CANINE LYMPHOMA

DK Farah Ana Binti Zaidun/ B94134217

History
A female Golden Retriever named Weiler was taken to University Veterinary
Hospital (UVH), UPM was presented with a history of lethargy, anorexia, and the owner
complained that there was an enlargement in the neck area of the patient.

Physical examination
Signalement
Name
Sex
Species
Body weight
Breed
Fur colour

: Weiler
: Female
: Dog
: 30 kg
: Golden Retriever
: Brown

Status present
Temperature
Respiratory Rate
Heart Rate
Care and Nutrition
Standing stance
Body growth

: 38.9 C
: Not examined
: Not examined
: Good
: Stand with 4 legs
: Good

Clinical Findings
The patient was presented with lethargy. The palpation was performed in the neck
area and showed that there was an enlargement of lymph node which were lgl.
Submandibullar, lgl. Parotid and lgl. Retropharyngeal. The swollen gland was also found
in lgl. Axillary and lgl. Prescapular. The enlargement of the lymph nodes was three times
bigger than the normal size.
Further Diagnosis
Further examinations were performed included hematology, biochemistry and
radiography in the neck area. The laboratory tests were conducted to determine eligibility
of the patient condition to undergo further therapy.
Diagnosa
Canine Lymphoma

Differential Diagnose
Systemic infectionsbacterial (eg, pyoderma)
Lymphadenitis
Prognose
Dubius
Treatment
Cyclophosphamide 250 mg/m2/IV
Vincristine 05 - 0.7 mg/m2/IV
Doxorubicin 30 mg/m2/IV
Prednisone 05 - 2 mg/kg/PO
NaCl 0.9% 100 ml/IV
Furosemide 1 mg/kg/PO
Discussion
A female Golden Retriever named Weiler was taken to the University Veterinary
Hospital (UVH), UPM with clinical signs of lumps in the neck area, lethargy and loss of
appetite. Based on physical examination and palpation of the neck, the swelling was
obtained alongside hard consistency of the lgl. submandibullar, lgl. parotid, and lgl.
retropharyngeal. In addition there was also swelling of the lymph node of the lgl.
prescapularis, lgl. axillary and lgl. Popliteal. The swelling of the lymph nodes was
approximately 3-4 cm with a hard consistency than normal. Lymph nodes were firm,
freely movable, and painless on palpation. Based on anamnesis, physical examination
with palpation and further examination, the patient was diagnosed with lymphoma.
Canine lymphoma is a cancer that originates from lymphoid tissues include the
lymphatic and immune system (Fan 2013). Canine lymphoma most commonly involves
organized primary and secondary lymphoid tissues, including the bone marrow, thymus,
lymph nodes, and spleen. In addition to these lymphoid-rich organs, extranodal sites
affected by lymphoma include the skin, intestinal tract, liver, eye, CNS, and bone. Canine
lymphoma is heterogeneous, characterized by a common disorder that is enlarged lymph
nodes followed by splenomegaly, hepatomegaly and bone marrow disorders (O'Connor
and Robles 2014).
Lymphoma is one of the most common cancer seen in dogs. Presentation lymphoma
incidence is quite high at 8-10% of all cancer cases that found in dogs (Martineau 2002).
In cats, lymphoma often associated with feline leukemia virus (FeLV). But in dogs, the
etiology of lymphoma is unknown. Breeds that are believed to have a higher incidence of
lymphoma comprised of Boxer, Basset hound, Rottweiler, Cocker spaniel, Saint-Bernard,
Scottish terriers, Airedale terrier, English bulldog, and Golden retriever. Lymphoma is
often found in dogs between the age of 6 to 12 years (Martineau 2002). This is
demonstrated by the case in Weiler. The owner of Weiler complains of swelling in the
neck area. During the physical examination, lymph nodes that can be found in dog is lgl.
submandibular, lgl. parotidea, lgl. retropharyngealis, lgl. prescapular, lgl. axillary (can be
felt when the foot is abducted), lgl. inguinal, and lgl. Popliteal (Nelson and Couto 1998).

Figure 13 Lymph node location in dog (Nelson dan Couto 1998)

Based on Weilers case, clinical sign like lethargy, anorexia and enlargement of
lymph nodes were found. According Vail (2009), most of time lymphoma in dogs appears
as a swollen glands (lymph nodes) that can be seen or felt under the neck, shoulder or
behind the knees. Ocassionally lymphoma can affect lymph nodes that are not visible or
palpable outside the body, such as those inside the chest or in the abdomen. Other
symptoms include vomiting, diarrhea, loss of appetite, weight loss and difficulty
breathing. In addition, the patient with lymphoma may also experience in kidney failure,
seizure and sometimes followed by polydipsi and polyuria.
In this case, further examination in the form of hematological examination, complete
blood biochemistry and radiography. The test results cannot be displayed because patient
data is confidential to the hospital. According Vail (2009), further examination can be
carried out in the case of lymphoma in the form of a physical examination, biopsy and
blood tests and complete blood biochemistry. Moreover, further investigation such as Xray, ultrasonography (USG), computerized tomography scanners (CT scan) may also be
done to diagnose lymphoma (Rassnick et al. 2009).
According to Martineau (2002), a thorough physical examination in dogs is an
important part in diagnosing cases of lymphoma. It is important to specify the test so that
the subsequent stages of lymphoma can be known. Stages of lymphoma can determine
the extent to which the lymphoma has spread throughout the animal's body. The spread
affects treatment conducted on animals. Based on the World Health Organization (WHO),
the stages of lymphoma in animals are represented in Table 3.
Table 3 World Health Organization Clinical Staging for Domestic Animals with
Lymphoma (WHO 2001)
Stage
I

Criteria
Single lymph node

II

Multiple lymph nodes in a regional area

III

Generalized lymphadenopathy

IV

Liver and/or spleen involvement (with or without stage III)

Bone marrow or blood involvement and/or any nonlymphoid organ

(with or without stages I to IV)

Substage a
Substage b

Without systemic signs of disease

With systemic signs of disease

Based on the Weilers case, the prognosis is dubious. Prognosis of lymphoma cases is
based on clinical stage and type of lymphoma (David 2009). Some therapies can be done
for cases of lymphoma including surgery, chemotherapy, immunotherapy, radiotherapy,
and hyperthermia (Martineau 2002). Chemotherapy is the most recommended treatment
for lymphoma. Chemotherapy treatment is considered the gold standard for this
aggressive form of cancer and usually consists of a combination of oral and injectable
drugs given on a frequent basis. In this case, the veterinary suggested to the owner to take
medication such as chemotherapy. There are several different chemotherapy protocols
from which to choose. They usually contain of 3 to 5 different chemotherapy drugs, each
of which works on cancer cells in different way. If some of the cancer cells are resistant
to one drug, hopefully they will be sensitive to another drug (Fan 2013).
Based on the Weilers case, chemotherapy treatment that had been running for 3
weeks was closely observed. Treatment was observed using vincristine treatment with
doses 05 - 0.7 mg/m2 intravenously. The treatment was performed in a chemotherapy
room with high level of accuracy. At the time of chemotherapy, all individuals are
required to use protective equipment such as gloves, masks and aprons to avoid direct
contact with the chemotherapeutic agent. Prior to chemotherapy, patients are first given
40 ml 0.9% NaCl intravenously. After that, the chemotherapy drug is given through
intravenous using intravenous catheters. Before that, catheter should be placed in the
correct position and should be checked repeatedly to avoid the catheter from entering the
subcutaneous area. After treatment, 0.9% NaCl is given 60 ml administered
intravenously. According to Martineau (2002), the success rate of chemotherapy use the
Madison-Wisconsin protocol amounted to 20%. Madison-Wisconsin chemotherapy
protocol in cases of lymphoma in dogs can be seen in Table 4.
Table 4 Combination of Madison-Wisconsin chemotherapy protocol for dogs with lymphoma
(NAVC 2009)
Treatment week

Drug

Dosage

Route

Vincristine

05 - 0.7 mg/m2

IV

Prednisone

2 mg/kg

PO

Cyclophosphamide

250 mg/m2

IV

Furosemide

1.5 mg/kg

IV

Prednisone

1 mg/kg

PO

Vincristine

05 - 0.7 mg/m2

IV

Doxorubicin

30 mg/m2

IV

1
2

0.5 mg/kg
Prednisone
6
7
8

Vincristine

PO
05 - 0.7 mg/m2

IV

Cyclophosphamide

250 mg/m

IV

Furosemide

250 mg/m2

IV

Vincristine

05 - 0.7 mg/m2

IV

Doxorubicin

30 mg/m

IV

11

Vincristine

05 - 0.7 mg/m2

IV

12

Cyclophosphamide

250 mg/m2

IV

Furosemide

1 mg/kg

PO

13

Vincristine

05 - 0.7 mg/m2

IV

14

Doxorubicin

30 mg/m2

IV

16

Vincristine

05 - 0.7 mg/m

17

Cyclophosphamide

250 mg/m2

Furosemide

1 mg/kg

18

Vincristine

05 - 0.7 mg/m

19

Doxorubicin

30 mg/m2

IV
IV
PO

IV
IV

In addition, chemotherapy protocol that can be used for lymphoma treatment is the
COP Protocol (Cyclophosphamide, Oncovin, Prednisone). This protocol is a combination
of cyclophosphamide in the form of tablets, oncovin (vincristine) and prednisone. The
vincristine is given intravenously within 4 weeks followed by injection at intervals of 3
weeks to 6 months of treatment. Cyclophosphamide is given for 4 days every 3 weeks.
Prednisone is given every day for 6 months. Based on this protocol, it was reported that
the average survival time of the patient ranged from 8-10 months (Martineau 2002).
Single-agent doxorubicin is another chemotherapy agent that can be used for
lymphoma. The therapy uses a total treatment with doxorubicin as much as 5 times with
intervals of 3 weeks (Elliot 2010). In addition, prednisone as a single-agent chemotherapy
may also be performed as lymphoma. Prednisone is a steroid drug that can be given every
day without under hospitalization. The dosage of prednisone is 0.5 - 2 mg / kg/ PO.
Observation in Weiler was only done for 3 days and chemotherapy treatment was
observed was a chemotherapy that had been running for 3 weeks. Based on daily
observations, the patient's condition showed a positive response to treatment. The lymph
node was smaller and approaching normal consistency. In addition patient was also more
active and has increased in appetite.
Conclusion
Based on the anamnesis and clinical symptoms were found, the patient was
diagnosed with canine lymphoma. The treatment was carried out in the form of

chemotherapy treatment is Madison-Wisconsin protocol (CHOP). Patient improved

gradually through observation after being medicated with chemotherapy. The patient
showed a positive response to treatment.
References
Colleen M. OConnor and Heather Wilson-Robles. 2014. Developing T Cell Cancer
Immunotherapy in the Dog with Lymphoma. ILAR Journal.55 (1): 10.1093
David M.Vail. 2009. Lymphoma in Dogs: Diagnosis & Treatment [internet]. Tersedia
pada:
http://www.veterinaryteambrief.com/sites/default/files/sites/cliniciansbrief.
com/files/LymphomainDogs.pdf. Diunduh pada: 12 April 2015.
James Elliot. 2010. Approach to canine lymphoma part two: treatment option [internet].
Tersedia pada: http://www.vetsonline.com/publications/veterinary- times/archives/n40-43/approach-to-canine-lymphoma-part-two-treatment-options.html.
Diunduh
pada: 12 April 2015
K.M. Rassnick, A.S. Moore, K.E. Collister, N.C. Northrup, O. Kristal, J.D. Chretin, dan
D.B. Bailey. 2009. Efficacy of Combination Chemotherapy for Treatment
ofGastrointestinal Lymphoma in Dogs. Journal of Veterinary Internal Medicine.
23:317322
Mireille M.C. Martineau. 2002. Multicentric canine lymphoma in a 12-year-old
keeshond: chemotherapy options. The Canadian Veterinary Journal. 43(9): 709711.
Nelson RW, Couto CG. 1998. Small Animal Internal Medicine. St. Louis.
Timothy M. Fan. 2013. Canine Lymphoma [internet]. Tersedia pada :
http://www.merckvetmanual.com/mvm/zk/circulatory_system/canine_lymphoma/ov
erview_of_canine_lymphoma.html. Diunduh pada 15 April 2015.