Hemangiosarcoma in Dogs: Overview, Treatment, and End-of-Life Decisions

Hemangiosarcoma (HSA) is a devastating diagnosis. HSA is a cancer that most often starts in the spleen, heart, or liver but usually has spread throughout the body by the time it’s detected. It is most common in older, larger breed dogs, particularly Golden Retrievers, German Shepherds, and Labrador Retrievers, but can occur in any breed at any age. 

One of the most challenging facts about hemangiosarcoma is that it is most often diagnosed in an emergency: a perfectly healthy dog is suddenly extremely lethargic and pale or collapses. This is due to a tumor that has been silent until now and suddenly bursts, causing internal bleeding and a significant loss of blood. As an ER doctor, I HATED making this diagnosis, because it’s such a terrible shock to give pet parents. 

Because of this, pet parents often find themselves having to make serious and potentially costly medical decisions about their dog in a matter of minutes without much time to consider the options. 

If you are in the emergency room and find this article, hopefully it will help you decide which option is best for you and your family. 

If you have a dog that is currently stable at home with a diagnosis of hemangiosarcoma, and you’re trying to decide how to know when it’s time to choose euthanasia, I hope this article helps you make decisions that allow your dog’s last days and weeks to be as peaceful and happy as possible. 

This article mostly focuses on hemangiosarcoma of the spleen, the most common location. We’ll have another article soon on hemangiosarcoma of the heart, which causes fluid buildup around the heart (pericardial effusion) and has different treatment options and criteria for euthanasia. 

Treatment Options

In the emergency room

When your dog is diagnosed with hemangiosarcoma you may be faced with a sudden very dire choice: immediately take your dog to surgery to stop the bleeding and remove the spleen, or perform euthanasia. There is often no third option, because if you do not go to surgery, your dog will die quickly from bleeding. Occasionally, the bleeding is mild enough that we can send a dog home to spend a night or two with the family so they can have euthanasia performed at home. I usually don’t recommend waiting until your dog starts bleeding again because they can bleed to death which is really scary for them. 

1. Surgery – an incision is made in your dog’s belly, the bleeding is stopped, and the spleen is removed and biopsied. The biopsy results come back in about a week. About 25% of the time, the biopsy is benign – meaning your dog is cured of cancer! Unfortunately, about 75% of the time, the biopsy confirms hemangiosarcoma, and without chemotherapy, survival time is usually less than 3 months.

• Pros: 

• Surgery stops the bleeding IMMEDIATELY

• There is a potential for a CURE if the biopsy is benign

•  Cons: 

• In most cases, the cancer has already spread to other organs such as the heart, lungs, spine, or brain and other tumors start bleeding elsewhere in the body, leading to an average survival time of less than 3 months. It can take about 2 weeks for your dog to fully recover from surgery, so surgery alone may not significantly extend your dog’s quality of life, unless the tumor is benign

• This is a really big surgery and may be a lot to put a very old or infirm dog through. 

• The cost of surgery can be $5,000-$10,000

Reasons a pet parent might consider surgery:

• You have a middle-aged or younger senior pet that is otherwise healthy: they may do well with surgery so you’re willing to risk it for the small possibility of a cure

• You are comfortable knowing that in all likelihood, your dog doesn’t have much time, but you’re committed to making the time left amazing and making the compassionate decision for euthanasia before the cancer gets bad again. 

2. Chemotherapy

Chemotherapy is never performed alone, but after splenectomy can help extend survival time. Dogs who receive chemotherapy in addition to surgery have a medial survival time of about 6 months.  

• Pros: 

• Can extend survival time when combined with surgery, on average about 6 months (some longer), often with good quality after initial recovery from surgery

• Most dogs tolerate chemotherapy well with minimal side effects

• Cons: 

• Not a long term cure

• Frequent vet visits for chemotherapy, chemotherapy can be costly 

• Chemotherapy may have side-effects including nausea and loss of appetite

3. Euthanasia

Often euthanasia in the emergency room is the most compassionate decision, even though it’s a terrible decision to have to make on an emergency basis. If your dog needs surgery but is not a good candidate for surgery, taking your dog home (unless your doctor thinks it’s safe to do) can lead your dog to suffer and bleed to death at home. 

Palliative care options

If your dog was diagnosed with hemangiosarcoma, you did not choose surgery, and your pet was stable enough to go home:

Sometimes, a dog may be diagnosed with hemangiosarcoma and the bleeding may have stopped on its own and the dog is stable. Sometimes we can send the dog home with medications to try to slow bleeding and maximize quality of life. 

The bleeding WILL return, usually in a matter of days or weeks at most. The question you need to answer for yourself (and this answer is different for everyone): 

• Do you want to wait for the bleeding to return, in which case you may have to rush your dog to the hospital for euthanasia, or you could risk they bleed and pass away while you are not with them? 

• Or would you rather give them a few amazing days at home and elect euthanasia while they are still happy to they never have to have the experience of bleeding internally again? This may sound crazy, but this option ensures your dog’s last moments are happy and free of fear or pain. 

If your dog had surgery, and symptoms of cancer are coming back: 

Sometimes the tumor was removed, and it appears somewhere else in the body. Some common locations it may return, the symptoms you might see (this is not an exhaustive list), and treatments you can do to help

• The liver:  if hemangiosarcoma spreads to the liver, it can start to bleed in which case you’ll see lethargy, pale gums, weakness, a rapid heart rate, and sometimes collapse again. 

• The lungs: The most common place for hemangiosarcoma to spread is the lungs. If it happens, you may see coughing (sometimes with blood) and changes to breathing.

• The heart – hemangiosarcoma can spread to the heart, leading to bleeding around the heart which can cause severe weakness/collapse, pale gums, and sudden death. 

• The brain – Hemangiosarcoma can sometimes spread to the brain leading to seizures disorientation, blindness, and trouble walking

• The spine – Hemangiosarcoma can spread to the spine leading to difficulty walking, a wobbly gait (ataxia) and paralysis in either the front legs, back legs, or both. 

Palliative care treatment options

Treatment options are focused on symptom management. Personally, I recommend making the decision to euthanize before the symptoms are very bad, because when we wait too long, hemangiosarcoma often ends in a crisis. 

1. Yunnan Baiyao – your vet may prescribe Yunnan Baiyao, a Chinese herb. There is some (but not much) evidence it may slow/reduce bleeding in dogs with hemangiosarcoma.

2. Pain Management – your vet may prescribe gabapentin or another pain medication.

How to know when it’s time for euthanasia

Deciding when to say goodbye is particularly hard for this disease. Most pet parents end up having to choose between saying goodbye on an emergency basis, or when their dog is doing relatively well at home to prevent another emergency/crisis. Below are some indicators that it may be time for euthanasia: 

1. Bleeding episodes 

If your dog has experienced a bleeding episode and the source of the bleeding has not been removed, I generally recommend making the decision for euthanasia before another bleeding episode occurs. 

2. Tumor on the heart/fluid around the heart (pericardial effusion)

If a tumor is diagnosed on the heart, fluid can build up causing the heart to be unable to beat. If your dog has a tumor on the heart, I would recommend euthanasia before the tumor bursts, which can lead to a crisis or even rapid death. If your dog is diagnosed with fluid around the heart, sometimes pet parents will elect to have the fluid drained one time in order to give their dog a night or two at home to say goodbye, but I do not recommend waiting until the fluid builds up a second time. 

3. Difficulty breathing/excessive coughing 

If the cancer has spread to the lungs, your dog may have difficulty breathing or develop a cough, sometimes with blood. If the cough is becoming very frequent or difficult to manage, or your dog is having any difficulties breathing, euthanasia is recommended. 

4. Seizures/paralysis

If the cancer has spread to the brain or spinal cord, you might see seizures or paralysis. If your dog starts to develop seizures I recommend considering euthanasia before they get severe. 

5. Pain, nausea, general distress 

If your dog seems to be in pain, is vomiting frequently, has a poor appetite, seems lethargic, and generally does not seem to feel well, it is probably time to consider euthanasia. 

Final Thoughts

Hemangiosarcoma is a devastating diagnosis, but understanding the disease and available options can help you make informed, compassionate decisions. If you would like more guidance and support, schedule a 45 minute teleconsult with one of our compassionate veterinarians who can review your pet’s medical records and history and help you formulate the most compassionate and loving plan for your family.