Sammy's sore mouth made eating difficult
When Sammy, an eight year old Black Cocker Spaniel, started to have some difficulty eating, his owner brought him to see me.
He started to describe to me how Sammy seemed to be eating to one side of his mouth, then he stopped, and said "Wait a minute".
He then showed me a video on his phone, and I was able to look at Sammy's problem for myself. Modern technology is wonderful in this way: vets are able to watch all sorts of odd behaviours in animals that in the past had to be described by owners. It's far easier to understand if you can see something for yourself.
Sammy clearly had a good appetite: when food was put in front of him, he rushed up to it. But then he paused, and then he ate slowly, using the right side of his mouth. It was obvious that there was something happening on the left side of his mouth that was causing difficulty.
His owner went on to say that they had tried to have a look, but Sammy wouldn't let them see. I discovered this for myself when I tried to examine his mouth. He wasn't aggressive in any way, but he was a wriggler, shaking his head and struggling whenever anyone came close to his head. There was only one answer: sedation.
Ten minutes later, Sammy was sleeping peacefully, and I was able to lift up the lip on the left side of his mouth to see what was happening. I was also able to open his mouth wide, examining the full extent of his tongue and oral cavity.
The problem was immediately clear to see: Sammy had lumpy, bumpy growths sprouting from the gums, on the outer side of his molar teeth on the left side of his mouth. I was able to say to his owner immediately: Sammy has developed some type of tumour on this left side of his mouth.
The oral cavity is the fourth most common site for tumours in dogs, representing 6% of all the tumours seen by vets in dogs. There are two significant challenges particularly associated with oral cancer.
First, it often remains undetected until an advanced stage, because owners don't generally carry out close examinations of their pets' mouths. When dogs, like Sammy, aren't used to having their mouths checked, they don't like it, and owners then find it difficult to do. This is one of the useful side effects of good dental hygiene in dogs. If you are in the habit of brushing your pet's teeth every day, your dog gets used to having their mouth handled, and in any case, during the act of tooth brushing, you will automatically notice any odd growths before they grow too big.
Second, it is only possible to make a specific diagnosis of the type of growth in a dog's mouth by taking a biopsy of thediseased tissue. All growths, both benign and malignant, tend to appear as reddened, swollen, "new" tissue. Sometimes even harmless disease processes such as healing wounds can resemble cancerous tissue. Often, the only way to be clear about the cause of diseased tissue in the mouth is to have a small biopsy sample analysed in the laboratory. Only once a precise diagnosis has been made, can the appropriate treatment be given.
Just like other types of tumours, growths in the mouth can be classified as benign (harmless) or malignant (cancerous).
The most common benign oral tumour is a growth from the gum, known as an "epulis" . These make up around 20 - 30% of oral tumours, and they are particularly common in certain breeds of dog, such as Boxers. They appear as fleshy outgrowths from the gum, like pink, smooth, cauliflower florets. Sometimes these are left in place, causing no distress or discomfort to the dog, but it's always best to have veterinary monitoring of these cases. A biopsy may be needed to confirm the benign nature of the growths, and if they are bothering the dog, surgical removal is needed.
There are four common types of malingant oral tumours, making up 70 - 80% of the growths seen in dogs' mouths. They often have a superficially similar resemblance, and the only way that a precise diagnosis can be made is by having a sample of biopsy tissue analysed.
The standard treatment approach for most of these cancers is complete surgical resection of the affected tissue, with as wide a margin as possible. Follow-up treatments, such as radiation therapy or chemotherapy are sometimes possible, and referral to a veterinary oncologist can be the best way to ensure that the most comprehensive treatment regime. Most cases do very well in the short term, but there can be a high rate of recurrence, with the tumour growing back in the same place, and some cancers can spread to elsewhere in the body.
So what about Sammy? The first stage was to take a biospy of the fleshy outgrowths, and fortunately, the news was good: he had the benign type of tumour, known as epulis. He came in for a full general anaesthetic, and I trimmed off the bulky, fibrous growths that were causing him difficulty with eating.
Two weeks later, his owner came back, bringing another video for me to see. This time the video wasn't really necessary: he could simply have told me "Sammy is completely back to normal, wolfing down his food using both sides of his mouth".