleoli. Occasional binucleation and multinucleation is noted. These cells have a small to moderate amount of lightly basophilic, wispy cytoplasm with one to several tails. A small amount of light pink material is associated with aggregates of cells.
INTERPRETATION: Mesenchymal cell proliferation; most compatible with a spindle cell neoplasm.
COMMENT: The findings are suggestive of a spindle cell tumor, such as a soft tissue sarcoma (i.e. peripheral nerve sheath tumor, perivascular wall tumor). However, due to the mild atypia and pleomorphism overall, I cannot completely rule out that the findings are not reflective of reactive fibroplasia or a benign tumor, as these can look cytologically similar. Biopsy/excision with histopathology is recommended for further characterization.
This meant two things: 1. It was probably cancer and 2. We had to have the tumor removed to understand how bad it was.
February — Month 1
We travel full time out of our van and were in St. George, Utah at the time of discovery. We were able to find a surgeon in Las Vegas could perform both surgeries. So, Harper had her TPLO surgery done and the tumor excised at the same time on February 4.
Many STC dogs have their affected leg amputated. However, because Harper had an existing hind leg injury, and because the tumor was as far away from her chest as possible (where these tumors are most likely to spread), we were not able/required to amputate.
In a dark moment, I asked our vet if it was worth doing the TPLO surgery considering Harper had cancer that could spread. TPLO recovery is very difficult and I didn’t want to put her through any additional hurdles if she was only going to be with us for a few more months. He said without a doubt. This was a moment of relief amidst a scary few weeks.
The Surgeries
Harper’s surgeries went smoothly, though dropping her off was not fun. I had not met the vet in person, she had never been boarded, and we knew this was the last time we were gonna see her be herself for a while.
TPLO Tip: let your vet keep them overnight for as long as they want. This can range from 2–5 nights. If your vet is ready to send them home day of, or is only offering to keep them one night, I would ask some serious questions. We took her home after one night on our own accord (even though the vet recommended three to five). Don’t do this. When we picked her up, she was so out of it from the medication it didn’t matter where she was. She peed the bed in our van, could barely walk, and it was incredibly stressful dealing with her in such a fragile state. Leave it to to the professionals.
This is what her final pathology report read:
Grade: 2 of 3.
Mitotic count: 11 in 10 HPF (2.37 mm2).
Angiolymphatic invasion: No.
Histologic Margins: The mass is fully excised. The closest approach
of the neoplasm to the specimen’s lateral histologic margins and to
the deep histologic margin is 12 mm and less than 1 mm, respectively. Necrosis
is seen.Right forelimb. Two slides, one of which is prestained. Right front
leg. Right front leg, lateral aspect just proximal to carpus, about
1.0 cm x 1.0 cm x 1.0 cm. Inflammatory versus neoplasia.
Interpretation: Mesenchymal cell proliferation; most compatible with
a spindle cell neoplasia.
Received: 5.5 cm x 5.0 cm skin biopsy, with a 2.0 cm x 2.0 cm mass.
STC’s are known to have many tendril that spread beyond the edges of the mass. Because of this vine-like quality, it’s important to remove as much of the area as possible. The research says to avoid local tumor recurrence, conventional surgical recommendations requires wide excision at 2–3cm and “one fascial plane” deep.
However, for distal extremities, taking a very deep margin can compromise limb function. They say that marginal excision may be comparable to wide surgical excision, with low recurrence rates, especially for low-grade tumors (grades 1 and 2) and tumors below to the elbow.
Harper’s surgical margins were 2.5cm laterally and 1 fascial plain deep. The mass was about 1cm, so our vet removed about 6cm all around and the space between the next layer of fascia.
Because he was so aggressive in removing the tumor, and because dog legs don’t have much skin to begin with, Harper would have to heal via “second intention” for a while. This occurs when a wound cannot be stitched closed and the body relies on its own healing mechanisms. Second intention healing can take a long time, and the risk of infection is high.
This is what it looked like post-surgery on (graphic photos below).
The Recovery
February was rough and mostly just sad. She was in a full cast on her front leg for about 3 weeks and her back leg had a large incision. We got an AirBnB in Vegas and would walk around the backyard here and there, graduating from 2 to 5 and 10 minute walks around the neighborhood. She mostly just rested for 3 weeks with rounds of PT throughout the day. She was confined to a play pen when she wasn’t being supervised.
Her difficulties at this time were mostly due to the TPLO surgery, though the front leg being in a cast only made it more challenging for her. We had to return to the vet every 3 days for the first 3 weeks to get her bandaged changed and to do laser treatment on her back leg. At week three, her paw was finally allowed to be exposed and her walking improved a lot.
Month 2— March
Harper spent March healing and in good spirits. We moved on to Joshua Tree, California, an area that is more familiar to us all.
It was our job to change the bandages now. Every 2–3 of days, we would clean the wound, apply Silvadene, and wrap her up. It closed little by little each day. Luckily, we barely had to keep a cone on her, as she didn’t seem bothered. We were doing PT for her back leg and enjoying life in the desert.
Harper’s would was healing was steadily. We were very diligent with keeping it clean and wrapped. Here’s some pictures of her progression over March:
Months 3 & 4 — April & May
We got a few opinions from vet oncologists as to what to do next. Her “histological margins” were 12mm lateral and 1mm deep. This is what the person in the lab is observing (when the tumor is removed and sent off to the lab, it inevitably shrinks). These numbers meant there were 12mm of clean margins side to side, but only 1mm down. Apparently, even though the most you can remove is that fascial plane, you ideally would see more than 1mm of clean margins in that direction. Because of this, the oncologists said that if we could, we should pursue radiation.
The decision to do radiation was not an easy one, at first. There was conflicting information online as to whether one facial plane deep, regardless of the margins, is enough to avoid recurrence. Some studies say that “most of these tumors are locally expansile and grow between fascial planes.” In the world of STC’s, there are clean (wide), dirty, and clean-but-close margins (margins that are technically clean but only minimally). Another study says that no local recurrence is seen in 77% of STS excised with clean but close margins (CbCM) and in 58% even with infiltrated margins.
Radiation
In order to have the best outcome and avoid recurrance, we decided to go for it. Harper would do 19 fractions of radiation, M-F. She would have to be put fully under anesthesia every day she went in.
Additionally, Harper’s wound would not fully close by the time we went in for radiation. Because radiation is meant to kill all cells, both good and bad, this meant we would be dealing with her wound healing for even longer.
Annoyingly, on her first day of radiation, they left her alone, unwrapped, in a crate of some kind while they were prepping. She did some serious damage and bruising to her leg that caused us to have to postpone for a few days.
Once underway, I would say this was the most difficult period of the whole ordeal. She had to have an IV in her (unattached) even at home to avoid poking her every day. It was really sad to watch her go in only to be knocked out. Some days she had energy and others she just wanted to sleep. My partner and I would alternate days and wait in the parking lot while she was in the vet cancer center for an hour or so. It felt never ending.
We were not supposed to keep the site wrapped anymore, hence the sleeve. We only wrapped it in bandages when we were doing light hiking or walks where should could damage it. The sleeve would get really gross so we had to wash it frequently but it did a good job protecting her.
On May 10, after 19 days of radiation, Harper was free!
After getting the all clear, we were back on the road doing some of her very favorite things.
Months 4 & 5— May & June
Radiation Recovery
Harper’s surgery site was still pretty raw, and we were instructed to not mess with it, put anything on it, or wrap it, etc. It would have to scab over and heal on its own. Additionally, this is when her hair would start falling out locally. You can see how bald she gets in the photos below.
Towards mid June is when she didn’t have to wear the sleeve anymore for the most part. By the end of June, we were back in moderate adventure mode, still not pushing her on hikes (4 miles max) but getting out much more.
TPLO Status
Even though Harper was hiking pretty well, the muscle in her TPLO leg muscles remained very small and flabby. We did more PT, the water-treadmill, etc. but none of it seemed to help. She had basically learned how to become a tripod dog and wasn’t weighing the leg.
Back in April, we kind of had a suspicion she had hurt it again. She was temporarily limping and she never seemed to fully recover. But, there was nothing showing up in her follow up appointments so we assumed we just needed to do more PT.
Month 6— July
We were still only hiking relatively flat trails so Harper had to stay behind a few times while we were exploring Montana. Her fitness level was pretty poor still so we kept it relatively chill.
While swimming one day, I realized she was not using her TPLO to swim at all. It was glued to her side, like a duck. This is when we knew something was really wrong, either with her leg or her confidence using it (though she was still having a blast).
Month 7— August
Harper did her longest (albeit flat) hike in August. She didn’t seem like she was in pain or sore after, which was great. She was acting like a puppy again.
Then, sadly, while we were back in CA for a week and she was with one of her regular sitters sitter, her meniscus in the same TPLO leg tore (though we didn’t know this for sure at this point). Her and her sitter were playing with the hose, jumping around, etc. She said after that, she could hear a very large pop every step Harper took. We heard it too when we got home, though it wasn’t consistent and she really didn’t seem bothered in the leg, so we actually assumed it was her hips because that’s where the noise sounded like it was coming from, so we basically just decided to up her glucosamine and turmeric supplements, and started giving her Galiprant before activities.
Month 8— September
September we made our way to Park City, UT, Lander, WY, and finally Boulder, CO. Her leg was presenting as normal, except for the occasional clicking which we were still attributing to aging hips. She was feeling pretty spritely, so much so that she decided to chase after a few horses and cows nearby.
Month 9— October
All of a sudden, the click became very apparent, probably because she was walking around on hard, tile floor throughout the day in our new house. We realized it wasn’t going away so we brought her into an orthopedic surgeon in Colorado Springs to be evaluated. He assumed it was her meniscus, but couldn’t tell if it was a full or partial tear.
The surgery would basically be a clean up, vs. a repair, of the torn bit of her meniscus. It would be much less recovery time than the TPLO, about 6 weeks of true rest + stretching and PT. No stairs, no jumping, no hiking. We had to break out the play pen again to leave her in there while we were out.
We stretched her out everyday, carried her up the stairs, and started doing little walks with her after about a week.
Our hope is that this would finally fix her leg issues, and that she could start really building muscle and evening out. So, we decided to do weekly PT for 12 weeks once she was ready. This included the water treadmill, but also massage, elevated hip sways, reach backs, step overs, and others.
Month 10 — November
We were pretty paranoid about messing her up again, so we were lifting her up a lot, including on and off the bed for weeks after her 6 week clearance.
During this time, however, we took her into the Flint Animal Cancer Center up in Fort Collins to get her established as a patient and to do her required chest x-rays. They also took samples of her all of her lumps and bumps, all of which ended up being lipomas. They checked out her scar and said there were no signs of local recurrance from the cancer.
Months 11 & 12 — December and January
After 12 weeks of PT, her left glute was finally the same size as her healthy right leg. She could jump up onto the couch, and was standing squarely, placing equal weight on each leg (something she hadn’t done in a year). This was a huge accomplishment.
February — 1 year later
A year later, Harps is happy, healthy, and cancer free!
COSTS
We, unfortunately, do not have pet insurance. Here are rough estimates of what we spent.
TPLO + Tumor Removal = $5,000
Radiation = $9,400
Meniscus Surgery = $2,500
PT = $2,000
TPLO #2*: $5,000
Total Spent = $23,900
To anyone who is interested donating to her care, you can find our Go Fund Me page here.
*NOTE: In March of 2023, Harper tore her other CCL. This happens in about 40–60% of dogs who tear one. She underwent her second TPLO and recovered beautifully. For anyone doing a second TPLO, it is much easier the second time around!
