Shrinking Tumors Nonsurgically

Tumor bulk reduction

Older dogs often get mammary tumors and benign masses. Though benign, these lumps can cause problems if they get very large or start to restrict movement. But owners are often reluctant to put their older dogs under anesthesia for surgery, or they do not have the money.

Calcium chloride in alcohol, which is used as a testicular injection to shrink the testes for nonsurgical neuter, may be an option for tumor bulk reduction too. The first known report of this use was in 1977 by Koger. Besides allowing veterinarians to offer their clients an anesthesia-free treatment for older dogs, calcium chloride in alcohol has the advantage of being made from readily available ingredients and thus being an option for use in exceedingly low-resource or remote settings. It provides an option for treating animals that otherwise wouldn’t get treated.

Mammary tumor reduction in older dog using injection of calcium chloride

A case study using 20% calcium chloride in alcohol was presented in 2011, with photos, of bulk reduction in a mammary mass (see Lissner et al, 2011).

Bunny Tumors

Left: Mammary tumor before treatment; Center: Inflammation that occurred after calcium chloride injection, which subsided within 2 weeks; Right: Reduction in size of tumor following treatment.

 

Since it is in the published literature, with publications from both 1977 and 2011, there is precedent for veterinarians to cite when using calcium chloride. Calcium chloride alcohol injection is ordered from a sterile-filling-capable compounding pharmacy by requesting “20% (w/v) Calcium Chloride Dihydrate, USP in Ethyl Alcohol 190 proof, USP.”

Treatment of lipomas (fatty tumors)

Calcium chloride has been used to reduce the size of lipomas, which are fatty tumors. Albers and Theilen (1985) published a study using 10% calcium chloride injected into the subcutaneous lipoma. The authors reported that six months later, 4 tumors had disappeared and 14 were less than 50% of their original size. However, skin necrosis over the tumor developed in 3 dogs.

Our experience using 20% calcium chloride in alcohol in a lipomas has resulted in complications. By 24-48 hours after the injection, the mass may be shrunk by half, but the skin can rupture, creating a draining wound that has to be treated with antibiotics and possibly surgical excision. It may be that the body cannot absorb the lipoma adequately using the 20% calcium chloride. We suggest that calcium chloride-alcohol injection should not be used on masses containing fat until further research reveals techniques with more acceptable outcomes (such as perhaps aspirating the material after 24-48 hours, plus prophylactic antibiotics).

Other nonsurgical injections to treat lipomas have been attempted. A study in 2005 by Rotunda and colleagues evaluated deoxycholate, a bile salt, to treat lipomas in dogs. They reported an average of 75% reduction in tumor size after 2 or more injections, and concluded that this injectable treatment might be useful for small lipomas, but that further research was needed. Steroid injection (triamcinolone acetonide at a dose of 40 mg/mL) was also used to treat lipomas in dogs (Lamagna et al., 2012). Nine of 15 tumors showed a complete regression, with shrinkage in the remaining dogs with only minor complications.

Next steps

While calcium chloride in alcohol appears to be effective in reducing the size of certain benign tumors, more research is needed to quantify results and evaluate options for lipomas.

Are you a veterinarian who would be willing to offer calcium chloride injection in alcohol for nonsurgical tumor bulk reduction of solid (non-fatty) tumors? Please contact us if you would like to be added to a list of veterinarians who offer the service, and tell us your experience after you’ve tried it.

Learn more:

First descriptions of use:

Koger, LM, 1977. Item #451 of the Annual Meeting of the American Society of Animal Science, University of Wisconsin, July 24-27, 1977. Abstract

Koger, Nov 1977. Calcium Chloride, Practical Necrotizing Agent, Journal of the American Association of Bovine Practitioners (USA), (Nov 1977), v. 12, p. 118–119.Free full text.

Later publications:

Albers GW, Theilen GH, 1985. Calcium chloride for treatment of subcutaneous lipomas in dogs. J Am Vet Med Assoc, 186(5):492-4. Abstract.

Lamagna B et al., 2012. Canine lipomas treated with steroid injections: Clinical findings. PLoS One. 2012; 7(11): e50234. Free full text.

Lissner E, Montilla H, Kutzler M, 2011. Intralesional injection of calcium chloride dihydrate in alcohol for minimally-invasive bulk reduction of a mammary mass. Poster download.

Rotunda AM, Ablon G, Kolodney MS, 2005. Lipomas treated with subcutaneous deoxycholate injections. J Am Acad Dermatol 53(6):973-8 Abstract.