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Anal Sac Gland Carcinoma
Anal sac gland carcinoma (also known as apocrine gland carcinoma of the anal sacs and anal sac adenocarcinoma) is a malignant tumour of the anal sacs of the dog. This is described as an uncommon tumour but we do seem to see a significant number of patients with this disease, no doubt partly due to this being a special interest in our clinic.

What is anal sac gland carcinoma?
Anal sac gland carcinoma arises as a primary tumour in the anal sac of the dog; these can be found by the anus, more or less at 4 o’clock and 8 o’clock (if the back end of the dog is imagined as a clock face). In a number of cases this is the only site that the tumour is growing in but in other cases the may be spread to the lymph nodes or via the bloodstream to places like the lungs, liver and spleen. Sometimes these tumours are associated with the production of a hormone that causes excessive drinking and urination. In some circumstances this may be the only problem evident prior to diagnosis of the tumour.

Evaluation
In order to plan the most appropriate treatment, it is ideal to know how much of a tumour problem the individual patient has. This means we need to know whether there is spread to the lymph nodes or to other organs. In addition it is helpful to check patients’ calcium levels in their blood as this is related to the hormone disturbance noted above. Presence or absence of spread is determined by x-rays and ultrasound examinations. These can usually be performed under light sedation. The treatment advice is then related to the location and amount of tumour we need to treat.


Above: enlarged medial iliac lymph nodes in a springer spaniel with anal sac gland carcinoma.

Treatment and Prognosis
There are a number of treatment options available for the management of anal sac gland carcinoma. Decisions are made on the basis of a number of factors, primarily the amount and location of tumour tissue as noted above.

For patients with small (less than 3cm diameter) primary tumours and no evidence of spread of the tumour, local surgical excision can be the most appropriate therapy. For patients where this proves difficult or where the surgeon is concerned about the completeness of tumour removal, radiotherapy is used post-operatively to improve the tumour control. The average life expectancy for these patients in our clinic is three years and three months.

For patients with larger primary tumours but still no evidence of spread, chemotherapy can be used to attempt to shrink the tumour, permitting definitive excision to be performed with reduced risks of post-operative complications. Again, radiotherapy may be appropriate following surgery to improve the duration of the resulting complete remission. The average life expectancy for these patients in our clinic is two years.

Some patients have spread to their regional lymph nodes but no further and in these cases the treatment plan is determined by whether those enlarged lymph nodes can be removed surgically or not. As always, our aim is always to achieve optimal quality of life first and foremost and a good long and enjoyable life second. Therefore, if it is apparent that the enlarged lymph nodes can be excised without causing undue risk, they are removed. Subsequent surgery can be performed in these dogs to remove other lymph nodes that become enlarged months or years in the future.

For these patients there is an average life expectancy of sixteen months. If the lymph nodes look like they cannot be removed in their entirety or without presenting the patient with undue risk, they can be left or managed by either chemotherapy or radiotherapy or sometimes by a combination of these. Sadly less than 50% of these patients live more than 12 months from the time of diagnosis but as before, their quality of life is paramount during this time and measures are always being taken to ensure their well-being.

The final group of patients is the group with cancer that has spread throughout their body. Of course this is the worst case scenario but even in this situation patients can enjoy a normal quality of life for long periods of time with appropriate management.

Final Word
Despite the gravity of a diagnosis of malignant cancer, some patients can enjoy an extremely prolonged period of complete normality and an excellent quality of life with appropriate therapy.


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