Female Rabbit that has cancer

Question
QUESTION: Hi Dana:

I have a wonderful 4 year old female Bunny named "Fluffy."
She is a Holland Lop. I brought her home from Angell Memorial Hospital in Boston after she BEAT KIDNEY FAILURE and was in a time since she had been there that they felt she was at the top of her game for surgery. I know and was told by the Dr. that rabbits do not tolerate chemo the way cats and dogs do. This little bunny is our life and she loves us as much as we love her. I have the results of the Histology Report and I am scheduled to take her in on Saturday for her follow up check up after surgery and to discuss what they think will be the next course of action.
I will know on Saturday what the Oncologist said but in the meantime here is the lab results that the Dr. gave me over the phone. I will fly her anywhere if someone has a "cutting edge" treatment or if you know what they might be able to do that might save her. She is a fighter and I know because she and I love each other that that has helped tremendously. Her lab report stated that she had three types of tumors. Uterus had cancer cells that are caused by a hormonal imbalance and I was told that there is a part of the Uterus that they have to leave behind. The chances are that the part, I think the Vet called it a "stub" has cancer cells in it. There were Leudeomas (spelling?) areas and changes in her ovaries. Everything except that one part in the uterus was removed. They also found during the initial testing that she had a mass in her Mammary Tissue - that was removed during surgery as well and the test results were that it was a Carcinoma. Initially, she was fine one day and the next morning she was not standing up and waiting to give me bunny kisses when I fed her. Because her Xrays, Ultrasound and the fact that she was in Renal Failure and that she might have an Intestinal Blockage that they felt it would be best to put her down. I told them she was very loving and that she loved me and we are so bonded that I wanted them to try to get her kidneys going again and then make any further decisions after we see what happened with her kidneys. Well, she pulled out of it and went from the Critical Care Unit back to the Exotic Ward where she remained until her surgery and went back after her surgery. The hospital is wonderful and between Fluffy fighting and they working so hard to hopefully get her well enough for surgery it all came together.
I have no clue until I see the Dr. on Saturday what the Oncologist may have told the Dr. after reading the Histology Report. But, leaving nothing to chance, I wanted to find someone or some place that may have suggestions for treatment, etc. Fluffy has been eating everything I give her and her Kidneys are continuing to function well and she is passing normal fecal pellets. Her Intestintal tract came back on its own before the surgery and as far as I know, there was nothing suspicious in the way of cancer in that area so, it may have been a shadow on the Xray or partially hidden by her Uterine Tumor. I am not a Dr. or Vet so I can't say for sure. But, she is doing fine, hopping around and eating and drinking water and it was only a week ago today that she had her surgery. SO, hopefully, you may have some suggestions for treatment and/or how to handle her situation. I think if love can pull her through, which it did, then I want to believe that love and some "cutting edge" suggestions or treatment that she might tolerate can cure her! Hopefully, you will read this and offer some suggestions that I might be able to share with the Doctor at the Hospital when I take Fluffy on Saturday. Again, if I have to fly her somewhere where they are fairly sure that they can treat her or even see if they can tell if that part of her uterus DEFINITELY has cancer cells in it that is where I will go! I know that her cancer spread from one area to the other but they removed everything and as far as I know, they got it all with the exception of not knowing but, I would think because she did have Uterine Cancer, if she has cancer cells in the part they had to leave in.
I will thank you in advance for your time and knowledge.
Sincerely,
Billie

ANSWER: Dear Billie,

Fluffy is lucky to have such a caring mom!

Before I make any suggestions, I wanted to make sure I'm understanding this correctly:  Fluffy had both uterine adenocarcinoma, some evidence of hyperplasia (pre-cancer) in the ovaries, as well as mammary cancer.  From your note, it sounds as if all the lesions were successfully removed, that she had a complete ovariohysterectomy, and that the affected mammary gland was removed, apparently with the tumor intact.

If that's correct, then what I'll say next will make sense.  If that's not right, then please write back and correct me so I can try to give you accurate information.

The three main things you described are all interrelated, and these types of cancers tend to be estrogen sensitive.  This means that if her ovaries were removed, that alone will drastically reduce her chances of recurrence, though nothing is ever 100% sure with cancer.

The most common place for uterine adenocarcinoma to metastasize is to the lungs.  In rabbits of her age that have had this cancer, it's recommended that a chest radiograph be done to determine if there are any lesions in the lungs.  In most cases, if the cancer was removed relatively early, this has not happened.  This type of cancer is one that apparently does not spread quickly.

Although it is possible for the uterine stump to contain some cancer cells, there's no way to know if they are there without actually removing the stump and sending it off for biopsy.  In the cases I know of in which a cancerous rabbit uterus has been removed, there have been no recurrences at the stump.

If chest radiographs are clear, and if the vet believes that all cancerous tissues were removed with good margins, then your brave bunny's prognosis may actually be quite good.  I would *not* pursue chemotherapy or radiation treatments if there is no evidence of cancer, particularly because chemo drugs have not been well studied in or developed for rabbits.  The doses are too high, and although I know of a good number of people who have *tried* chemo on their rabbits, every one of them died from the chemo (and their quality of life may also have been reduced because of the harshness of the treatment).

In short, if the tumors have been removed, and she has had a complete ovariohysterectomy, and her lungs are clear, I would adopt a "wait and see" strategy.  If it ain't broke, don't fix it!

If you are not sure that the vets you are seeing are very experienced with rabbits, and think they may be interpreting Fluffy's condition as if she were a dog or cat, then it might be a good idea to find an experienced *rabbit* vet for a second opinion.  You can find one here:

www.rabbit.org/vets

But I hope she'll be fine, and suffer no other health problems again.  It seems she's already had her share!

Take care,

Dana



---------- FOLLOW-UP ----------

QUESTION: Dana,
Thank you for your very thorough reply. I wanted to tell you that, as far as I know, the only place it spread to was her mammary gland. They did Xrays, etc., and no one has mentioned anything about her lungs being affected.
Angell Memorial Hospital and the Exotic Vets that they have there is just an unbelievable hospital. They saved her life with a little "push" from me to do so. I know when I brought her in she was so sick that they thought that I would still lose her even if her kidneys did start to function again.
If you ever get anyone looking for a Animal Hospital that is run exactly like a "people" hospital with an Exotic Vet on the premises seven days a week, Angell Memorial is fabulous and the Vets and Techs are very dedicated. Most people may associate this hospital with Animal Adoptions as it is part of the MSPCA-but, the day I found Fluffy sick, two local Vets recommended that I take her to them. I have to thank those Animal Clinics as well as I too, associate it with Animal Adoptions! They are set up for everything. They even have operating rooms in a whole different area of the hospital.
Thanks again. I am going to take your reply in with me tomorrow and go over it with them.
I HIGHLY recommend this website and FYI, I HIGHLY recommend Angell Memorial Hospital. They treat all types of Exotics with a whole separate Exotics area and Vets that specialize in them. If any one of my other bunnies gets sick, I am going to take them right in to Boston - no more local vets for me!


Answer
Dear Billie,

Thank you for the information on Angell hospital.  If you would be so kind as to send me their address and contact information (send to dana@miami.edu), I'll send it on to the Boston House Rabbit Society folks to be sure they're added to the web site, if they're not already on it.

Sending lots of healing thoughts for you and Fluffy!

Take care,

Dana