By Matthew Kearns, DVM
February is National Pet Dental Health Month; so I wanted to write an article on swellings of the oral cavity in dogs and cats. Swellings of the oral cavity are relatively common in dogs and cats. Some are tumors, some are not. Some are malignant, some are not. A fair number of cases of oral swellings are actually related to inflammation and not a tumor at all. Unfortunately, if these swellings are tumors, the majority of these tumors are malignant. This is why early diagnosis and treatment is so important.
How do we keep an eye on these things? Most veterinary oral surgeons recommend brushing your pet’s teeth daily, but I have not always found this approach feasible, even with my own pets. I think checking our pet’s mouths once weekly or as often as one can remember is more reasonable. Please bring any new swellings or masses in your pet’s mouth to your veterinarian’s attention right away. The “wait and see” approach is not recommended.
If I or any of my colleagues suspect a tumor, surgical excision and biopsy are recommended; however, certain pre-surgical testing is very important. Chest X-rays are recommended in all cases even though the rate of metastasis, or spread to other organ systems, in oral tumors is low. Chest X-rays can usually be performed without any sedation or anesthesia and, if evidence of metastasis is present, I recommend a discussion with the pet owner before proceeding with surgery/biopsy.
Also, if lymph nodes are enlarged, they should either be tested before surgery or removed and biopsied at the time of surgery to differentiate between secondary inflammation or metastasis. Preoperative blood work rules out other concurrent disease such as organ dysfunction to determine a patient’s risk of anesthesia more than it evaluates the tumor.
Oral swellings of the maxilla (upper portion of the jaw connected to the sinuses) suspected to be tumors should have either a CT (CAT-SCAN) or skull X-rays to see if there is invasion of the tumor into the bone of the skull. CT and skull X-rays require anesthesia so these are scheduled the same day as surgery.
Depending on the location of the tumor, surgical excision can be curative. The down side is that a “wide excision” is necessary. This means a large amount of tissue (both the tumor itself and a fair amount of healthy tissue around it) is necessary to ensure complete removal.
If a wide resection is not possible due to location, follow-up radiation therapy can be used after surgery to kill any remaining cancer cells. Radiation alone is only potentially curative in benign, or noncancerous, oral tumors. Chemotherapy is also sometimes used after surgery for cancerous oral tumors with either confirmed metastasis before surgery or a high metastatic potential based on biopsy.
Much of what we veterinarians recommend is not only based on location and suspicion of metastasis but also age and pre-existing disease. Whether or not to pursue testing and treatment is always up to you (as the owner) but diligent monitoring and prompt intervention should be discussed earlier rather than later.
Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.