The Truth about Sarcoids

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The Truth about Sarcoids Powered By Docstoc
					                                                                                                             WINTER 2010
Plum Park Farm, Watling Street, Paulerspury,
Towcester, Northants NN12 6LQ
☎ 01327 811007                                                                               NEWS
  Practice News                                                                                              Sarcoid tumour

  Well Done Jade!
                                         The Truth                                                           near horse’s eye

  Jade Goff one of our team
  of hard working veterinary
                                       about Sarcoids
  nurses has passed her first
  year equine veterinary nurs-         Equine sarcoids are the most common tumours seen and account for approxi-
  ing exams.                           mately nine out of every ten skin tumours seen in horses. They are non-malignant
  Blakesley Show                       (i.e. they do not spread throughout the body) but do grow larger and often spread
                                       and multiply locally. Their presence can cause irritation, interference with tack and
                                       loss of value to the affected horse. If knocked or rubbed their surface will bleed,
                                       and fly worry and local infection commonly occur.

                                     What do sarcoids look like?
                                     Sarcoids can occur just about anywhere on
  It was lovely to see so many                                                             Typical examples of sarcoids
                                     the body but are most commonly found on
  of you at Blakesley show
                                     the head, (especially around the eyes), the
  this year. The above is just
                                     underneath of the abdomen and around the
  a snapshot of some of the
                                     sheath, chest, ears and lower limbs. Single
  goings on at the Towcester
                                     tumours or a number of sarcoids may occur
  Veterinary Centre marquee.
                                     in one area or over many parts of the body.
  Welcome Matilda!                   There are different types of sarcoid and they
                                     can vary quite widely in appearance. Flat
                                     (occult) sarcoids appear as round to oval, flat         Mixed              Occult
                                     areas of roughened, hairless, irregular skin.
                                     Fibroblastic sarcoids are irregularly round,
                                     raised, firm lumps. They are usually smooth
                                     and hairless at least over part of their surface
                                     but smaller ones are sometimes covered with
                                     normal-looking skin. If the surface becomes
                                     damaged, the tumour will ulcerate and bleed,
                                     leading to scab formation. Verrucous sarcoids
                                     appear wart-like with an irregular surface.
  Congratulations to Mike and        A horse may have different types of sarcoids
  Alice, Matilda Belle Sheldon       at the same time and mixed-types also occur.
  came into this world at a          Sarcoids can grow to become very large                Verrucous           Nodular
  very civilised time on the         (over 8-10 cms), although most remain
  evening of Sunday the 8th          smaller than this.
  of August. She has already         Sarcoids can be similar in appearance to other
  been up to Plum Park help-         skin tumours (e.g. fibromas, mast cell tumours
  ing Mummy and Daddy with           and non-pigmented melanomas) and it may be
  their horses.                      necessary to submit a sample (biopsy) or the
                                     whole tumour to a laboratory for analysis for a
                                     precise diagnosis to be made. If possible it is
                                     usually preferable to remove the whole tumour
                                     in the first instance for laboratory examination.
                                     This avoids a second surgical procedure after
                                     diagnosis and avoids traumatising the tumour          Fibroblastic       Malignant
                                     still ‘in situ’ potentially encouraging its spread.

                                                                                                                   Continued overleaf
                                Towcester Veterinary Centre Equine Clinic
                Plum Park Farm, Watling Street, Paulerspury, Towcester, Northants NN12 6LQ
                             Tel: 01327 811007 •
What treatments are available?                                                                                                                         than surgery alone, but often results in the development of
There are several options for treatment of sarcoids and                                                                                                patches of white hair due to damage to hair follicles.
more than one treatment may be used at the same time.                                                                                                  BCG vaccine
The important thing to remember is that sarcoids have                                                                                                  BCG is a vaccine produced from the bacterium Mycobac-
a great tendency to recur either at the site of removal or                                                                                             terium bovis for immunization against tuberculosis. It may
nearby. The choice of treatment will depend upon several                                                                                               be injected into the sarcoid tumour(s), often with useful
factors:                                                                                                                                               results. Several injections over several weeks or months
     • The number and size of the                                                                                                                      may be required. This treatment is aimed at provoking
       sarcoids present                                                                                                                                an immune reaction from the horse’s body to destroy or
                                                                                                                                                       reject the sarcoid tissue. It is most commonly used for
     • The part of the horse affected                                                                                                                  eyelid tumours because, if effective, it allows the eyelid to
     • The facilities and drugs available                                                                                                              be saved. A response may not be seen for several weeks
                                                                                                                                                                      after first injection. There is often initial
     • Financial considerations                                                                                                                                       swelling and there may be skin damage fol-
What methods of treatment                                                                                                                                             lowing injections and rarely, death has been
                                                                                                                                                                      reported following an anaphylactic shock
are there?
                                                                                                                                                                      reaction to the vaccine. Horses to be treated
Chemotherapy                                                                                                                                                          with BCG should receive anti-inflammatory
Specially-prepared cytotoxic (tissue                                                                                                                                  drugs prior to each treatment.
killing) creams have been widely used
to treat sarcoid tumours. These attack                                                                                                                                                Radioactive beads or wires
the abnormal cells in the sarcoid and are                                                                                                                                             This highly specialised technique is not
often highly effective, but can also damage                                                                                                                                           widely used but can be effective particularly
healthy tissues. They must be used with                                                                                                                                               for eyelid sarcoids where it is necessary
great care, especially over bony areas                                                                                                                                                to try to save the eyelid. The radioactive
or blood vessels and nerves. They can                                                                           BCG can be used in the                                                treatment shrinks the tumour and may
be used on smaller and flat sarcoids or                                                                          treatment of sarcoids                                                disfigure the eyelid. This form of treatment
larger ones after surgical de-bulking. The                                                                                                                                            must be performed under specially licensed
cream can only be supplied to and used                                                                                                                                                conditions.
by a veterinary surgeon. Another cytotoxic                                                                                                                                            No matter which treatment option is
drug (Cisplatin) is available but must be                                                                                                                                             chosen it can take many months to remove
injected into a sarcoid to be effective. This                                                                                                                                         some sarcoids and the effect might not
is another highly specialised technique                                                                                                                                               be permanent. Treatment may need to be
as dose and pattern of injections varies                                                                                                                                              repeated or changed if new sarcoids appear.
with size and shape of the sarcoid. Both                                                                       The application of small                                               Such treatment can be costly.
techniques cause local inflammation and
                                                                                                                 strong rubber rings
scarring is variable, depending on the size                                                                                                                                           Should I buy a horse with sarcoids?
                                                                                                                  (elastrator rings)
and location of the sarcoids.                                                          In addition to welfare considerations,
Applying ligatures or rubber rings                                                     sarcoids affect the potential value of a horse
It is possible to remove the bulk of some                                              or pony in two main ways:
sarcoids, especially those with a short                                                1. If they interfere with tack or are knocked
stalk or neck, by fixing a tight ligature                                              during exercise, they reduce the ability of
around its base or applying ‘elastrator’                                               that horse or pony to perform. If a mare
rings. The ligature cuts off the tumour’s                                              has sarcoids between her back legs or on
blood supply and it dies away or falls off                                             her udder they might be knocked or sucked
usually 10 days to two weeks later. This               Sarcoids can affect the         when the foal nurses.
method is useful for short-term control of            potential value of a horse
relatively large sarcoids on the inside of                     or pony                 2. They may be expensive to remove or be
the hind limbs or abdomen but does not                                                 treated if prolonged or repeated treatments
usually give long-term resolution of the                                               are required.
problem. The most common system used is the applica-                     These considerations must be considered against the
tion of small strong rubber rings (elastrator rings) using               value of the horse and its other qualities or potentials.
a special applicator. There may be some local swelling
after their application but this usually subsides once the               Conclusion
sarcoid drops off.
                                                                         Sarcoids are much more significant than ‘just a few lumps’
Freezing (Cryosurgery)                                                   and can be difficult and costly to deal with. If you think
The sarcoid may be frozen by using liquid nitrogen or                    your horse or pony may have one or more sarcoids, you
another appropriate freezing agent, which causes the tissue              should ask a veterinary surgeon for advice. Best results
to die away. If the sarcoid is large, most of it can be cut              are achieved when a diagnosis is made and appropriate
away first (de-bulking), leaving only the base to be frozen.             treatment is started early. Scarring is less obvious when the
This method is more effective at preventing recurrence                   sarcoids are removed or treated when they are small.

This Newsletter is provided as an education service to our clients. All news and other items in this newsletter are for information only and should not be treated as a substitute for specialist veterinary advice. For all images, the copyright is the property of the photographer.

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