My dog was diagnosed with osteosarcoma. What do I do? How do I know when it’s time to say goodbye?

What is osteosarcoma?

Osteosarcoma (OSA) is an aggressive and malignant bone cancer that commonly affects dogs, particularly large breeds like Golden Retrievers, Rottweilers, and Great Danes. It typically begins in the bones of the legs (although occasionally elsewhere) and can rapidly spread to other areas, most commonly the lungs. Osteosarcoma is commonly very painful, because the cancer eats away at the bone and causes severe pain, leading to limping, swelling, crying out, and often the bone can be so weakened by the cancer that it suddenly breaks. There are several treatment options for osteosarcoma, including surgery, chemotherapy, radiation, and pain management, but regardless of treatment, most dogs with osteosarcoma usually survive only a few months to a year after diagnosis.

Our goal for this blog is to help you ensure your dog’s time left is as wonderful and happy as possible.

What are my treatment options? How do I decide what to do?

When your dog is diagnosed with osteosarcoma, several treatment options are available, each with its own pros and cons. The right choice depends on factors like the stage of the cancer, the dog’s age, overall health, and your goals for treatment.

1. Amputation and chemotherapy

The “gold standard” for treatment of osteosarcoma in dogs is amputation followed up by chemotherapy. By “gold standard, we mean the treatment that is most likely to result in the longest extension of lifespan, but that does not mean it’s the best treatment for every dog.

Pros: 

• Most likely to result in longer term survival. On average dogs survive 1 year after diagnosis.

• Most dogs adjust to walking on 3 legs very well within a matter of weeks

• Chemotherapy is generally well tolerated by most dogs with minimal side effects

Cons: 

• Major surgery, requiring a period of several weeks of recovery and rehabilitation

• Frequent vet visits and follow ups for chemotherapy, which may not be ideal if a dog is fearful at the vet or the owner has a busy schedule

• Cost: total costs of surgery and chemotherapy may exceed $10,000

• While most dogs tolerate chemotherapy well, some can experience side effects

Dogs who might be good candidates for amputation and chemotherapy: 

• 7 YO golden retriever with no history of arthritis or leg issues and loves going to the vet

Dogs who might not be great candidates for this treatment: 

• 14 year old Rottweiler with severe arthritis in both back leg

• A dog whose cancer has already spread to the lungs, so the cancer is likely to progress rapidly regardless of treatment

2. Amputation alone: 

Sometimes owners elect to pursue amputation without chemotherapy. This reduces the cost and intensity of the treatments. The average survival time of dogs with osteosarcoma following amputation alone is 4-6 months. Why would someone choose this treatment?

Pros:

• Relieves the severe pain associated with cancer in the limb

• Less time and cost required than amputation plus chemotherapy

Cons: 

• Average survival time not as long as with chemotherapy, but relieves pain and often provides good quality of life for a matter of months

• There are a few weeks of recovery from surgery, which could be a significant portion of the time the dog has left

Dogs who might be good candidates for this treatment:

• Pet who is too fearful for frequent oncology visits but can handle a single surgery

• Dogs who may not be candidates for chemotherapy due to comorbidities

Dogs who might be poor candidates for this treatment:

• Dogs with other orthopedic injuries or elderly age making amputation not a great idea

3. Palliative Care (Pain Management and Comfort Measures)

Palliative care refers to treatments that do not aim to cure the cancer or extend lifespan, but only to keep the patient comfortable. Palliative care measures for osteosarcoma may include the following:

• Pain relievers such as NSAIDs or opioids

• Measures to reduce weight-bearing to reduce the likelihood of pathological fracture (assistance with a harness, discouraging weight-bearing on the limb

• Bisphosphonates:

• Radiation therapy:

One of the biggest concerns of palliative care is without amputation, there is a risk of catastrophic fracture at any time. This is so devastating of an outcome (with a dog’s life ending in extreme pain) that many owners elect euthanasia relatively soon after the diagnosis to prevent the possibility of a catastrophic fracture.

Pros:

• Focuses on quality of life: Palliative care aims to alleviate pain and ensure comfort

• No risk associated with amputation or chemotherapy

Cons:

• Limited lifespan extension: Palliative care doesn’t address the cancer itself but focuses on comfort. It may only offer days to weeks of good quality life

• Other than radiation, no amount of medication will completely eliminate the pain in the bone

• As long as there is cancer in the bones of one of the legs, there is a risk of catastrophic fracture, and most pet parents would like to avoid this.

Good candidates for palliative care: 

• Pets whose cancer has spread to the lungs

• Pets who due to age or comorbidities are not good candidates for amputation

Conclusion

Osteosarcoma is such a difficult disease to make decisions about. Every case is different and what’s right for your family and your pet is different for every pet. If you would like more guidance, 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.