Let me first caveat this article by saying this is a case study with a sample size of one. It may or may not be relevant to anyone else facing hemangiosarcoma, but as there were no side effects to the treatment and Millie has outlived her prognosis with a good quality of life, at the very least this is worth discussing with your veterinarian.
Hemangiosarcoma is typically a very aggressive cancer with a poor prognosis (Kitchell, 2008) (Phillips, n.d.) (Wendelburg, et al., 2015). The average time from discovery of the cancer to death is only 6-8 weeks (Wendelburg, et al., 2015). It metastasizes quickly and since it is a cancer of the blood vessels, it can go anywhere in the body. The most typical presentation is called visceral: a tumor on the spleen (most common location), or one on the heart (second most common location), or any other internal organ. It is often not caught until the tumor starts to bleed and is therefore known as a silent killer, as there are few symptoms before a massive hemorrhage. There are two other types of hemangiosarcoma: cutaneous or dermal, which is literally in the skin and may be cured surgically, and subcutaneous or hypodermal, which is below the skin but not in the internal organs. The latter is the most unusual presentation of the disease, and it’s the one Millie has.
Millie is 7 and intact, although I don’t think that makes any difference. Her cancer initially presented as a large lump on her neck/shoulder. Both my vet and the surgeon we consulted expected it to be a mast cell tumor, which has a good chance of being cured surgically if the surgeon gets clear margins and it hasn’t metastasized (Clinical Oncology Service, Ryan Veterinary Hospital of the University of Pennsylvania, n.d.).
She had her surgery at the end of June, 2018. Her tumor had grown into her muscle and was large. To everyone’s surprise, the pathology report showed hemangiosarcoma. The surgeon did get clean margins. The concern was that it might already have metastasized, although a quick ultrasound of her spleen (the most likely site for a tumor) showed no gross tumors.
Needless to say, this was devastating news. I knew how serious this cancer diagnosis was. I began my research.
We consulted with an oncologist who recommended chemotherapy, but also two Chinese herbs: I’m-Yunity (a mushroom derivative) and Yunnan Baiyao, which a friend had also suggested I look into. The former has been (Brown & Reetz, 2012) and is (University of Pennsylvania, n.d.) currently being studied at the University of Pennsylvania as a treatment for hemangiosarcoma after a splenectomy and in conjunction with chemotherapy (Millie did not qualify for this study as she still had her spleen). Yunnan Baiyao has been used for decades to control bleeding (Wirth, Kow, Salute, Bacon, & Milner, 2016). The exact mechanism is still a mystery, as are the exact ingredients, but it has been used in both humans and animals. The oncologist said to start her on the I’m-Yunity immediately and then start the Yunnan Baiyao if she developed another tumor. He gave her 6-9 months with chemo and the herbs; maybe 3 months without the chemo. From his report (my emphasis added):
“Millie has been diagnosed with subcutaneous hemangiosarcoma based on the biopsy results from surgery. This is an aggressive tumor that develops from blood vessels and stem cells. Large and invasive hemangiosarcomas typically have a behavior similar to that of splenic hemangiosarcoma. Unfortunately, this means Millie’s hemangiosarcoma is expected to spread within her abdomen, lungs or other more uncommon sites (heart, brain, and others). These sites of spread can bleed and cause sudden weakness or collapse. Additionally, they can cause poor appetite, low energy, and breathing changes.
The tumor itself may regrow and this can cause pain, swelling, bleeding or became an open wound. This risk is lower because of the complete margins accomplished by her surgeon, but not zero. Because of spread or problems with her local tumor, Millie would be expected to live about 3 months without chemotherapy. The addition of chemotherapy on average extends a dog’s life by an additional 3-6 months. Some dogs like Millie with subcutaneous hemangiosarcoma will have longer and better responses than expected.”
Because she had a sibling who also had hemangiosarcoma and developed heart problems due to the chemo, we opted not to go that route. It also would have meant close to half the time she had left would have been spent in treatment, with who knows what side effects. The cost/benefit analysis just didn’t make sense in this case. While hemangiosarcoma can respond to chemo, it appears to increase short-term survival but not long-term survival (Wendelburg, et al., 2015) (Vucenik & Shamsuddin, 2003).
The recommended dosage was 10-14 capsules of I’m-Yunity daily, split into two doses (she weighs about 125). We chose to go with the lower dose simply because it was easier to manage quantities that way. The I’m-Yunity website recommended the higher dosage, but since the oncologist gave us a range we felt safe staying within that range. (Note: there are other supplements which contain Turkey Tail mushroom, which is what I’m-Yunity is derived from. We have chosen to stick with the “name brand” but many people on the Facebook group report similar results with other products, such as Host Defense Turkey Tail, which are significantly lower in cost.)
After 4 months at this dose Millie was still acting normal. Eating, playing, running in the field with wild abandon. An echocardiogram in October showed her heart to be free of gross tumors. Thinking that this was about how long she would have been undergoing chemo, we decided to drop her down to a maintenance dose of 2 I’m-Yunity daily, which she is still taking. Note that this “maintenance dose” was not recommended by anyone; we were taking a stab in the dark, in essence. We were reluctant to take her off the I’m-Yunity entirely since she seemed to be doing so well, but if it’s killing cancer cells we thought it should have done the bulk of its work already.
After 8 months, still acting normal, Millie developed a lump on her hock. We assumed it was the cancer and started her on Yunnan Baiyao. I also joined a canine hemangiosarcoma group on Facebook which recommended additional supplements. After some research we added a supplement called IP 6 plus inositol, which has also been shown to kill cancer cells in vitro (Vucenik & Shamsuddin, 2003).
At 10 months the lump/tumor seemed to be growing and she was slowing down in her activity level, so we added yet another cancer-killing supplement, graviola (Qazi, et al., 2018). We shall see what effect that has, if any. After 3 weeks all I can say is that the tumor hasn’t gotten any larger since we started the graviola.
Millie is still a happy dog, although she is starting to show some rear end issues, which may or may not be related to the cancer. She has outlived her prognosis and has suffered no side effects from the supplements we are giving her. The odds are still against her winning against hemangiosarcoma in the long run, but for now, she is enjoying life and we are very grateful for every day we have with her.
I hesitate to say that the supplements have prolonged her life, but then I can’t say they haven’t. I am impressed enough with her longevity and quality of life to want to share her story, and my research, in case anyone is facing a similar situation and wants to investigate using one or all of these supplements.
Brown, D. C., & Reetz, J. A. (2012). Single Agent Polysaccharopeptide Delays Metastases and Improves Survival in Naturally Occurring Hemangiosarcoma. Evidence-based Complementary and Alternative Medicine, 2012, 384301-384301. Retrieved 4 29, 2019, from https://hindawi.com/journals/ecam/2012/384301
Chaikin, P., & Welihozkiy, A. (2018). Hemangiosarcoma in a Dog: Unusual Presentation and Increased Survival Using a Complementary/Holistic Approach Combined with Metronomic Chemotherapy. Case reports in Veterinary Medicine, 2018, 1-6. Retrieved 4 29, 2019, from https://hindawi.com/journals/crivem/2018/6160980
Clinical Oncology Service, Ryan Veterinary Hospital of the University of Pennsylvania. (n.d.). Mast Cell Tumors in Dogs. Retrieved from University of Pennsylvania: https://www.vet.upenn.edu/docs/default-source/ryan/oncology-handouts/final-canine-mct.pdf?sfvrsn=4
Kitchell, B. E. (2008). Advances in Hemangiosarcoma Treatment. Retrieved from Veterinary Information Network: https://www.vin.com/apputil/content/defaultadv1.aspx?id=3866584&pid=11268&
Phillips, B. D. (n.d.). ACVIM Fact Sheet: Hemangiosarcoma. Retrieved from American College of Veterinary Internal Medicine: http://www.acvim.org/Portals/0/PDF/Animal%20Owner%20Fact%20Sheets/Oncology/Onco%20Hemangiosarcoma.pdf
Qazi, A. K., Siddiqui, J. A., Jahan, R., Chaudhary, S., Walker, L. A., Sayed, Z., . . . Macha, M. A. (2018). Emerging therapeutic potential of graviola and its constituents in cancers. Carcinogenesis, 39(4), 522-533. Retrieved 5 5, 2019, from https://academic.oup.com/carcin/article/39/4/522/4859483
University of Pennsylvania. (n.d.). Clinical Trial - HEMANGIOSARCOMA - Supplement for Dogs with Cancer of the Spleen. Retrieved from University of Pennsylvania: https://www.vet.upenn.edu/research/clinical-trials-vcic/all-clinical-trials/further-evaluation-of-the-benefits-of-a-traditional-chinese-medicine-supplement-for-dogs-with-splenic-hemangiosarcoma
unknown. (n.d.). Canine Cancer Library: Hemangiosarcoma. Retrieved from National Canine Cancer Foundation: https://wearethecure.org/learn-more-about-canince-cancer/canine-cancer-library/hemangiosarcoma/
Vucenik, I., & Shamsuddin, A. M. (2003). Cancer Inhibition by Inositol Hexaphosphate (IP6) and Inositol: From Laboratory to Clinic. Journal of Nutrition, 133(11). Retrieved 4 29, 2019, from https://ncbi.nlm.nih.gov/pubmed/14608114
Wendelburg, K. M., Price, L. L., Burgess, K., Lyons, J. A., Lew, F. H., & Berg, J. (2015). Survival time of dogs with splenic hemangiosarcoma treated by splenectomy with or without adjuvant chemotherapy: 208 cases (2001–2012). Javma-journal of The American Veterinary Medical Association, 247(4), 393-403. Retrieved 4 29, 2019, from https://avmajournals.avma.org/doi/full/10.2460/javma.247.4.393
Wirth, K., Kow, K., Salute, M. E., Bacon, N. J., & Milner, R. J. (2016). In vitro effects of Yunnan Baiyao on canine hemangiosarcoma cell lines. Veterinary and Comparative Oncology, 14(3), 281-294. Retrieved 4 29, 2019, from https://ncbi.nlm.nih.gov/pubmed/24976212