Also called malignant hemangiothelioma or angiosarcoma, a hemangiosarcoma (HSA) is an aggressive, rapid growing malignant tumour which arises from the endothelial cells which line the interior surface of blood vessels and help blood to flow smoothly. It is more common in dogs, and is thankfully quite rare in cats with an incidence of 0.3-2%. There is no breed or sex predilection, however pale skinned cats have a higher incidence of the dermal hemangiosarcoma, especially cats with chronic sun exposure. The average age is 10.
As hemangiosarcomas are a cancer of the blood vessels which are found throughout the body, tumours can develop anywhere. There are three types of hemangiosarcoma:
- Dermal (skin)
- Hypodermal (beneath the skin)
- Viseral (affecting the organs)
The skin, liver, heart and spleen are the most common locations. Visceral hemangiosarcoma have a higher incidence of metastasis, common sites of metastasis include the heart, liver, brain, spleen and lungs.
Symptoms can vary depending on the location of the primary tumour and if it has metastasised but can include the following:
Dermal and hypodermal:
- Single or multiple masses which are firm, raised and dark. The most common locations for dermal hemangiosarcoma are the head and rear legs.
- Soft or firm masses which underneath the skin.
Because hemangiosarcomas originate from blood vessels, they contain blood, which can easily cause the tumour to rupture. Often the first sign that the cat has a hemangiosarcoma is when this occurs and the pet collapses. Rupture can cause fluid in the abdomen or thorax, organ dysfunction or disseminated intravascular coagulation, a life threatening condition where tiny blood clots form throughout the body.
Symptoms can include:
- Pale gums
- Weight loss
- Loss of appetite
- Rapid heartbeat
- Hemoabdomen (blood in the abdomen)
- Sudden collapse
Your veterinarian will perform a complete physical examination of the cat and obtain a medical history from you. It will be necessary to perform some tests which may include:
Baseline tests: Complete blood count and biochemical profile. These can evaluate the overall health of the cat and may reveal low blood platelets or anemia (low red blood cells) and fragmented red blood cells (schistocytes) or nucleated red blood cells (metarubricytes) if the spleen is affected.
Biopsy and histopathology: A definitive diagnosis is made by biopsy, which will be evaluated by a veterinary pathologist.
Abdominal and thoracic imaging: To look for tumours on the abdominal organs and/or signs of metastasis and evaluate for fluid in the abdominal cavity.
Surgery: Removal of the tumour with a wide margin is the treatment of choice. Obviously dermal and subcutaneous tumours are easier to remove than those on the organs and have a better prognosis.
Splenectomy: Complete removal of the spleen. This alone gives an average survival time of between 1-3 months, if chemotherapy is added, this can increase the survival time by an additional 1-2 months.
Chemotherapy: As a follow up for cats who have had a tumour surgically removed or as a standalone treatment for cats with a tumour that is inoperable.
Supportive care: To manage symptoms, which may include fluids to treat dehydration, blood transfusion, analgesics (painkillers) and nutritional support.
Cutaneous and subcutaneous tumours without muscle involvement have a mean survival time (MST) of over 1,000 days, unfortunately the survival time for visceral hemangiosarcoma is considerably shorter.