A veterinarian from Caring Pathways performs an in-home hospice examination of Jake, a Great Dane-labrador mix. The owner helps restrain and comfort Jake while the veterinarian does a thorough oronasal examination. Photo courtesy Josh Lewis, Caring Pathways Nasal tumors in dogs represent a significant clinical challenge for both practitioners and clients. Not only can the clinical signs be difficult to manage, but depending on type, location, and progression of the disease, treatment options may be limited. Most nasal tumors in dogs are diagnosed as adenocarcinoma,1 although other histological types do occur. While the exact cause of nasal adenocarcinoma is considered idiopathic, there appears to be an increased incidence with exposure to airborne pollutants, such as tobacco smoke, kerosene, and coal combustion. Therefore, nasal adenocarcinoma is more commonly diagnosed in urban areas. Additionally, a higher incidence is appreciated in older, large-breed dogs with elongated noses, such as German Shepherds and Collies, although any breed can be affected. Nasal adenocarcinoma originates from the glandular tissue of the nasal passages. While the etiology remains unclear, it is locally aggressive and can obstruct nasal passage and nostril airflow. Due to the proximity of the nasal cavity to the eyes and brain, it can also invade these structures, complicating the clinical picture. Symptoms, diagnosis, and prognosis Clinical signs can vary in presentation and severity, but common early symptoms may include: Persistent nasal discharge Sneezing and nasal congestion Expistaxis Dyspnea Snoring A patient with mid-to late-stage symptoms may also demonstrate: Lethargy and decreased energy levels Decreased appetite and weight loss Ocular discharge and vision problems Disorientation, circling, and seizures Facial swelling or deformity Inability to breathe through the nostrils Extreme difficulty sleeping due to nasal obstruction A thorough investigation, including screening for nasal neoplasia, for patients presenting with any of the above clinical signs is crucial for disease detection and intervention. Diagnosis typically involves a combination of physical examination, imaging (such as radiography and CT scans), and biopsy to confirm the presence of malignant cells. By the time a diagnosis is made, most dogs have shown symptoms for several months due to the nonspecific nature of early signs. Without treatment, the survival time for dogs with nasal cancer is typically three to five months post-diagnosis.1 Even though radiation therapy is the preferred treatment, it may not be feasible for all clients due to accessibility, cost, or health status of the patient, making symptom control and comfort care paramount. Nasal tumors in dogs pose a clinical challenge, with difficult-to-manage signs and limited treatment options based on type, location, and disease progression. Photo courtesy Josh Lewis, Caring Pathways Treatment options The following remedies are available for nasal adenocarcinoma, but some may not be a fit for every patient or every client. Radiation therapy. Considered the gold standard for treating nasal tumors, providing excellent local control and symptom relief. The average survival time with radiation therapy is around 12 months, ranging from six to 18 months, depending on factors such as early intervention, response to therapy, and tumor aggressiveness. Chemotherapy. This is used in conjunction with radiation or as a standalone treatment to manage systemic effects and control tumor growth. Symptom management and pain relief. Critical for improving or maintaining quality of life, options include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and other analgesics tailored to the individual patient̒'s needs. Surgery. Rarely recommended due to the complex anatomy of the nasal passages and the invasive nature of the tumors. Decisions are made on a case-by-case basis. l The role of palliative care Palliative care in veterinary oncology focuses on alleviating pain and discomfort, enhancing quality of life, and providing emotional support for both pets and their owners. It can be integrated at any stage of the disease, either alongside curative treatments or as the primary approach when curative measures are not viable. Alleviate pain and discomfort in oncology patients through palliative care. Photo courtesy Josh Lewis, Caring Pathways Key components of palliative care Pain management. Effective pain control is essential. Analgesic regimens often include NSAIDs, opioids, and adjunctive therapies to ensure the pet’s comfort. Symptom control. Addressing symptoms, such as nasal discharge, appetite changes, and weight loss through medications and supportive care is vital. Nutritional support. Maintaining adequate nutrition is challenging but crucial. Appetite stimulants and specialized diets can help ensure dogs receive the necessary nutrients. Emotional support. Providing emotional support to pet owners is as important as treating the pet. Counseling, support groups, and resources can help families navigate the emotional complexities of caring for a terminally ill pet. Benefits of palliative care Improved quality of life. By focusing on symptom management, palliative care enhances the pet’s comfort and overall well-being, allowing them to engage more fully with their families. Extended survival time. Pets receiving palliative care often live longer with a better quality of life compared to those without such care. Enhanced bonding. The palliative care journey fosters a deeper connection between pets and their owners through attentive and compassionate care. Reduced stress. Comprehensive support and guidance alleviate the stress associated with managing a pet’s terminal illness, providing peace of mind for pet owners. Empowerment in decision-making. Palliative care empowers owners to make informed decisions about their pet’s care, ensuring their needs and preferences are respected and carried out. Nasal tumors in dogs present significant clinical challenges, but with a comprehensive approach that includes early detection, appropriate treatment, and palliative care, veterinarians can significantly enhance the quality of life for affected pets and clients. Palliative care, focusing on pain management, symptom control, nutritional support, and emotional well-being, provides invaluable support, allowing families to cherish their time with their pets and ensure their comfort and dignity until the end. Chelsea McGivney, DVM, attended veterinary school at the Colorado State University. She has practiced general medicine, emergency medicine, as well as at-home end-of-life veterinary care. Currently, Dr. McGivney is the general manager of Caring Pathways, a multi-practice at-home end-of-life veterinary company focused on providing compassionate hospice and palliative care, as well as in-home euthanasia at life’s end. Reference Rassnick K. M., Goldkamp C. E., Erb H. N., et al. Evaluation of factors associated with survival in dogs with untreated nasal carcinomas: 139 cases (1993–2003). Jour Am Vet Med. Assoc. 2006. 229: 401–406.
