Harbinger: 2009's Mast Cell Tumor

WARNING: This post contains graphic photographs of Stella's surgical incision.  One person's fascinating medical info is another person's gory nightmare.  If you are the latter, you might want to skip this post. 

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We were fairly shocked to discover that the tiny bump on Stella's chest was not a sebaceous cyst as we had initially been told, but actually a mast cell tumor.  Stella was immediately scheduled for surgery a few days later and we started her on 20mg pepcid, a Histamine-2 blocker, and 50mg Benadryl, the traditional antihistamine.

Honestly, back in that little examination room, when Dr. Stacy started telling us about mastocytoma, I utterly checked out.  I'm sure I had a serious look on my face and nodded along at the appropriate times while she spoke, but I did not hear a word she said. All that echoed through my brain was a chorus of "CANCER! CANCER! CANCER!" I very quickly became useless as a functioning advocate for Stella and am so thankful that Jim was in the room, because as we were walking out of the vet hospital, I turned to Jim and said, "Jesus fucking christ, Stella has cancer.  Our little girl has cancer."
"She said it is very small and looks as if she'll be able to get all of it."
"Stella has cancer."
"Beth, Dr. Stacy is going to remove it and that will be that."
"What?"
"It's small and it's been there a long time, so she doesn't think it's aggressive."
"When did she say she doesn't think it's aggressive?"
"Five minutes ago."
"Really?"
"Really."
"Oh..." And then I burst into tears out of relief and sobbed so hard I gave myself a nosebleed.

We took Stella home, loved her up, and walked the hell out of her down by the duck pond (Sea Squirrels!).  She was dopey from the Benadryl, but seemed no worse the wear, and when Tuesday rolled around, we skipped her breakfast (the horror!) and brought her over to Village Vets.  When I handed her leash over to Kat, I once again burst into tears (by this time, they were very used to this behavior on my part).  I know, I know, you're not supposed to do this, as it stresses out your dog, but Stella's a lab.  She'll happily skip off with whomever is holding her leash, and that morning was no different.  She didn't even look back.

I was amazed to discover that Stella wouldn't even have to spend the night and that we would be able to pick her up that very evening.  The year before, out of the blue at the age of 5 1/2 (well out of her puppyhood), Stella ate two stuffed toys and required gastrotomy surgery to remove the two plus quarts of stuffing and toy fabric. Village vets kept her for three nights as a precaution.  This surgery couldn't be too bad, right?

When we picked her up that evening, Stella was pretty much whacked out of her mind and beside herself with discomfort.  Not pain, per se, but obvious discomfort.  Stella, we would learn, gets a truly dysphoric response to opiate pain killers.  Unlike, say, her mommy, who on narcotic pain meds gets all warm and fuzzy and happy and blissed out, Stella wants to crawl out of her skin.  I helped her into the Egg, and she cried the entire way home.  Once home, her big black pupils dilated to full tilt boogie, she wandered around the house, making the most pitiful noises.  I went into a panic, my belly turning over, but Dr. Stacy told me not to worry, that she would snap out of it as the pain meds wore off (anyone ever take just a leeeetle too much acid back in the day?).  I then worried about her being in pain, but this didn't end up being the case.  Once the fentanyl wore off, she was a little slow, but back to being the Stella we knew and loved (who wined for food and walks and balls and squirrels).  Within a day, Stella had bounced back from the surgery and acted like nothing had ever happened.  She never bothered her incision and we gave up on the inflatable donut collar within a few days (it was resting on the top of the incision, aggravating it).  Her resilience was astounding.

Stella in her blow up donut collar (much better than the cone of shame)

Now, ready to see the incision?  It's a doosey!

Even though the tumor, on the surface was pretty teeny, the trick to a successful excision surgery is making sure one doesn't leave behind a single, microscopic cancer cell.  The only way to do that is to also remove a certain measurement of unaffected, healthy tissue from all sides of the tumor (called "clean margins").  Leave a single malignant mast cell in place and that one tiny fucker will replicate and start the process all over again.  Dr. Stacy said she was able to get wide, clean margins (+5cm) from all angles except for the behind the tumor, where she ran up against the chest wall (1mm).  When the pathology report was returned the following week, it showed that all margins were good and clean, so Dr. Stacy was confident she had removed it all safely.

So, what did the pathology report show?  It was, indeed, a malignant mast cell tumor, but it was a graded as a low 1, non-invasive, and had a 0 mitotic index (please see the glossary of terms for explanations).  Basically, if you had to have a mast cell tumor, this was the best possible type to have.  Dr. Stacy said that was probably it for treatment, that it was considered "cured", but to keep an eye on the incision site out of caution, because that would be where another mass would turn up if there were any cells left behind.  For the next two years, I continued to run my finger along her incision scar and we brought her in every time a new lump or bump showed up (and she was really starting to collect them by 7 years old), but they were always benign lipomas (fatty tumors).  I blithely believed Stella was in the clear and put the whole concept of mastocytoma behind us.  Lalalala!