https://www.vetsurgeon.org/f/clinical-questions/24932/splenic-histiocytosis-sarcoma I removed a large abnormal spleen from a springer a few weeks ago. The initial histopath said round cell tumour, probably MCT or lymphoma. Several immunohistochemistry stains have been done, and repeated and they have now re categorised the mass as aen-USTelligent Community 10https://www.vetsurgeon.org/thread/166548?ContentTypeID=1Tue, 11 Oct 2016 15:24:02 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:e1b0c800-b189-480d-a1b1-ac099feae635Gerry Polton<p>As a general principle, chemotherapy is more effective against cancer that is present but microscopic than against cancer that is macroscopic. However, it is not effective against cancer that is not there... This is all part of the discussion that would happen at a specialist appointment. If an owner is disposed towards more active management, serial reassessments are a better way to define suitability for chemotherapy than simply giving treatment because of the diagnosis received. If, by contrast, we have one chance to get the best outcome we can (owner not disposed to pursue more active management), I would hedge my bets and just give the four doses of lomustine.</p> <p>Gerry</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/166547?ContentTypeID=1Tue, 11 Oct 2016 15:20:42 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:340d9e83-7dee-48ce-b22c-5ad73f4bfd7ejanine redman<p>Thanks Gerry&nbsp;</p> <p>chest radiographs clear and liver normal on ultrasound and visual evaluation as well so will discuss it. If no visible mets is it more effective or less effective?</p> <p>janine</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/166546?ContentTypeID=1Tue, 11 Oct 2016 15:13:19 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:085471a7-2f6f-4e23-aec4-12182e3ad3fbGerry Polton<p>Hi Janine</p> <p>Definitely worth considering chemotherapy. These cases will frequently develop further intra-abdominal metastasis (can be elsewhere too) but they are generally responsive, to a greater or lesser extent, to lomustine chemotherapy. There are risks with lomustine, so I tend to manage these cases by balancing the risks of not performing chemo against the risks of performing it. This is done by a combination of serial imaging evaluations to assess for metastasis and well-judged short courses of lomustine at times of greatest potential benefit. If the owners are minded to pursue referral, I would heartily endorse it. There are judgements to be made in these cases.</p> <p>To answer the wider question of how to deal with these cases in the context of limited resources, inability to travel to specialist centre, etc, check for presence or absence of metastasis (chest x-ray and abdominal ultrasound usually adequate) and then give four doses of oral lomustine at a dose of 70mg/sqm once every four weeks. Do not give more than four doses. Check haematology prior to each treatment. There is a risk of irreversible (lethal) hepatotoxicity but this is really quite unlikely with a cumulative dose of 280mg/sqm.</p> <p>Regards to all</p> <p>Gerry</p><div style="clear:both;"></div>