Found a large tumour on her dewlap

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Liung

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I had a vet appointment booked for Delilah today to talk about her watery eye, which I posted about previously
So during their physical the Dr took a look and pronounced it likely a blocked tear duct. When the corner of her eye is pressed, it leaks fairly copious amounts of a white, milky liquid.

...

So we're going to give it a few weeks, see if it resolves on its own with some help of some face massages. This is a thing that is apparently possible, a rabbit getting better without major effort and medical intervention. I know, I was shocked too.

It did clear up a lot with regular expression, but then got worse again, so two weeks ago (my Dr is in very high demand) I booked a recheck appointment for her. I went in today to discuss doing an x-ray to look for possible overgrown tooth roots or put her under to do an antibiotic flush for possible dacryocystitis. I probably would have said do the x-ray, because if it's a tooth root flushing won't solve the problem...

And then as I was packing her up to leave for our appointment, I felt something strange in her dewlap. "Delilah what is this, do you have something in your fur? Do you have a mat in your fur? Have you been neglecting your grooming and letting your fur get all—IS THAT A TUMOUR?!"

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Wow how happy am I that we are literally on our way to the vet right now.

So it's probably about the size of a quarter, covered in blood vessels, and is pretty much in the middle of her dewlap, on the underside. It's also very firm, the skin feels super tight and there's almost no give. There's absolutely no way anyone would have noticed it if they weren't picking her up and directly handling the skin in that area, which of course doesn't happen often. I was only doing so because I was putting her harness on as I always do when we go out. It's not quite large enough to be visible without pushing the fur back; maaaaaybe I might have spotted it if I were lying on the floor and she stood up directly in front of me... but I doubt it would have been visible without growing much larger.

This also means I have no idea how long it's been there, how quickly it grew...

Sure did make the decision about what to do for her eye a lot easier. Surgery is scheduled for next Wednesday, they'll remove the lump and flush her tear duct while she's under.

So, options: vet said there were three possibilities: a solid tumour, a cyst (tumour filled with fluid) and a third type of tumour which my brain has already dropped the word for but is basically a tumour filled with a whole bunch of cysts. He confirmed with me that I wanted it removed—it's unlikely to be malignant and so really the worst it can do is get bigger, so a lot of people don't bother for rabbits. But that is a lot of blood vessels, and it's in a very inconvenient spot, so I think it fully possible that it could get torn off and she'd be pouring blood everywhere. Also it is a horrible growth that has dared to appear on my precious baby, I want it GONE.

He then started telling me about draining it; if it's a solid tumour of course it won't drain, but the other two types can usually be drained. That shrinks it down so that it's hardly noticeable anymore. And while I'm staring at him in bafflement, wondering why he's talking about draining instead of surgical removal, he tells me that for cysts however, they're always going to come back.

What?! This thing will come back no matter what?? It'll grow back even if you cut it out?!?! No no, he said, if you cut it out it's gone. But if you drain it, the fluid is being produced by cells inside the lump, so you can drain it but it will just fill again.

... So why bother to drain it in the first place?! Apparently my vet is far too used to rabbit owners that don't want to spend any amount of money on their pets, because he always seems faintly shocked when I tell him I'd much rather have the more expensive option. But I don't consider it the more expensive option when the less expensive option won't actually fix the problem.

So, surgery. In the case of a cyst, cutting it out fixes it, you've removed the cells causing the growth, everything's fine and dandy. In the case of a solid tumour, there's no such guarantee. Tumours like this are rarely malignant, but they can be "locally invasive", which he drew a little diagram and which I am given to understand means "they can have horrible roots extending further into the skin that allow it to grow back". Dear lord it's like the issues of removing an abscess all over again.

Fingers crossed it's not that.

And then while talking to the vet about options, I was of course petting her as she sat on the examination table, and under my fingers I feel... DELILAH NO WHAT IS THIS.

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Another lump. On her back, between the end of her ribcage and pelvis, to the side of her spine. Very small, I probably would have dismissed it as a mole or something if it weren't for the massive one on her neck. Grr. Vet said don't worry, he'll remove that one too, free of charge, probably won't even need stitches for that one, glue might be a better choice since she'll be able to reach that and chew on stitches.

Then I asked about testing. "Oh, it's quite expensive, I'd have to send it to a pathologist, not many people want to spend that kind of money..." "Is it more expensive than having to pay for a second surgery if it grows back or more develop?"

So if it's a cyst he doesn't think it will need to be tested, but if it's a solid tumour I'm going to have it tested. The fact that there's a second one obviously starting to develop makes me believe attempting to find the cause is a priority. $165 for him to ship it out to an OVC pathologist in Guelph, but actually I'm currently doing a field placement in Guelph at a facility associated with the Ontario Veterinary College, so I'm going to put out my own feelers to see if I can find someone who might be interested in taking a look at it for less. Honestly I might be able to get it done at my own workplace, since I know they do autopsies sometimes. \o/

Also because my vet is awesome and loves clients that actually take good care of their pets and brings them in for medical attention long before they're actually suffering and on death's door... The surgery estimate printed out at ~$900 but he scratched a bunch of things out and is quoting me $400-500, depending on surgery time.

So anyway, similar to my eye post this is less a "please advise" post and more of a "FYI" for anyone who encounters something like this with their own pet... but if anyone has suggestions or their own experiences with this I'd appreciate the input. Tests I should ask to have done? Things to watch out for?

Poor bunny. It doesn't seem to bother her any but I've already noticed that as she's grooming her face, that part of her dewlap gets pushed between her paws/forelimbs. And when she's flopping over something... what if it catches on the edge of the litterbox? The sooner this vile thing is gone the better.

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It looks like it's on the side of her neck but that's just because the dewlap is so loose I pull it out from underneath her rather than try to lift her up. It's almost in the dead centre of her neck.
 

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Thanks for sharing this. Hopefully the surgery takes care of it all and nothing grows back. I'm very interested to hear how the surgery goes so please do update afterwards.
 

Liung

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I really have to remember to ask my vet for the medical name for things before I leave, it makes things so much harder to research at home. "Cutaneous neoplasia" is as far as I've gotten. On this page (http://www.medirabbit.com/EN/Skin_diseases/Diff/Alopcia.htm) about halfway down is a rabbit with a tumour on its abdomen that has that same bulbous, vein-y look that Delilah's has.

But I can't really find what kind. Probably not a "lipoma" because "Rabbits don't typically get this type of tumor that is composed of fatty tissue. Lipomas can be found all over the body and are usually softer or more "squishy" than other types of tumors." and Delilah's is not squishy in the slightest. I'm actually having a great deal of trouble with google images because anything about tumours or masses keeps bringing up abscesses, anything about tumours at all brings up papillomavirus... And the one picture that actually did look exact (on medirabbit) didn't specify what type of neoplasia it was. Neoplasia just means that something abnormal has grown, and is considered synonymous with "tumour". Sigh.

I found a chart from an academic journal article for types of cutaneous neoplasia in rabbits but none of them look right. (https://ai2-s2-public.s3.amazonaws....076763d8f813f7b2bf46a908aecee0/9-Table2-1.png) The trichoblastoma looks closest but it's very lumpy looking, Delilah's is almost perfectly spherical with a rather small attachment to the skin compared to the maximum circumference of the growth.

One question I do want to ask... someone in my family asked me why I wanted to get the tumour tested. "Uh, so we know what causes it and if it's going to try to grow back?" And since my whole argument is that it's better to pay $100 for testing now than $500 a second time later if it grows back, they asked me how testing would accomplish finding that out and moreover what they would do about whatever test results come back. O_O Well gee I'm in school to be an animal care assistant not an animal care technician, that's a little above my paygrade! But I actually have no idea further than knowledge is power and I'd rather have some idea of what to expect than to just cross my fingers and hope the surgery solves everything.
 

Stinkerbunnies

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OMG! I hope she is all right! Please keep us updated. My bunny might have the same problem. I was petting him, and I noticed a raised area on his back. We are going to get it checked out as soon as possible. Hopes for Delilahs quick recovery.
 

Popsicles

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Let us know how she gets on! I agree with you that testing is the best option though - when performing histopathology (which I assume is the testing they are going to do?) they will be able to tell you if the tumour was completely excised and if there was any “left behind” to grow back. They will also be able to give an idea of where the tumour came from in the unlikely even that it is a metastasis. Hopefully they will also confirm that it is a benign tumour which will be a win, even if it does grow back you know you don’t have to worry :) hope she is okay and keep us updated! I’m a vet Student so everything I read on here almost feels like a case study haha, very interested.
 

Liung

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@ladysown no, an abscess in the skin is usually caused by a wound getting infected, and there's no lesion here. Abscesses are the result of thick pus accumulating in an infected area, so they are usually seen as an area of swelling, with the skin angry and inflamed were it's still intact; whereas this resembles a huge skin tag more than anything else: a large growth with a small base where it attaches to the skin. The thought of it being an abscess never even crossed my mind, it's too well-formed and distinct.

Cancer/tumours, on the other hand, are something in the DNA of a cell going wrong and it loses its limiter on how much it should reproduce/on doing its actual job. So to simplify it by a lot... the cells just start going nuts, growing wildly and inappropriately. So that would be why Delilah's lump has blood vessels in it: it's her own body growing in abnormal ways, and her circulatory system is getting dragged into supplying it and keeping it alive.

That nature of cancer is why it's so hard to treat nonsurgically: it's your own cells, so how do you create a treatment that targets only cancerous cells instead of healthy cells as well? Generally, you can't. That's why cancer patients are so **** sickly: the treatment is killing them. You can target the treatment: injecting chemotherapy into the area of a tumour, aiming radiation in a narrow focus only at the tumour... but healthy cells get in the way. Treating cancer nonsurgically is a three-way race between what dies first: the patient from the cancer, the patient from the treatment, or the cancer from the treatment. Obviously that's not great odds for the patient, so cancer research is mostly aimed not at "curing" cancer, but at increasing the effectiveness and survivability of the treatment. And of course since it's just cells reproducing wildly, if you don't get them all it can just come back. Surgical removal is great... as long as the tumour is localized. "Cancer" specifically refers to abnormal cells that don't stay in one spot. If it's a single mass that just grows without spreading, it's benign.

For example, moles are considered skin tumours, but they're completely benign, don't grow much, and are essentially just cosmetic problems. It's a collection of skin cells with melanin in them that aren't necessarily supposed to be there but aren't hurting anything. Cancerous skin tumours is when what looks like a mole is changing, growing, and spreading out into more skin or down deeper into the skin.

So, if this is a benign growth, removing it will solve all problems. Fingers goddamn crossed.

Very interestingly, I work in a research facility, and there's a researcher that's looking at reprogramming viruses. Viruses are basically organic computers that work by finding cells, injecting their programming into the cells, which wipes out the cell's normal DNA and rewrites it into a factory that creates more viruses (this is why viruses aren't considered alive, they don't reproduce on their own). So viruses do actually specifically target certain types of cells, and if someone could get a virus to target only cancerous cells... and last I heard this researcher is having some promising results.

Ahahah hope you enjoyed my mini-lecture the surgery is tomorrow morning as is the due date for a major course assignment I'm unbelievably stressed and sleep-deprived and that means word vomit and babbling.
 

Liung

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@Popsicles I'm a college student in an Animal Care Assistant program... step below Vet Tech, essentially, but more generalized with training for things beyond clinics like shelters, wildlife sanctuaries, zoos... in my case I'm working in a research facility. So we learn about diseases and testing but there's a whole lot of "if you want more detail go to vet school".

So a few weeks ago in my Lab Ops course we covered hematology, since ACAs could be asked to do blood smears and CBCs, so we had to learn the different types of RBCs and what it means to observe immature cells in the smear, and learn to recognize different types of WBCs... at the end of class I asked my prof, are they also stages of maturity? No, but they have different functions, different types for different jobs. Oh, I said, so you can tell what an animal's sick with by looking for what WBCs it has! Exactly; but if you want to know the specifics... go to vet school.

She didn't include that as part of our lecture. It's a college program: we are taught exactly enough to be able to do our jobs, and not much more than that. So it meant that in the other post mentioned about Delilah's tears, someone said "did your vet do a smear of the tears?" And I had no bloody clue what they meant until they mentioned that rabbits had heterophils instead of eosinophils. HEY I KNOW THAT WORD~!! And it's only because I specifically questioned why different types of WBCs in a smear mattered that I understood the significance of that.

So my diseases and emergencies class covered common cancers and causes/preventions... but not at all how to treat them. Because as ACAs we might be called upon to do client education but treatment is way above our pay grade.

I have just enough of an education to try and research this stuff and actually be able to read the dense medical terminology in the actually good sites... but not quite enough education to fully understand what it means. Hahh. It doesn't help that the medical community is super insular; I've if the found that you're completely blocked from nearly anything not intended for patients if you're not a medical professional. Had to try and look up the actual meds given to patients with FLUTD and it took literal hours to find something that gave proper brand names and dosages.

I'm babbling again. Stressssss.

The point I'm driving at here: I understand how testing could show if a tumour is part of a metastasis (I assume it's because if you find liver cells in a skin tumour you get to conclude the skin tumour didn't start there) and I think I can understand how you would tell if it was benign (maybe you'd look to see how many cells were in the process of replication, in a normal or benign tissue sample I'm guessing the number would be pretty low whereas a malignant sample would be "most of them"??) but how on earth would you test a tumour to see if any was left behind?

I'm also super concerned because the most detailed result I found on what testing a tumour would involve said "Often, tissue arrives in the pathology laboratory in formalin or other fixatives. At that stage, it is already too late to perform many special studies... (therefore it's important to know ahead of time what testing will be needed)" which had me alarmed because the vet specifically said he would give it to me in formalin??? So should I have a list of things I want him to do to the tumour before he puts it in formalin??

I just don't knooooooow. And there was a massive ice storm here that kept me home so I didn't even get the chance to go to the OVC this week to ask around for a pathologist.
 

Popsicles

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Yeah you’ve got it all worked out pretty well, seems like you know more than you think you do haha. Usually when a tumour is removed we try and take a margin of a few centimetres to ensure there is none left behind, which when performing histopathology (looking at sections of the biopsy under a microscope) we should be able to see an “edge” to the tumour and hwalthy tissue surrounding. It’s not a definitive way of checking but it has been proven to reduce recurrence if there is a proper margin taken.
As far as I know, formalin won’t affect the ability of a pathologist to stain and section, and then view the sections on a microscope. It will almost certainly be sufficient for basic staining to look at what cell type is present, if not for complicated immunohistochemia staining. I’ll have a look into that to see if I find anything to the contrary.
If you have anything you do read and don’t understand, feel free to PM me and I’ll see if I can help :)
 

Popsicles

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I have spoken to some colleagues and they agree that formalin shouldn’t affect testing - it just preserves the architecture of the tissue so you can look at it accurately under the microscope. The only thing it would affect is bacteriology or virology, but as this is probably a tumour all the testing you’d need to do is still possible from a preserved specimen. My dissertation involves tissue from horse lung preserved in formalin and in paraffin blocks - it is still possible to stain and view on a microscope. Hope this helps.
 

Liung

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Took me a while to get back because my semester was ending, trying to organize meds around exams, whew!

I talked to my vet about where he would have the tumour tested, and he said he would send it to Histovet. I learned about that in my Lab Ops lecture on external laboratories, my teacher saying they were the best... but when I looked them up myself the website said they were a small company that deals primarily with cats and dogs. So I talked to my coworkers in Guelph, who recommended the Animal Health Laboratory. They do all the testing for... everything, pretty much. However, they don't accept samples from the public, and don't make their fee schedule public.

So while in Guelph I went in to talk to them in person! They confirmed that they can't accept a sample directly from me, and that I'll have to get the prices from my vet... but they assured me that if I were to send Delilah's tumour to them, the pathologist that examined it would be one who specialized in rabbits. So that makes me think that, unless the price difference is truly significant, I'll have it sent to the AHL rather than Histovet.

The day of the surgery was super stressful, I dropped her off at 10am before going to class, and then coming back after class at 1pm... I was willing to just wait and do homework until I could take her home, until the receptionist said "yeah, it won't be for another couple of hours! She's in surgery right now. We had an emergency come in this morning so we're running really behind."

So I had to go home and try not to vibrate out of my skin until I finally caved around 5pm and called them, and they said it was fine to come and get them.

The tumour was solid, unfortunately... they showed it to me.

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Ugh, it's so horrible! They also gave me an impression slide to look at during my Lab session that Friday. I had an actual blood smear to look at to focus the microscope first, and ended up looking back at it after I took my first look at the impression slide to double check that what I was seeing wasn't normal... the cells look WEIRD. The shapes are all wrong, weird and blobby, I asked the prof "what could it mean that the cells look like they're exploding??" But she said it could just be because we weren't using mineral oil and cover slips.

Because it was so late, the vet had already gone home, but he was going to call me the next day to talk about his findings, so I just got discharge instructions and her pain meds and antibiotics.

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My poor baby!! She looks like a plucked chicken! The stitches on her neck are internal, but even so I watched and she can't lick at it without the fur around it folding over and blocking her. But she can reach it with her back foot, so I've been watching carefully to make sure she doesn't scratch. I don't know what he did to the one on her back; he said beforehand that it was so small he'd probably use glue instead of stitches. And she definitely can't reach that, she's too fat.

And I don't know because the next day, he called me as I was leaving for my class! I told him when class would be over, but he said he'd have left by then, but to call the clinic and they'd let him know that he could call me from his cell phone.

And I haven't heard from him! I called the clinic again to ask what was going on, but they said he's gone and won't be back until sometime next week!! Ugh. I'm assuming there's no bad news or he would have made sure to leave a message with the clinic to pass on if he couldn't tell me himself, but still.

I don't have any current pictures of the incision site but Delilah's doing well. She's even getting better at taking her meds! She is convinced that anything put in or even near her mouth against her will is deadly poison, and generally reacts accordingly. But she's only bitten someone once so far! And hasn't tried peeing on anyone yet, so I'm calling it a win.
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I'll letcha know when I find out more. But once I do get the tumour sent to a lab, just preparing the sample for testing will take them a few days (the main reason I'm annoyed that I can't get a hold of the vet.)
 

Popsicles

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That’s so frustrating that you keep missing the vet, But hopefully that means it isn’t bad news, like you said. If you were able to get a pic of your impression smear down the microscope I’d be interested to take a look? I’m not too bad with cytology. You are right though, if it is a poorly prepared smear it is possible to crush the cells, which would make them look like they are exploding. The wounds look nice and it’s good she isn’t able to get to them. She looks pretty happy in that last picture :)
Glad the surgery went okay anyway, and do let us know what the vet says! Got my fingers crossed for you!
 

Liung

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I'm in Canada. Guelph is the #1 place for veterinary services in Ontario, so how fortunate it is that I'm moving there!

And I only have the slide, I don't know if I have access to a microscope that can take pictures like that. Otherwise I totally would!

Got a call back from the vet just now. He'll take a look at the fee schedule for the AHL—he agrees that they're much more specialized than Histovet, he says when he went to the OVC he remembers them taking samples from the zoo, elephants and stuff.

Unfortunately he did have some bad news for me... her eye (the reason she was brought into the clinic in the first place) was not able to be flushed. "Anything I tried backfired on me" were the words he used. Her right eye is completely blocked and he couldn't get anything through it at all. Her left he thinks he got a little through but it is also nearing blocked.

And with that attempt, he's pretty much reached the limit of his expertise and equipment. He could do an X-ray but even if he found a tooth root causing the blockage he hasn't got the equipment to do a rabbit extraction. His only advice is to continue massaging, watch for skin irritation from the tears, and for pink eye. Management, not treatment. My main concern though (and I'll try to remember to ask when he calls back about lab fees) is whether it will interfere with her breathing at all.

Delilah got to go on an outing with me yesterday, she's looking happy and energetic and healing really well, even if her fur is taking its sweet time growing back in! I was a little worried about her Y front harness rubbing at the incision but it didn't seem to be too badly placed and there was no irritation that I could see. And of course going out to see people and receive worship made her super happy! (She LOVES meeting new people)

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Popsicles

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There is no way I would accept that answer from your vet! It’s highly possible it IS a tooth root causing the problem, which can be fixed by a competent vet. At the very least she needs a dental where they can burr down the problem teeth. If he doesn’t feel comfortable can you ask him to refer you elsewhere? The watery eyes are probably only a secondary issue, and the primary dental issue is much more serious.
I’m glad she is healing well from the op though! She looks really good! (And so cute in her little bag hahaha)
 
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Popsicles

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Also the fact that he couldn’t flush it highly suggests an obstruction such as a tooth root. Please take her to be checked by another vet, preferably one who deals with rabbits often.
 
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