Squamous cell carcinoma

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Flossy71

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I need some advice regarding the outcomes of surgery for squamous cell carcinoma on the sheath please. My boy has always had sweet itch, RAO and a filthy willy, all of which have been totally managed over the past 15 years. However now he's reached the grand old age of 24 his annual MOT confirmed he has developed both Cushings and squamous cell carcinoma. The vet who discovered it stated he wouldn't recommend operating due to his age as it would be unlikely he would survive the operation and if he did it would be likely to recur within 6 months. He suggested getting one of the partners out to take a look, which I did, who promptly booked him in for surgery. Realising this would be a hefty bill I checked with my insurance company that he was covered. They assessed the claim and won't be covering it due to the fact I claimed for a biopsy on his filthy willy when I first bought him. So i guess I'm trying to ascertain whether or not I should put him through the trauma of surgery and if I do, in reality what are the chances of recurrence. My vet hasn't tested to see if the cancer has spread so there's also that possibility. I'm confused given the first vet said no point operating and the second booked him in. Was he booked in purely because they thought the operation was insured so may as well do it, if that makes sense? Any vet opinions and experiences from people who have been through a similar thing would be greatly appreciated!
 
How annoying re the insurance.

I had a mare with a Squamous cell carcinoma in the corner of her eye. I operated within weeks of it appearing, even so it had rooted down into the tear duct.

The operation was a total success, she did have some tears afterwards as they had to remove some tear duct so the 'dam' for her tears was lower, so some escaped. She was no more watery than any other horse, just lost some due to the topography of her lower eye.

3 years later it had not come back. Vet said it was removed cleanly and would not be likely to come back.

However, I am not sure how that would relate to a sheath, other than I would presume it is an easier area to operate on. Having said that, it may have been there for some time as the eye was easy to spot, the sheath less so, I suspect.

Not sure of an operation of a horse in their 20s.
 
I know things get lost in translation and that you have just put the basic details down but the one thing that jumps out is that the senior vet "promptly booked him in for surgery" it may be that he gave you the options, discussed the surgery, the risks, the costs, the aftercare, the expectation of full recovery etc. but it does read as if he has assumed you will go ahead and that you feel rather taken along by the whole scenario and have not been given the full picture.
The partner may be thinking of the short term, the fact that an operation is an option and that it all helps keep his facilities paid for, that may be a bit cynical but they are in business and the option of doing nothing and pts when you feel he has had enough will not bring in very much.
I would want to know more so as to make an educated decision based on all the facts, the quality of life ahead must be the primary consideration and your quality of life also needs to be in the equation, there is no point in leaving yourself with a huge debt if it only gives him a few more months, or something goes wrong while he is undergoing the op.

Like Red-1 I have only seen it in an eye, a very rapid onset and very aggressively growing, the horse was in his 20's so the decision was made to not operate having discussed everything with my vet, she was fully supportive and he was pts within days of the diagnosis, whatever you do it needs to be your choice, not the vets, the horse will know nothing of what you are currently going through and from the sound of things has been very lucky to have had such a caring owner looking after all his needs, so don't feel guilty if this operation is a step too far, unfortunately we do have to make tough decisions at some point in their lives and it is never easy.
 
I wouldn't put a 24 yr old through a GA for something which may come back anyway. I would want to know a lot more about what ALL the options are before making any decision. I had a sarcoid removed from my young cob's face under sedation.
 
Hi, thanks for your response. TBH the first vet told me the cons and said he wouldn't put a horse his age with a tumour the size it is through an operation, but the practice partner who booked him in and is doing the operation didn't actually discuss anything with me, just assumed it was covered under his insurance. You are right, I do feel like I've been swept along by the whole thing and not given the full picture, although I have emailed them this morning asking them to provide me with a risk profile so to speak, as in the likelihood of him surviving the operation, the recovery time, chances of it recurring and whether or not it is likely to have spread. I have a feeling it has. Although not directly related, he had a sarcoid removed last summer and now has cushings, which is essentially a tumour on the pituitary gland. He lives out and last winter was the first winter in 15 years I couldn't keep the weight on him despite the fact he spends 24 hours a day munching on haylage!

I do agree with you though, I feel the same way in that in their eyes they are running a business so if the horse is insured then operate, it's income. But like you say, I could pay out £2.5k and he doesn't even survive the operation. I went through a similar thing with my ageing cat with kidney failure last year. One vet kept pumping him full of drugs and transfusions and telling me he was fine when I knew he wasn't. Took him to another vet who told me he was too ill to be left alone for more than a few hours at a time and said it was time to pts, only a day after the previous vet had charged me another few hundred to say he was fine!
 
Even if it was covered by insurance I am not sure it is in the best interests of the horse and my feeling is that the first vet is the one who is thinking of him and not his income, along with the other health issues it is in reality just delaying the inevitable, it may be another few years but is his quality of life going to be good, only you can decide but if he were mine I would probably give him the rest of the summer, as long as he is happy, and not take him into what could be a tough winter.
As I have already said it is never easy to make the decision but once it is made and you have a plan you can accept it, the horse knows nothing of what is ahead so can enjoy its last days, weeks or months without a care in the world, while you are agonising over it all, tough choices ahead for you.
 
My gelding had it when he was 15. He was in good health otherwise, albeit retired due to a ligament injury since he was 6, so I opted for a partial phallectomy. He has the majority of the lesions removed and the removing few we treated topically. I chose not to do the full en bloc resection to remove the whole thing.

He had another 3 fabulous years and then it started swelling and going gunky again. He just didn't seem himself and there were signs that it may have spread. I had him put to sleep last year at the age of 18.
 
I had a very similar experience to you. My old boy, same sort of age, with Cushings etc ...... vet didnt recommend surgery, he had another very happy 2 or 3 years until it was obvious his quality of life was rapidly changing, and he was quietly pts at home. Xx
 
No cushings here and suspected SCC (not biopsies) at 19. Lesions not huge and vet reluctant to do surgery so was treated using a protocol from Liverpool with chemo cream and freezing the day after. It took two cycles to clear, partly as the vet was a bit nice the first time.

At 24 I spotted some more smaller lesions this weekend, vet isn't convinced (he loved receiving the pic this morning!) so we are just going to monitor. He has liver issues too now and I'm at the point of accepting that if he isn't in pain something will be his demise at some point sadly.
 
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