Finding and Treating the Big C and Other Lumps

 

In This Chapter

•  Surveying the top three ferret cancers
•  Identifying and removing skin tumors and chordomas
•  Reviewing your treatment and manageability options

Unfortunately, whether you own one ferret or ten, you’re likely to encounter ferret cancer during your time as a ferret owner. The three most prevalent cancer conditions are adrenal disease (which may or may not be cancerous), insulinoma, and lymphosarcoma. Symptoms and treatments vary, as well as prognoses.

As you’ll see in this chapter, the Big C diagnosis is rarely an immediate death sentence. Many cases are treatable. Others are manageable, and your ferret may live a few more quality years after the diagnosis, with or without ongoing medical intervention. However, early detection and treatment are instrumental in adding quality months or even years to your fuzzy’s life, so you need to watch for changes in your fuzzy’s appearance, habits, and behavior. A good vet will trust your judgment that something isn’t quite right with your fuzzbutt (see Chapter Setting Up Your Ferret’s Health Plan: Vets and First-Aid Kits for tips on finding a good vet). In this chapter, I discuss the three main types of ferret cancer. I also discuss chordomas and skin tumors.

Adrenal Gland Disease

Everyone has adrenal glands, including ferrets. These tiny organs are located very close to the kidneys. In a nutshell, adrenal glands produce extremely important hormones that help regulate blood glucose levels and electrolyte levels, increase musculature, and help the ferret in times of stress. Different areas of the adrenal glands are responsible for producing different hormones. For instance, small amounts of sex hormones, or “sex steroids,” are produced by these glands.

Adrenal gland disease is extremely common in ferrets, but no one knows exactly why. The adrenal glands can start overproducing sex steroids that act the same way excessive amounts of the sex hormones testosterone and progesterone would act. Usually starting out as hyperplasia, the adrenal glands produce more gland tissue, which results in excessive hormone production. As the disease progresses, however, neoplasia (cancer) can develop. Fortunately for ferrets, metastasis, or spreading of the cancer beyond the adrenal gland(s) to other organs, doesn’t happen often.

The disease can strike ferrets as young as 2 years old, but it commonly hits ferrets that are 3 and older. Many theories exist pertaining to the cause:

• Some people suspect the problem has something to do with early neutering, which I define as neutering before puberty or prior to sexual development.
• Others believe adrenal gland disease is caused by the unnatural light cycles that ferrets experience while living in people’s homes. These light cycles differ greatly from what the ferrets would experience naturally in the wild.
• Still others believe that prolonged stress may be a factor. Perhaps the cause is a combination of all these things.

The signs of adrenal gland disease depend largely on which hormones are being produced, the gender of the ferret, and the stage of the disease’s development. Within these factors, the signs may include the following:

• Hair loss on the tail/body

Remember

Hair loss on the tail and/or body is one of the most common signs of adrenal gland disease. However, it doesn’t have to be present for adrenal gland disease to exist. Hair loss can come and go. A ferret may lose all her tail fur only to have it grow back thick and fluffy later on. Some may attribute this phenomenon to a seasonal coat change. It is, however, thought to be the early stage of adrenal gland disease — hyperplasia that temporarily resolves itself. As the disease progresses, hair loss usually starts on the tail and progresses up the body. The hair loss, if adrenal-gland related, is always symmetrical. Sometimes, ferrets lose all but their socks and hats.

• Excessive itchiness, with or without crusts, redness, or flaking
• Swollen vulva in spayed females (see Figure 16-1)

Figure 16-1: Female ferret with swollen vulva caused by adrenal gland disease.

• Aggressive mating behavior (in neutered males)
• Unusual aggressive behavior (in either gender) toward owners or cagemates
• Difficulty urinating for males that develop enlarged prostates
• Anemia in females
• Some muscle thinning, weakness, or a potbellied appearance

Making the diagnosis

Diagnosing adrenal gland disease can, at times, be pretty easy. In many cases, just looking at the ferret is enough. If she’s experiencing serious hair loss alone or if the hair loss is coupled with any of the other common signs, she probably has adrenal gland disease. However, it’s very important that you take your fuzzy to your vet as soon as you notice a symptom of the disease. The unfortunate thing is, a fuzzy can be suffering from adrenal gland disease and show no signs for a very long time. Your vet may get lucky and detect an enlarged adrenal gland during a routine physical examination, but this doesn’t usually happen.

Tip

Because the adrenal glands are so tiny, an ultrasound of the abdomen often will miss the early stages of adrenal gland disease. Running more bloodwork and taking X-rays won’t help in diagnosing adrenal gland disease, either. However, it’s common for a ferret with adrenal gland disease to have another disease present, as well. Therefore, you should consider asking for additional bloodwork and X-rays anyway so that you and your vet can develop a treatment plan that’s suitable for your pet’s special needs.

After you discover some symptoms, you and your vet may opt to send your fuzzy’s blood to the University of Tennessee, where experts can perform a test that’s helpful in diagnosing adrenal gland disease. The experts can perform an adrenal-gland panel to evaluate the levels of sex steroids in your ferret’s system. This is one way to zero in on a diagnosis — especially in cases where the diagnosis isn’t so obvious.

Remember

Many vets will suggest surgically removing the affected adrenal gland(s) without going to extreme diagnostic measures if the major signs of the disease are already there.

Treating the disease

When it comes to treating adrenal gland disease, you have a few options to consider, which may be used independently or together. Many variables will come into play, such as the age and health of your ferret and your financial situation, but undoubtedly your vet will help you decide what’s best for you and your ferret. One option, which is frequently recommended, is surgery. However, some medications may also have a positive effect in treating adrenal gland disease and/or managing its signs.

Surgery

The adrenal gland disease treatment most effective and most often opted for is surgical removal of one or both adrenal glands. Adrenal gland surgery is a fairly common procedure. Your ferret may be a candidate if she’s in good health otherwise and can withstand general anesthesia. Another option is to debulk, or surgically remove, as much adrenal tissue as possible, followed by medical therapy. Post-operative prognosis is pretty good but depends on the tumors present and what else is going on inside the ferret’s body. After the diseased gland(s) is removed, the signs gradually disappear. The ferret’s fur usually grows back, although it can take many months. The fur also may be thinner and a different color.

Tip

Ferrets are prone to developing multi-organ diseases, so when your vet performs an abdominal exploratory surgery on your ferret, ask him to take a good look around inside your fuzzy. Your vet should check the condition of her adrenal glands, pancreas, stomach, intestines, spleen, and kidneys, which only takes a couple extra minutes. Biopsies can be performed on anything suspicious, and your vet can remove anything obvious right then and there. Early detection of disease can prolong your fuzzy’s life and make medical management more successful.

What if surgery isn’t the right option for your ferret? Reasons may include the following:

• Your fuzzy is at an advanced age.
• Your fuzzy has other complicating diseases, such as advanced heart disease.
• Maybe your own fears are preventing you from going the preferred surgical route.

Well, if surgery isn’t an option for you, fuzzies can live up to three years completely untreated. However, your ferret may experience behavioral changes, or other medical conditions may develop, such as prostate problems, as a result of untreated adrenal gland disease. Sometimes her fur will grow back at the next seasonal coat change. But affected ferrets usually lose more hair the next time around. And it may not grow back at all.

Other treatment options

You do have alternative medical options to treat adrenal gland disease — some of which have been used with great results. The following list outlines some of these options and what they can do for your sick fuzzy: (Note: Not all adrenal ferrets are candidates for alternative treatments. Speak with your vet about what’s right for your furkid.)

• Medical therapy alone is an alternative treatment option.
• Lupron depot (the long-acting lupron), also known as Lueprorlin in Europe, is currently the most widely used adrenal medication because it’s safe for ferrets. The medication has very few, if any, known side effects and can be ordered directly from your vet. It acts by stopping the LH (Luteinizing Hormone) stimulation to the adrenal glands. In turn, the adrenal glands stop overproducing adrenal androgens and sex hormones. In carcinomas (cancer), Lupron may keep tumors from getting bigger, but Lupron does nothing directly to shrink tumors. Lupron can be an expensive treatment option, and it’s necessary for the remainder of the ferret’s life.

Suprelorin implants are currently being used in Australia, New Zealand, and a few other countries. Perhaps in the near future this option will be available to our ferrets, as well. This medication works like Lupron, stopping the LH stimulation to the adrenal glands and turning off the over-production of sex hormones and adrenal androgens.

• Giving a ferret melatonin (orally or through implants) is another popular medical approach to treating adrenal disease. Some ferret owners have used this option as a preventative. It works by lowering LH, sex hormone, and androgen levels. However, some are concerned that ferrets may develop immunity to melatonin after long-term use, rendering it relatively useless. Like Lupron and Suprelorin, it does nothing directly to stop the progression of the disease. Also, because it’s a relatively new treatment, the long-term effects are as yet unknown.

Melatonin implants can be used in conjunction with adrenal surgery or along with Lupron. In fact, your veterinarian may recommend it.

Technical Stuff

Prostate problems in the male ferret often are associated with adrenal gland disease. The overproduction of the testosterone-like sex steroid causes the prostate to enlarge. Some enlarged prostatic tissue can apply pressure on the urinary tract, leading to the ferret having difficulty urinating or creating urinary blockage. Ferrets can develop bacterial infections in the prostatic tissue leading to more serious disease. (Bacterial infections need to be treated with appropriate antibiotics.) Lupron, in high doses, inhibits the production of sex steroids, causing the prostate to shrink back to normal size.

Insulinoma

Insulinoma is one of the most diagnosed ferret cancers. A ferret with insulinoma has cancer of the insulin-secreting pancreatic cells, or beta cells. One of the pancreas’s main roles is to release insulin as needed to regulate the ferret’s blood sugar levels. It does its job by facilitating the movement of glucose out of the bloodstream and into the cells, which use it as a primary fuel source. In ferrets with insulinoma, tumors cause an overproduction of insulin. Too much glucose moves out of the bloodstream quickly, which causes rapid drops in blood sugar, or hypoglycemia. And without blood glucose, the ferret’s brain and red blood cells are left with little to no fuel to maintain.

Insulinoma most often strikes ferrets after the age of 3. Sometimes, the disease goes unnoticed for a long time as the ferret’s system fights to regulate its own blood sugar levels. During this time, the signs may not be overly apparent. When they do show up, some of the signs may include  Weakness and lethargy

• Excessive salivation
• Pawing at the mouth
• Dazed and confused look
• Tremors and seizures
• Loss of coordination
• Rear leg weakness
• Enlarged spleen
• Coma

Remember

With insulinoma, the signs may come and go as the ferret’s body works to counteract the swings in blood glucose by producing more glucose from the liver. Things that can trigger and aggravate the signs include exercise, stress, and diet (see the upcoming sidebar for more on diet and the possible causes of insulinoma). However, any of the signs warrants a trip to the vet.

Making the diagnosis

A vet usually obtains a diagnosis by drawing a fasting blood sugar level, in which the fuzzy goes three to four hours without food before the blood is drawn. Anything longer than three to four hours is too long for a ferret with insulinoma to go without food. Normal blood glucose levels are between 90 and 120. Having a fasting blood glucose level of less than 70 generally is considered diagnostic for insulinoma. If you want to take the diagnostic process a step further, exploratory surgery will confirm the presence of insulinoma tumors.

Treating the disease

Your vet can help you determine the best course of action to treat insulinoma, based on your ferret’s history and current condition. Surgery is frequently an option and may stop or slow the progression of insulinoma. Unfortunately, pancreatic tumors can be small and seedy nodules, located throughout the pancreas, making the treatment process surgically challenging. In some cases, the tumors are isolated nodules that can be more easily removed. And although surgery can stop or slow the progression of the disease, the condition is never completely curable. Tumors frequently return at a later date.

Your fuzzy may live an additional ten months or longer after diagnosis, with a lot of tender, loving care and a consistent management program, including dietary changes (see Chapter Filling Your Ferret’s Belly). Some of the medications that vets have found to be successful in managing insulinoma are diazoxide (Proglycem) and corticosteroids (such as prednisone). Only your vet can determine what’s best for your ferret.

Warning!

People often recommend that you add Brewer’s yeast to the insulinoma patient’s diet. I suggest that you not do this. The chromium in Brewer’s yeast has been shown to actually lower blood sugar levels as opposed to stabilizing them, as once thought.

Every ferret owner should keep some Karo syrup or honey on hand, especially if you have a ferret with insulinoma. If your fuzzy crashes (shows extreme lethargy, weakness, or has seizures) due to low blood sugar, take a cotton swab and dab a little honey or Karo syrup on her gums. The sugar helps to stabilize the ferret until you can get her to a vet, which you should do as quickly as possible. Follow up with some high-protein food like chicken baby food.

Remember

Use this type of sugar boost in emergency situations only — to bring your ferret out of a hypoglycemic episode. Too much sugar can be dangerous for a fuzzy with insulinoma.

Lymphosarcoma (Lymphoma)

Very common in beloved furballs is lymphosarcoma, a cancer of the lymphatic system (the organs and cells designed to fight disease). Many fuzzies suffering from this type of cancer can have severely impaired immune systems, while other ferrets are subclinical — they have no overt signs of the disease at all. The cause of lymphosarcoma remains a bit of a mystery. Environmental and genetic influences are possible factors. Some experts are convinced that lymphosarcoma is linked directly to some type of virus. The condition sometimes shows up in multiple cagemates, reinforcing the viral theory by implying some sort of viral transmission.

The two most common types of lymphosarcoma in ferrets are juvenile lymphosarcoma (lymphoblastic form), which hits furkids typically under the age of 14 months, and classic lymphosarcoma (lymphocytic form), which generally is diagnosed in middle-aged and older ferrets. Because of the instances of subclinical ferrets, lymphosarcoma isn’t always easy to recognize. Thankfully, many ferrets may show signs, including

• Lethargy
• Extreme weight loss
• Diarrhea
• Labored breathing
• Loss of appetite
• Enlarged spleen
• Enlarged lymph nodes (locally or throughout the body)

Making the diagnosis

In juvenile lymphosarcoma, death can occur suddenly and with no signs, because the disease raids many organs at once. Vets often misdiagnose any warning signs that do exist in the youngsters as an upper respiratory infection, pneumonia, or cardiomyopathy. This is due mainly to respiratory and circulatory distress resulting from large, fast-growing tumors that invade the chest cavity and squish the lungs.

Classic lymphosarcoma, on the other hand, is more often recognized by vets. Unlike with the juvenile version, classic lymphosarcoma frequently causes enlarged lymph nodes that a vet can easily feel under the armpits and on the neck. The vet should confirm diagnosis with a biopsy of a lymph node, bone marrow, spleen, or chest fluid. Often, irregularities in the ferret’s complete blood count raise a red flag, but that isn’t always the case. It’s always best to send out biopsy samples to a pathologist.

Treating the disease

Some fuzzy cancers, including lymphosarcoma, respond pretty well to chemotherapy. For many ferrets, chemotherapy provides a decent remission rate (with the exception of the intestinal form of lymphosarcoma), with life often prolonged 6 to 36 months from the start of treatment. However, this form of treatment can be very expensive, and not all cancer patients are good chemo candidates. You must talk to your vet about all your possible treatment options.

Some signs of lymphosarcoma can be alleviated temporarily with steroids, but this treatment isn’t a cure for the condition.

Chordomas

Chordomas are the most common musculoskeletal tumors found in the ferret. It’s difficult to explain these icky tumors without first giving you a simple lesson on a complex matter of development. All developing embryos have certain tissues that develop to form their basic support systems, such as the spine (including the tail). Leftover embryonic tissue that doesn’t develop into the skeletal structure rests in between the vertebrae. These remnants sometimes continue to grow, causing the formation of chordomas.

The mass often grows slowly at the tip of the ferret’s tail, eventually giving the tail a club-like appearance. The tumor itself is made up of a bony center beneath a layer of cartilage and rough cells that resemble red, raw elephant skin. For the Herculean fuzzbutt, this tumor can be quite a weapon.

Chordomas are easily diagnosed and typically appear in fuzzies over 3 years old. The most common ferret chordoma is located on the tip of the tail. In some rare instances, a chordoma grows in between the vertebrae near the head, in a tumor called a cervical chordoma. This more serious tumor can cause compression of the spinal cord, at which point the ferret becomes physically impaired. Cervical chordomas also are more apt to spread and cause severe pain and neurological problems.

Remember

Chordomas can present more than just cosmetic problems for your ferret. They frequently cause hair loss on and surrounding the tumor. Often, the mass becomes ulcerated and oozy. Because of its vulnerable location and the probability of trauma to the tail, vets generally recommend removal, which is a relatively simple procedure.

Itchy Growths: Skin Tumors

Skin tumors appear in all shapes and sizes on fuzzy friends. The good news is that the majority of these skin tumors are benign, or non-cancerous. However, all are capable of becoming malignant, or cancerous. Vets usually recommend the removal of the lump, bump, or ugly formation. Although the most common ferret skin tumors rarely develop into cancer, the possibility will always remain if you don’t have a tumor removed.

Also, several types of skin tumors are itchy and easy to rub and irritate. Removing a tumor from your ferret eliminates the risk of her developing secondary infections from open sores. Be sure to send a tumor tissue sample to a lab for analysis, just for peace of mind. If your vet suspects cancer, removal of a nearby lymph node for biopsy also is a good idea to determine if the cancer has spread. You and your vet can determine a course of treatment from there. Remember: The earlier you act, the better chance you give your fuzzy!

Many types of skin tumors can afflict ferrets. The following sections touch on the most common skin tumors.

Mast cell tumors

Mast cells are directly related to the immune system. They produce histamines to combat foreign bodies in the ferret’s system. For reasons unknown, these cells may migrate and form small tumors on the ferret’s skin. The growths can appear anywhere on your fuzzy as a single tumor or multiple tumors.

Tumor talk

Allow me to try to unravel the mystery of tumors and the terms used to describe them. Neoplasia is the process in which cells grow in an abnormal and uncontrolled manner. The result is a neoplasm, also known as a tumor, which is made up of cells that serve no useful purpose to the body. Tumors may occur just about anywhere on the ferret’s body — either externally on the skin or internally. There are two types of tumors: Benign (non-cancerous) and malignant (cancerous). A benign tumor remains local, or at the site where it originally grows. Although it doesn’t spread, or metastasize, to other parts of the body, it may grow big enough to become medically dangerous. Some tumors also have the potential to become malignant. A malignant tumor can metastasize through neoplastic cells being shed; these cells then travel to other areas of the body, such as the lungs, liver, brain, and lymph nodes. The rate of metastasis depends on the type of tumor and many other factors relating to the individual animal.

The suffix –oma doesn’t designate a tumor as benign or malignant. For instance, lymphoma usually is malignant but may occur as a solitary tumor that doesn’t spread; this is rare but possible (in people). An adenoma is a benign tumor — specifically a benign epithelial tumor having a glandular origin and structure. Adenocarcinoma is a malignant tumor originating in the glandular tissue. Carcinoma always means malignant; it’s an invasive malignant tumor derived from epithelial tissue that tends to metastasize to other areas of the body. Approximately 80 percent of all malignant tumors are carcinomas (in humans). You can’t always tell whether a tumor is benign or malignant just by looking at it with the naked eye or by where it resides. A pathologist examines the tissues microscopically to determine the tumor type, which is why sending tissues off to a lab is so important.

Mast cell tumors often are round, slightly raised red lumps — button-like in appearance. Sometimes they’re flat and scaly in appearance. Because of the ferret’s constant production of histamines, this type of tumor is extremely itchy. You’ll know something’s up if you witness your poor ferret scratching feverishly at her skin (at the area of the tumor), causing excessive bleeding and oozing. Also, the site usually shows some hair loss and may be scabbed over from the constant irritation.

Remember

Although mast cell tumors often are malignant in other animals, they rarely become cancerous in ferrets. Nonetheless, because of the risk of infection and the obvious discomfort your fuzzy feels, you should be a nice human and have any mast cell tumors removed. Always have a biopsy done. You should also expect more, though, because they frequently pop up in other places.

Basal cell tumors

Basal cell tumors are slow-growing, wart-like nodules that feature little craters in the middle. They can pop up anywhere on your ferret. They’re loose on the skin and move freely when you push on them.

Because of their raised presentation and mobility, basal cell tumors are easy to rub or scrape, which presents the possibility of infection. For these very same reasons, basal cell tumors are easy to remove, and you should have them removed. If removed properly by your vet, the tumors shouldn’t recur in the same place.

Sebaceous cell tumors

Sebaceous cell tumors generally are tumors of the skin’s oil glands or hair follicles. They’re really funky in shape — sometimes branching out like cauliflower. They may appear as bluish-colored lumps just under the skin, although on the outside they can range in color from tan to brown to blue. Like the other common skin tumors, sebaceous cell tumors can appear anywhere on the fuzzy’s body, and they’re usually firm to the touch.

Remember

Removing sebaceous cell tumors is important because they often grow rapidly and can become cancerous. Besides, your ferret won’t like sporting a vegetable-shaped mass for all the world to see.

 by Kim Schilling