I met with the surgeon today.
Apparently, adenocarcinoma sucks and what sucks about it is its metastatic rate (it gets big and ugly fast) and its recursion rate (it comes back, even if you get the whole tumor; you have to make sure you have “clean margins”* and even that is no guarantee). What sucks particular in Kumi’s case is that the tumor is right on, and around, her sphincter. I realize that may be too much information for you, but as the surgeon put it: there is a very good chance that she is going to be incontinent for life if he has to snip both nerves that control the sphincter.
The normal surgical method to ensure clean margins is to excise a gratuitous amount of tissue around the tumor — so if it were on her back, for example, he’d cut out a good half-inch all the way around, and just sew it up. But because it’s on her sphincter, he can’t do that. And if he is trying to get as close as possible to the edge of the tumor, it means the chances of getting good clean margins goes way down.
Further adding to the equation is that “rest of her life” — statistically, dogs with adenocarcinoma have an average of 8 months post-surgery. Without surgery she has a “few weeks to a few months”. There is no more accurate way to look at it, because of the nature of the cancer. And with the recursion rate post-surgery, and her age (she’s 9yrs 9mos, the average Malamute lives to 9-11 years), it wasn’t a good sign that the usually optimistic surgeon was telling me about all the tough decisions he’s had to make with his pets. (Veterinary surgeons are among the most optimistic people in the world — they have to be, because of all of the complications that surgery brings). He kept bringing up “quality of life” and “there’s no good way to go” and “I tell my wife that one of these days we’ll be lucky and have one of our pets go peacefully in their sleep”.
*Clean margins – they excise the tumor and send it to the lab. The idea is as they slice it, all of the exterior edges should have noncancerous cells.