If you just found out your beloved dog has lymphoma, you may be feeling overwhelmed as a million questions run through your head. Integrative veterinarian Dr. Julie Buzby is here to help. In her characteristic compassionate way, she shares the types, signs, diagnosis, treatment, and prognosis for lymphoma in dogs with a special emphasis on multicentric (lymph node) lymphoma.
To his parents, 10-year-old Basset Hound mix, Joshua, was the picture of health. When he visited me for his annual exam, they said he was acting like his normal silly, slobbery self. They had no concerns and expected a routine visit. However, their world soon came crashing down around them.
On his physical exam, I discovered significant enlargement of most of Joshua’s external lymph nodes. As I examined the cells from his lymph nodes under the microscope, his parents anxiously awaited the results. Unfortunately, their worst fears were confirmed. Joshua had lymphoma.
What is lymphoma?
This common cancer of the lymphocytes (i.e. a type of white blood cells) is also known as malignant lymphoma, lymphosarcoma, or LSA. It is responsible for up to 24% of canine cancer cases in the U.S. and affects 13 to 24 dogs per 100,000 each year.
To understand lymphoma a little better, it helps to understand lymphocytes. In a normal dog, they are an important part of the immune system’s defense against infections. Like other types of white blood cells, lymphocytes circulate in the blood.
However, they are also a very important part of the lymphatic system. This is the system of tiny vessels that runs parallel to some of the blood vessels. Lymphatic vessels collect fluid that has moved out of the blood vessels and into the tissue. This fluid can pick up foreign materials such as bacteria, viruses, and proteins that don’t belong in the body.
Along the path of the lymphatic vessels are lymphocyte-rich lymph nodes. Think about lymph nodes as the inspection checkpoints along the lymphatic road. There’s no getting around them. As the lymphatic fluid flows through the lymph node, the immune system cells come in contact with the foreign substances. This allows the body to detect then mount a response against anything it sees as potentially dangerous.
In addition to lymph nodes, the spleen and bone marrow also contain large amounts of lymphatic tissue (i.e. lymphocytes and other immune system cells). However, lymphatic tissue is present to some extent in almost every organ. Thus, lymphoma can develop almost anywhere in the body.
How is lymphoma classified?
There are three forms of lymphoma, defined by the primary location:
- Multicentric or nodal lymphoma—found in the peripheral lymph nodes, bone marrow, liver, or as a cause of splenic masses in dogs.
- Gastrointestinal (GI) lymphoma—affecting the small intestines and/or stomach.
- Extranodal lymphoma—found in a location other than the lymph nodes or GI tract.
Extranodal lymphoma is further classified into different subtypes based on location:
- Mediastinal lymphoma—in the chest
- Cutaneous lymphoma—in the skin
- Renal lymphoma—in the kidneys
- Central nervous system lymphoma—in the brain or spinal cord
- Ocular lymphoma—in the eye
Multicentric is by far the most common type of lymphoma in dogs, accounting for approximately 80% of cases. GI lymphoma is responsible for about 5 to 7% of lymphoma cases and will be discussed in another blog. The remainder fall in the extranodular category. Because it is the most common, the rest of this blog will focus on multicentric lymphoma.
Which dogs are at the highest risk for multicentric lymphoma?
Although most dogs with lymphoma are middle-aged or older, it can affect dogs of any age. Unfortunately, I have seen it in dogs as young as nine months old. Lymphoma is equally common in male and female dogs. While it can affect all breeds of dogs (and mixed breeds), some breeds have an increased risk of lymphoma including:
- Golden Retrievers
- Scottish Terriers
- Bassett Hounds
- Cocker Spaniels
- Poodles
What are the symptoms of multicentric lymphoma in dogs?
One or more enlarged lymph nodes is the characteristic finding in multicentric lymphoma. When I say “enlarged,” I don’t mean just slightly bigger than normal. Often these lymph nodes are much larger, potentially the size of a golf ball or bigger, depending on the size of the dog. The lymph nodes are firm and usually not painful when palpated.
Locating the enlarged lymph nodes
Although there are lymph nodes throughout the body, some are more noticeable than others. The most prominent and easy to feel lymph nodes are the:
- Submandibular lymph nodes—located under the jaw where it meets the neck.
- Prescapular lymph nodes—in front of the shoulder blade.
- Axillary lymph nodes—found in the armpit area.
- Inguinal lymph nodes—on the lower abdomen where the legs connect to the body (groin region).
- Popliteal lymph nodes—located on the back side the dog’s knee (stifle).
It’s important to note that enlarged lymph nodes don’t always equal lymphoma. Due to their role in the immune response, lymph nodes can react and grow in response to an infection (viral, fungal, or bacterial) or even vaccinations. Vets usually refer to these as “reactive” lymph nodes.
The submandibular lymph nodes are the most likely lymph node to be enlarged due to non-lymphoma causes. This is in part because they filter the blood, and therefore the bacteria, from the mouth. If your dog has dental disease or your older dog is losing teeth, this may be enough to stimulate a response in the lymph nodes and cause moderate enlargement. Thus, finding enlarged lymph notes is suspicious, but not definitive for lymphoma.
Other signs of multicentric lymphoma in dogs
Many dogs are not initially sick. Sometimes their parents make a “check lump” appointment with their vet because they notice a firm swelling that isn’t going away. Other times the vet detects the enlarged lymph nodes on a physical exam like I did with Joshua.
Other dogs may stop eating, exhibit lethargy in dogs, or lose weight. Some dogs may experience trouble breathing. This can be due to enlarged lymph nodes in the chest causing fluid to build up. Alternatively, markedly enlarged submandibular lymph nodes may block the upper airways (throat). A dog could have an enlarged liver or spleen that causes the abdomen to look distended.
How is lymphoma diagnosed?
As we discussed earlier, just because a dog has enlarged lymph nodes, this doesn’t automatically mean it is lymphoma. Typically, your vet will use a fine needle aspirate of the lymph nodes to diagnose lymphoma. This involves poking a needle into the lymph node multiple times to obtain a sample of cells. Then the vet will examine the cells under a microscope.
A normal lymph node contains primarily small, mature lymphocytes. However, if the vet sees a large number of lymphoblasts (larger, immature lymphocytes), a diagnosis of lymphoma is likely. Many veterinarians will send the slides to a veterinary pathologist to confirm the diagnosis of lymphoma.
Sometimes, even when a veterinary pathologist examines the sample, it can be difficult to definitively determine if a lymph node is cancerous or reactive. In these cases, your veterinarian may want to take a biopsy, or a small piece of tissue from the lymph node, and submit it to a veterinary pathologist.
What is the treatment for lymphoma in dogs?
Unlike many other types of cancer, surgery cannot cure or treat this type of lymphoma. The lymphatic system is widespread throughout the body, so by the time of diagnosis, lymphoma has most likely spread to multiple locations. Thus, even if only one or two lymph nodes are enlarged, removal of those lymph nodes is not an effective treatment.
Chemotherapy to treat lymphoma
This is the treatment of choice for canine lymphoma. There are multiple different chemotherapy protocols (i.e. the type of drug or combinations of drugs administered on a set schedule) to treat lymphoma. A veterinary oncologist can discuss different protocols and determine which one is best for your dog.
To learn more, check out Veterinary Partner’s article on common lymphoma chemotherapy medications for dogs and cats.
Joshua’s chemotherapy story
Remember Joshua? I referred him to a veterinary oncologist who planned and administered a chemotherapy protocol. Joshua’s lymphoma went into remission, and he had an additional two wonderful years with his family. They were so happy with the time that the chemotherapy gave them with their sweet Joshua.
Prednisone to treat lymphoma
If you do not want to pursue chemotherapy for your dog, there is another option. Most dogs will go into partial or complete remission when treated appropriately with the corticosteroid prednisone for dogs (or prednisolone). It is a tablet that is readily available at most veterinary hospitals and can be given at home. Note that it does sometimes cause increased thirst and urination, excessive panting, or increased appetite.
Unfortunately, prednisone typically only causes a short-lived remission. Typically, the lymphoma develops resistance to prednisone after a couple of months. Another concern with starting prednisone right away is that it makes lymphoma less responsive to chemotherapy in the future. Before I start any of my patients on prednisone for lymphoma, I always counsel the family on the pros and cons. I also ensure they have no plans of pursuing chemotherapy down the road.
Charlie’s prednisone story
Charlie is a 10-year-old Golden Retriever who came to see me because he was not eating well and was acting lethargic. I discovered his lymph nodes were enlarged and lymph node aspirates confirmed the diagnosis of lymphoma. He also had high calcium (more on why that happens in a bit).
Referral to an oncologist and chemotherapy was not an option for this family, so we started treatment with prednisolone. I informed his family that the prednisolone may make him feel better for one to two months. But then he was likely to relapse. Amazingly, it has been almost five months since Charlie’s diagnosis and he is still happy and active.
I rechecked him last week. His lymph nodes are still very large and he is not in full remission but he is living his best life right now. His family is extremely happy for the extra time with him. While his story is not typical for dogs with lymphoma who are treated with prednisolone, I wanted to share it to demonstrate that some dogs defy the odds.
What is the life expectancy for multicentric lymphoma in dogs?
Without any treatment, lymphoma often progresses quickly. Most untreated dogs will succumb to the disease within one to two months of diagnosis. Treatment with prednisone alone can cause a temporary remission and may extend survival time by a few more months.
Treatment with chemotherapy can give your dog a good quality of life for months to years. People understandably tend to worry about the side effects of chemotherapy. Side effects are much less common in dogs than they are in people.
When considering the life expectancy of dogs treated with chemotherapy, there are certain factors that affect prognosis and overall outcome:
Gender
Female dogs tend to respond better than male dogs.
Dog size
Smaller dogs respond better than larger dogs.
Histological grade
The veterinary pathologist will determine the grade of the lymphoma, with high-grade lymphoma expected to behave more aggressively than low-grade lymphoma. Interestingly, high grade lymphoma is actually more likely to go into remission than low grade lymphoma.
Staging
Lymphoma is also classified into stages. The lower the stage, the better the prognosis (outlook).
- Stage I—only a single lymph node is affected
- Stage II—multiple lymph nodes in the same region of the body are affected
- Stage III—lymph nodes throughout the body are affected
- Stage IV—the liver or spleen are involved
- Stage V—lymphoma is found in the blood or bone marrow
Sub-stage
Dogs with lymphoma are classified into “substage a” (patients who ARE NOT sick at the time of diagnosis) and “substage b” (patients who ARE sick at the time of diagnosis). Dogs who are in “substage a” generally do better.
Phenotype
There are two types of lymphocytes—B-cells and T-cells. B-cells come from the bone marrow and create antibodies (immune system proteins that target specific foreign invaders). T-cells mature in the thymus (immune system tissue in the chest) and help direct the immune reaction or kill infected or abnormal cells. Dogs with B-cell lymphoma tend to fare better than dogs with T-cell lymphoma. A veterinary pathologist can perform special testing to determine the phenotype (i.e. T-cell or B-cell) of the lymphoma.
Hypercalcemia
Some cancerous cells, including some cancerous lymphocytes, produce a protein that mimics parathyroid hormone (PTH). Normally, PTH helps control calcium levels in the body. When cancer cells make parathyroid hormone-related protein (PTHrP) this can force the body to abnormally retain calcium. An elevated calcium causes kidney damage, weakness, and a loss of appetite. These dogs are often feel sick and have a worse prognosis than a dog with a normal calcium level.
Presence of a mediastinal mass
When there is a mass present in the center of the chest (mediastinum), this indicates that the thymus is probably involved. Thus, T-cell lymphoma is more likely. As mentioned above, T-cell lymphoma does not respond as well to chemotherapy.
Previous treatment with prednisone or prednisolone
As discussed in the treatment section, lymphoma that has previously been treated with prednisone alone is less likely to respond to chemotherapy.
When trying to decide the best course of action for your dog with lymphoma, I always recommend a consultation with a veterinary oncologist. He or she will evaluate your dog and look at the prognostic indicators. This will help determine your dog’s chance of achieving remission and allow the veterinary oncologist to formulate the best treatment plan for your family and your dog.
Hope in the midst of the hard times
Even though lymphoma is often a fatal disease, it is not hopeless. Many dogs with lymphoma don’t feel sick during the earlier stages of the disease. Like Joshua, they have no idea anything is wrong with them, and may wonder why their parents are so sad and worried.
Additionally, many dogs with lymphoma will respond well to chemotherapy or prednisone. They can have an excellent quality of life during their final weeks, months, or years. Treasure the time. Make a bucket list for your dog and see how many things you can check off of it. Spoil him or her like never before. Keep living and loving until it is time to say goodbye.
Saying goodbye to your dog with lymphoma
This next section might be hard to read, but I think it is worth sharing. Knowing that your dog has a disease that will most likely eventually claim his or her life gives you the chance to prepare for your dog’s euthanasia. Perhaps you want to plan an in-home dog euthanasia in your dog’s favorite location, surrounded by the things and people he or she loves. That’s how my family said goodbye to our dog, Luke, who had mediastinal lymphoma.
Or maybe you will say goodbye at the vet’s office, while your dog lies on a favorite bed after just having a meal of all his or her favorite foods (even the usually forbidden ones). The plan may look a bit different for everyone, and that’s ok.
No one wants to have to face losing their beloved dog, but sometimes being able to think about how you want those last days and moments to go—whenever they come—can bring a small measure of comfort.
Has your dog been diagnosed with lymphoma?
Feel free to share his or her story below.
Hi 15 year old schnauzer Max was doing great when I discovered the mass in the groin area, we took him to get checked out and vet did aspiration on it but 4 days later he started to decline. Monday he was diagnosed lymphoma, we started prednisone the same day and by Tuesday was better, and wed. him old self again but today he is not feeling well again. I don’t k ow if the prednisone stopped working on him. But his lymph nodes under his chin is causing some pain. We are waiting for the Laverdia to get here tomorrow so we can give him a fighting chance but I’m not sure if it’s too late for him. I am dying inside and I feel I can’t breath just thinking he is slipping from me and I feel like I did nothing for him. 😭 I feel so guilty.
Dear Adriana,
My heart aches for you during this difficult and emotional situation you are in with Max. Please know that you are doing everything you can, and you have not failed him. Lymphoma can seemingly pop up from nowhere and show up so quickly that you sometimes don’t have time to intervene. There is nothing you “missed” or should have done differently. Unfortunately, this is just how this disease happens in many dogs. I hope the medications will be able to extend Max’s life and give him some relief from the discomfort and pain. It might be a good idea to reach out to a veterinarian that practices hospice and palliative care, so you are ready with options for when that time comes. Praying for a miracle. Bless you both. ♥
Tragically we lost our beloved Pitbull girl of 14 years to awful cancer (lymphoma/leukemia stage 5). We torment and blaim ourself each day for first of all obviously going to the vet too late, and secondly because we and the oncologist most probably acted to slowly with this type of disease. Im fully aware that theres no cure, but she could’ve and should’ve be treated with chemo (it was decided and booked).
It all happened very Quickly actually, in just a week our girl was gone. We were on a regular routine senior healthcheck (before this it was 4 months since last normal CBC was Done, because of a UTI) where they did a CBC, this came back two days later as abnormal (high WBC, 50 000, about 60% cancerous). Prior to this she were very active and playful, no other symptoms other than a little red hairless patch near her mouth (looking back i suspect it could have been a demodex outbreak because of the lymphoma). That miss is my first regret, why i didnt go sooner to check it out.
Because of the CBC we were recommended to meet an oncologist next, that was 4 days after, On that next appointment they did a new CBC and ultrasound. The new CBC was the same, other than sligthly anemic now (RBC and hematocrit little under reference values) but the ultrasound revealed an enlarged spleen which they aspirated aswell, and some swollen nearby lymphnodes. All came back diagnosed as large cell Lymphoma, suspected T cell type. So because of findings in blood and spleen they staged it as 5.
That same day we got a new appointment three days later, to start chemo treatment, even if they gave us a bad prognosis (max 6 months). During this three days she obviously continued to deteriorate, and On the actual day of the appointment when the vet saw her she said she is in too bad shape now (heartfrequence 120 and pale gums) ,and even if we start the treatment they expect she wouldnt even last through the coming day or two. Of course we were completely crushed hearing this, and also so frightened by the vet to risc that she maybe dies in distress if we decide to go on. This all lead us to follow the recommendation and instead euthanize our best girl! This is off course our second and biggest regret of all , why did we not question the vet and push harder to give her a real honest chance instead? Was she really so past saving…? Would really appreciate your take On this story!
Next question i would ask you, is why she had the symptoms that she had during that week after diagnosis. If you could explain it?
Her first symptom was starting to pant from nowhere on her walk, and minutes after collapse on the side. I lifted her up immediately but she was weak and could not stand, so i carried her. however a little while later she could once again walk. The next day she got a fever, which stopped after three days. During these days she stopped eating, just sniffing and spitting the food, taking a bite here and there at best. Finally last two days she would loose balance while taking short walks in the yard to relief herself, panting on and off and during the night breath shallow and fast, also she seem to have developed an anemia. It was all in all very hard seeing all this how she deteriorated during just one week! How and why does these sort of symptoms and conditions developr?
Thank you, and once again i love your blog.
Dear Marko,
My heart aches for you as you grieve the loss of your sweet girl. I can tell this has been a very difficult process for you as I have read all the comments you have posted over the past couple of weeks. I wish I could ease your pain or take away the burden of contemplating the “what ifs”. Since I did not personally examine your pup, it is difficult to make specific conclusions. You mentioned the spleen was enlarged and there was an anemia. These issues alone can cause an elevated heart rate, difficulty breathing, weakness, and collapse. Also, cancer can do strange and unpredictable things. I agree with the assessment from the specialist that your girl’s condition was grave, and euthanasia was probably the most loving option at that point. I am sorry you had to suffer through such a devastating experience. I pray with time your heart will heal and allow the memories of the good days to be a comfort to your soul. ♥
My dog was diagnosed with TZL lymphoma last week. She was doing UW_25 protocolo but once the type of cancer was defined, the doctors decided to stop the protocolo as it doens’t improve life expentency. She has several Nodes. The biggest ones on her neck. Sometimes I notice She has difficulties to bread. Not sure if it’s a good decision to stop the protocol.
Hi Necas,
I am sorry your dog has received such a difficult diagnosis and poor prognosis. Since I have not been personally involved with your pup’s case, it is hard to make specific recommendations. If you need more information or reassurance about how to proceed with treatment, I highly recommend you talk to a veterinary oncologist in your area. It never hurts to get a second opinion, especially when dealing with cancer and quality of life issues. I hope you find the answers you need to make the best decision for you and your sweet girl. Wishing you the best as you navigate this difficult path.
My dog Daisy was 7 years old when the vet noticed enlarged submandibular lymph nodes and aspiration diagnosed lymphoma. We started the CHOP protocol of chemotherapy, which is very similar to what humans receive. She did so well with chemo, with no side effects. Chemotherapy provided an additional three years of quality life with my sweet girl, and although expensive, I’d do it all again because of the good results. Many times you can get a finance plan, and pet insurance can help if you have a policy before diagnosis.
Hi Karen,
Thank you for sharing your experience with chemotherapy for your girl Daisy. I love that you pointed out how well she tolerated chemotherapy with no side effects. I am so glad you were able to add three extra years to Daisy’s life! That is precious time I’m sure you both enjoyed. Best wishes!
Our 10.5 year old shih tzu was diagnosed 2weeks ago with lymphoma.Four lymp sites are already swollen. Not knowing what stage or B or T cell,how long approximately do you think how much time is left?Scruff has a lot of other physical problems also..Long story short we rescused him at 5 months old and pretty sure he is a result of puppy mill/back yard multi breeder.With lots of vet conversations and long hard thinking,we have decided not to pursue prednisone/or chemo. treatment.Without a whole of testing on scruff,vet wouldn’t give his thoughts on this.Does either B or T cell grow and spread faster than the other?Our plan is to keep in touch with vet as changes occur,and more hugs,carrides,kisses,pictures.and love
Hi Denise,
I am sorry you are heading down this path with your sweet boy. Lymphoma typically progresses quickly with both phenotypes B and T. Most dogs only live for a few months after diagnosis without chemotherapy. My best advice is to look for a vet that specializes in hospice care in your area. Hospice vets will come to your house so you don’t have to stress your dog by taking him into the clinic. They can examine Scruff and make suggestions on how to maintain his quality of life as you go through this process. They also have medications they can prescribe to make sure he is comfortable and pain free. My thoughts are with you and Scruff. I hope you are able to enjoy the time you have left and make memories you will cherish forever.
My Puddin (pit bull ) was diagnosed yesterday with Lymphoma, it is very hard to digest that myself . We adopted her , knowing she had an auto immune disease. She has needed treatment and vet visits so often , we are not doing the chemotherapy with her . Can you tell me because she has an auto immune disease, will she do well on prednisone? Or will lymphoma. Cause her to suffer more . She is very very lethargic. . I am beyond having dry eyes !
Hi Betty,
I’m so sorry to hear that Puddin just got diagnosed with lymphoma. It is always devastating to hear that sort of news. Unfortunately without being able to examine her and know more about which autoimmune disease she has, how it is being controlled, etc, I can’t give you a great idea of how she would tolerate the prednisone. I would suggest scheduling a follow up appointment with your vet to go over your concerns since he or she has a good working knowledge of Puddin’s history and medical concerns. You could also potentially consider doing a consultation with an oncologist. I know that you said that you wouldn’t want to do chemotherapy (which I respect and understand). The vet oncologists I have met are also very focused on helping their patients maintain a good quality of life, so they may be able to offer some good suggestions that help keep her comfortable and/or help answer your questions from the perspective of a specialist who has seen and treated many such case. I hope you are able to find some answers that help guide you during this difficult time. ❤
Our sweet Rookie, a Maltese/Shih Tuz mix who turned 15 on April 1, was just diagnosed with lymphoma today. His teeth were all pulled in March, and his lymph nodes have been very swollen since. We initially treated with antibiotics, etc. but our vet decided to do a biopsy on Friday after Rookie had 2 short seizures within an hour of waking. and the fact that his lymph nodes have gotten progressively bigger.
We have decided to not do chemo due to his age, and started on prednisone. I can’t stop crying. I think that the worst part is not knowing how much time that we have left with him. He still seems fine with a great appetite and zest for life, but I am dreading the day that this changes. He has been the best boy for his entire life, and I can’t imagine this world without him. For now, he is getting everything that his heart desires, like triple the amount of his favorite treats and an entire hotdog to hide his prednisone pill with ice cream for dessert. We do not want him to suffer and will cherish our remaining time with him.
Hi Christa,
So sorry to hear about your dog’s lymphoma diagnosis. I know how devastating that can be. It is great that Rookie is still feeling good right now and I bet he is loving every minute of getting spoiled with everything that his heart desires. (As a less fun side note, some dogs may get pancreatitis or GI upset from hotdogs or ice cream, but fingers crossed he isn’t one of them because I’m sure he loved them! I only mention it because while I definitely want you to be able to spoil him with lots of goodies, I don’t want them to inadvertently make him feel crummy and add to his woes.) It is hard not knowing what the future will hold for him, but I think you have the right idea to keep loving on him and treasuring every good day. Sending love as you navigate this difficult journey. ❤
My dog was diagnosed with stage V T-cell lymphoma almost two years ago. We started on a low dose chemotherapy pill which worked great for over a year. 5 months ago, it progressed and we tried IV chemotherapy but the side effects were more than we were willing to put her through. After stopping chemo, she did wonderful for 4 months. You would never have known she was sick. A few weeks ago, her sub-mandibular lymph nodes dramatically increased in size and she developed lesions in several places. We started prednisone and she had a good few weeks but the last couple of days she is just not herself. She is restless and can’t seem to get comfortable. She doesn’t have that gleam in her eyes anymore and doesn’t wag her tail when I come home. This may be our last weekend with her as we prepare to say “until we meet again”.
Hi Kristin,
Thanks so much for sharing your pup’s story! I am so glad you guys have had almost 2 wonderful years together after her lymphoma diagnosis, but I am also so sorry to hear that she is starting to decline. I hope you are able to have a sweet and meaningful weekend with her before you have to face that difficult goodbye.❤