Oral and Nasal Tumors in Dogs: Treatment Options, Palliative Care, and Knowing When It’s Time for Euthanasia

Oral and nasal tumors are serious, often aggressive cancers in dogs. They can affect the gums, tongue, jawbone, nasal passages, and sinuses. Symptoms often include bad breath, drooling, bleeding from the mouth or nose, facial swelling, sneezing, nasal discharge, and difficulty eating or breathing. Tumors can often invade the surrounding tissue and treatment options and prognosis depends on the tumor type, size, and location. 

As a hospice and palliative care veterinarian, my goal is always this: regardless of the path you choose, to make sure your cat’s remaining time left on this Earth is full of love and happiness. If your options are confusing, or you aren’t sure how to know when it’s time for euthanasia, don’t hesitate to schedule a comprehensive teleconsult with one of our doctors.

Treatment Options

Treatment for oral and nasal tumors in dogs generally falls into three main categories: surgery, radiation therapy, and medical management/palliative care. The best approach depends on the tumor’s location and extent, your dog’s overall health, and your family’s goals for treatment. Each option carries its own benefits and challenges, and the right choice will be different for every dog and family.

1. Surgery for Oral or Nasal Tumors

Surgery means removing all or as much of the tumor as possible. It may involve removal part of the jaw, teeth, or nasal structures. 

Pros:

• Can completely remove tumors in some cases, offering the best chance for long-term control.

• May significantly improve your dog’s comfort and breathing if the tumor is causing obstruction.

Cons:

• Surgery can be invasive, with significant recovery time.

• In some dogs, removal of a large portion of the jaw can cause long-term difficulties eating. 

• Depending on the tumor’s location, complete removal may not be possible.

• Surgery costs can be significant, and anesthesia carries risks, especially for older or fragile dogs.

Good Candidates:

• Dogs with isolated tumors that can be fully or mostly removed.

• Dogs who are otherwise healthy enough to tolerate anesthesia and healing.

Poor Candidates:

• Dogs with widespread tumors that cannot be surgically cleared.

• Dogs with advanced disease or major concurrent illnesses.

2. Radiation Therapy for Oral or Nasal Tumors

Radiation therapy is often recommended after surgery if the tumor could not be fully removed, or as a primary treatment if the tumor is not operable. Radiation can help shrink tumors and provide a good quality of life for a period of time but rarely is curative.

Pros:

• Effective for tumors that are difficult to surgically remove, especially nasal tumors.

• Can slow tumor growth, reduce bleeding, and ease breathing difficulties.

• May provide several months to year of good quality life in many cases.

Cons:

• Requires multiple treatments under anesthesia.

• Cost can be high, sometimes upwards of $10,000. 

• Side effects such as skin irritation, oral ulceration, or fatigue may occur during or after treatment.

Good Candidates:

• Dogs with tumors that are inoperable but localized.

• Dogs who can tolerate repeated anesthesia sessions.

• Dogs who do not mind frequent veterinary visits

Poor Candidates:

• Dogs with advanced disease that has spread

• Dogs who are not healthy enough for multiple anesthetic sessions

• Dogs who do not tolerate frequent veterinary visits

3. Medical Management/Palliative Care

When surgery and radiation are not feasible, or when a family prioritizes comfort over aggressive treatment, medical management and palliative care are a compassionate choice. The goal is to control symptoms and maintain the best quality of life.

Pros:

• Focuses on comfort, minimizing suffering and stress.

• Less invasive and can often be managed at home.

• May include medications like anti-inflammatories, pain relievers, appetite stimulants, or antibiotics if infections occur.

Cons:

• Does not cure the cancer or stop its progression.

• Symptoms such as bleeding, facial swelling, and difficulty eating may worsen over time despite medications.

Good Candidates:

• Dogs whose tumors are too advanced for surgical or radiation intervention.

• Dogs who have concurrent health problems making aggressive treatments risky.

• Families who wish to prioritize a peaceful, loving end-of-life experience.

Poor Candidates:

• Dogs whose symptoms (such as respiratory distress or uncontrolled bleeding) become unmanageable despite medical support, in which case euthanasia should be elected. 

How to Know When It’s Time for Euthanasia

One of the hardest decisions you may have to face if your dog has an oral or nasal tumor is deciding when it’s time for euthanasia. It’s essential to think through these challenging decisions before you are in a crisis.

I highly recommend making a comprehensive end of life care plan for your dog as soon as they have been diagnosed with a malignant oral or nasal tumor. Similar to an advanced directive in a human, you want to address important care questions like:

• Will you pursue chemotherapy or radiation in your dog with an oral or nasal tumor? 

• If your dog experienced complications from treatment, would you pursue hospitalization? What are the objective set of criteria you will choose for when to elect euthanasia so your dog does not suffer needlessly

• Do you want to ensure your dog has a home euthanasia instead of passing away at a hospital?

• Is everyone in your family comfortable with this plan?

It is much easier to make these decisions when you are in a relatively calm frame of mind. When we are facing an immediate crisis of possibly losing our pets, it’s easy to make the wrong decisions in a panic. I’ve made this mistake myself.

I also recommend keeping a daily journal of your dog’s quality of life in a journal. It doesn’t have to be complicated: a smiley face for a good day and a frown for a bad day is sufficient. The journal can also be a place where you write new memories you made with your dog each day. It is important when facing the end of life to live in the moment and cherish every single day.

Our comprehensive quality of life scale (https://pawsatpeace.com/quality-of-life-scale/) can help you assess your dog’s quality of life. This quiz can be taken once to give you a snapshot of your dog’s quality of life, or taken multiple times to assess trends over time.

Finally, the most compassionate choice is to give your dog a peaceful goodbye before too much suffering has set in. If you do this, you can give your dog the gift of a peaceful last day, and they don’t need to know the severe suffering that often accompanies end-stage cancer.

When you are starting to see more bad days than good days, it’s a good time to give them a beautiful send-off. When clients wait too long, they often end up having to rush their beloved dog to the emergency room for euthanasia.

Signs That Euthanasia May Be the Kindest Option for dogs with oral/nasal tumors:

• Difficulty eating/inability to eat/pain while eating: Dogs with oral tumors especially can start to have trouble picking up and chewing their food, or chewing and eating can become painful. If this is starting to happen and medications are no longer helping, it may be time to consider euthanasia. 

• Difficulty breathing: Sometimes oral or nasal tumors can begin to obstruct the nasal passages or the back of the throat. If you are noticing that both nasal passages are blocked so that your dog has to breathe through their mouth, or if the tumor is beginning to obstruct the airway, euthanasia should be pursued to prevent further difficulties breathing. 

• Seizures: Occasionally, nasal tumors can start to invade the brain, causing seizures or  sudden onset blindness. If your dog begins to have seizures or major neurologic problems, I recommend euthanasia before things get worse. 

• Eye problems: oral and nasal tumors can sometimes grow behind the eye, causing the eye to bulge. If it is simply a cosmetic issue, you are probably okay to continue, but if the eye starts to become very painful, or if your dog is developing painful, nonhealing ulcers on the front of the eye or glaucoma, it may be time to consider euthanasia. 

• Uncontrollable bleeding from the mouth or nose: Sometimes oral or nasal tumors can cause bleeding that is difficult to control. A small nosebleed can often be managed by sitting with your dog in a quiet dark place and allowing them to relax, but if nosebleeds are frequent and/or severe it may be time to consider euthanasia. Sometimes oral tumors can bleed into the mouth and they will swallow the blood. If you are noticing your dogs gums are getting very pale or their stool is black and tarry, this could be a sign they have a bleeding tumor in their mouth. 

• Persistent loss of appetite and weight loss: If your dog is not eating much, especially if they are starting to lose a significant amount of wait, it may be time to consider euthanasia as this is a sign they are suffering. 

• Lack of interest in life: If your dog is isolating or no longer seems interested in their normal activities or socialization, this may indicate they are suffering and euthanasia may be the kindest option. 

• Pain or distress: If your dog appears to be in pain or distress – crying out, panting, difficulty sleeping or getting comfortable, or isolating, and the pain is not responding to treatment, it may be time to consider euthanasia. 

One thing I do want to note: there are some cases where these tumors can become very unsightly but the dog still has an excellent quality of life! Try to make decisions based on the above criteria, rather than simply how the tumor looks.

Conclusion

I hope this guide has helped you make the best decisions for your dog diagnosed with an oral or nasal tumor. Whether pursuing surgery, radiation, or palliative care, the most important goal is ensuring your dog remains comfortable and happy. 

If you are not sure what to do and would like more guidance and support, we offer comprehensive teleconsults with compassionate veterinarians. We will review all your dog’s medical records and history, discuss all your options, and help you formulate the most compassionate and loving plan for your family. ** include a “Schedule a teleconsult” button here, centered, that links to: https://pawsatpeace.com/schedule-qol-teleconsult/ ***

And when the time for euthanasia does come, Paws at Peace offers in-home euthanasia to help your dog pass peacefully at home, surrounded by love and family. Home euthanasia can provide your dog with a gentle and dignified transition without the stress of a veterinary visit.