Ocular squamous cell carcinoma?--UPDATE: He's home!

texsuze
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Ocular squamous cell carcinoma?--UPDATE: He's home!

Postby texsuze » Tue Sep 25, 2018 8:58 pm

Yesterday, I noticed a tiny, gray "bleb" in the outside corner of my oldster's eye, on the sclera. DH sent photos to the equine vet at our local vet clinic and vet suspects squamous cell ca. A biopsy would be needed for a definitive diagnosis, and after that, there might be several treatment options.

My oldster (27 y.o. WB gelding, chestnut) has worn his fly mask nearly every day (including winter) for the past 10 years. Before that, when I boarded him, of course fly masks were always a management problem with multiple horses in each pasture, so were not allowed to be worn. I guess at this point it doesn't matter.

Complicating matters is my confidence in ophthalmic surgery at my small animal/large animal vet clinic. The folks are great and we've used them for years, but... having been to a different, equine-only clinic for my gelding's dentals last spring, I'd rather take my horse there for diagnosis and treatment, despite this initial 'curbside' consultation with our clinic.

Freaking out here that this is what we are dealing with. Any input with personal experience with this condition would help greatly.
Last edited by texsuze on Wed Dec 05, 2018 5:21 pm, edited 5 times in total.

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Re: Talk to me about ocular squamous cell carcinoma

Postby heddylamar » Tue Sep 25, 2018 10:33 pm

Mom's appy gelding who just passed away had an occular squamous cell carcinoma. On the advice of her vet, she hauled him to University of Missouri's vet school where their equine ophthalmologist, Elizabeth A. Giuliano, treated him. Part of G's eyelid was removed, but Dr. Giuliano stitched it back together in such a way what he didn't lose the eyelid (and thus the eye), and over two visits, G received chemo. On the advice of Dr. Giuliano, Mom put him in a fancy $$$ fly mask that blocked UV rays, etc. This is the fly mask: http://www.equinesunvisor.com/esvmaxx.aspx

The results were great -- his eye looked fantastic for the next 5 years, until he died. If I didn't know about the damage, and hadn't cared for his eye post-op, I wouldn't have been able to pin point the damage a year later.

I would recomend contacting Dr. Giuliano to see if she can recommend anyone in your area.

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Re: Talk to me about ocular squamous cell carcinoma

Postby Tsavo » Wed Sep 26, 2018 12:15 am

I have a thread that includes my horse's diagnosis and treatment of squamous cell carcinoma of the third eyelid. My regular vet did an expert job and got clean margins so we didn't need chemo. I added pictures of the surgery and the histopath report.

viewtopic.php?f=6&t=2817

That said, the sclera sounds like a lot more complex surgery than the third eyelid. I am surprised they did not just say they have to take the eye.

Good luck with this.

texsuze
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Re: Talk to me about ocular squamous cell carcinoma

Postby texsuze » Wed Sep 26, 2018 4:12 pm

Thanks for all the input so far. We are scheduled to see a veterinary ophthalmologist in two weeks' time. He works with the clinic I hoped to use, so fingers crossed. A fairly straightforward 2-hour drive away.

As best I can tell, this 'growth' on my horse's eye is limited to the eyeball and not involving the eyelid. He is asymptomatic re: discharge, tears, itching, etc. for now. According to the vet's office, the veterinary ophthalmologist will be able to undertake the diagnostics to confirm the extent of the lesion.

I'll be doing a follow-up post here after our appt. next month. Thanks for all the flymask and professional contact info.

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Re: Talk to me about ocular squamous cell carcinoma

Postby Ryeissa » Thu Sep 27, 2018 6:21 pm

jingles! my dog had a small growth removed from her lower eye, in the sclera. she ended up ok, it wasn't SCC

texsuze
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Re: Talk to me about ocular squamous cell carcinoma

Postby texsuze » Thu Sep 27, 2018 7:02 pm

Thanks; DH wonders if it might not be a pterygium, which humans get from not using sunglasses. Haven't researched to see if this occurs in equines. The vet also invoked a benign hyperplastic type of neoplasm, so that's what I hope this blob turns out to be. I should know in a couple weeks. Thanks for the jingles!

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Re: Ocular squamous cell carcinoma?--vet visit rescheduled

Postby texsuze » Tue Oct 09, 2018 5:22 pm

Flash floods, a bit of hail, big 'ol storms... I decided to reschedule today's vet visit, seeing as how we'd be making most of the 2-hour trip to the vet entirely within this line of strong storms as it moves eastward. If my horse were symptomatic, and/or if his eyeball were showing changes, I certainly would've kept the appt. Nerve-wracking decision to make, but it's more about the other drivers on a particular stretch of highway (notorious for MVA deaths).

Now it will be a few more weeks before being able to see the veterinary ophthalmologist. Plan B would be to see my current equine vet here in town if anything changes WRT the eye bleb, vision, or other signs between now and then.

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Re: Ocular squamous cell carcinoma?--vet visit rescheduled

Postby ironbessflint » Wed Oct 17, 2018 3:36 pm

Hi! We've got Haflingers (who are a bit prone to SCC), and have been dealing with this in my mare. Back in 2015 I noticed a small blob in the corner of her eye. Had my regular vet take a look and she agreed it was probably SCC, and to try a topical chemo cream. One tube of the 5-f/u cream later and the blob was gone. We did a few more months of treatment to be safe and I kept her in a UV fly mask from then on, and all was well for quite some time.

This spring I noticed the blob had returned. Vet prescribed the 5-f/u cream again, but three weeks later when it continued to grow despite treatment, she referred us to Michigan State's Ophthalmology department. They did a full exam, agreed that with her breed and history it was likely SCC, but also agreed that different pathology wouldn't necessarily change our course of treatment. Since she had previously responded to the 5-f/u cream and the lesion was quite small, we opted to try a strong chemo before jumping into surgery. After one round (6 weeks, three cycles of week on/week off application) of the mitomycin the lesion was MUCH smaller, so they recommended one more round of the mitomycin, with the understanding that if it was not 100% cleared up after that she WAS going in for surgery. Unfortunately the lesion started growing again during that round.

She went in for surgery on Thursday, September 20, under general anesthesia, and came home on Friday afternoon. She was on stall rest and had to wear a blinder on that eye for about 2 weeks, and had a triple-antibiotic ointment applied during that time as well. She went back for a recheck at the two week mark, we opted to keep going with the abx for another week, but she was allowed to lose the blinder and return to turnout and progress back into work at that point.

Pathology came back confirming that it was SCC, but also confirming clear margins on what was removed. She'll live a UV fly mask for the rest of her life of course, but they feel chance of recurrence will be pretty darn low. She's got some sun damage on the other eye as well (redness and loss of pigmentation), so we'll also keep a close watch on that one.

The tubes of chemo cream ran about $75 each (for both types). The surgery and followup care and supplies totaled less than $3000. Her vision is 100% and I was riding her 2 and a half weeks post op. I'm quite pleased. I was terrified of the surgery (particularly the fact that they wanted to do it under GA and not standing), but all in all it was really NOT a big deal, and I wouldn't hesitate to go down the same road again if needed.

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Re: Ocular squamous cell carcinoma?--vet visit rescheduled

Postby texsuze » Wed Oct 17, 2018 8:02 pm

Thanks, 'Flint, for your comprehensive run-down on your mare. Very glad that her prognosis is good, despite all the intervention and chemo. Interesting that the vets opted for treatment first to see if the lesion could be cleared. Our rescheduled appt is 3 weeks from now and I don't have a feel for how extensive the exam will be. My oldster will be seeing a vet ophthalmologist at an equine clinic, not a university center but I am within half a day's drive of Texas A&M University (my alma mater), so presume this vet would refer me to them if necessary. Fingers crossed.

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Re: Ocular squamous cell carcinoma?--UPDATE: biopsy done

Postby texsuze » Wed Nov 07, 2018 5:40 pm

Took my oldster on a 4-hour round trip jaunt to the ophthalmologist vet. Vet didn't want to commit to a diagnosis, but seeing the little bleb on my gelding's eyeball leads him to cautiously suspect squamous cell ca. He did, however, mention the possibility of habronemiasis (?sp)-("summer sores"), which I hadn't heard of in a long time.
If that were the diagnosis, then a good dose of ivermectin would be the cure, although my guy has been dewormed with ivermectin within the last 6 months.

Vet took a biopsy sample (getting most of the bleb) and followed up with a spritz of cryo on the bit that remained on the eyeball. My guy was a very good boy with his standing sedation and local numbing of the area involved. DH was there, close to the action, while I stood back with both hands over my eyes, peeking through closed fingers!

Now we wait for the pathology report; hopefully will have it by the end of the work week, but just waiting right now. I'm gooping his eye with a 3-way AB for the next week. If the path comes back SCC, vet recommends I board my gelding at the clinic, where they would undertake applying a chemotherapy agent 4x/day. I believe a period of two weeks treatment was mentioned, then reassess.

The vet ophthalmologist (they are all so young these days!) rotates between three clinics, seeing only eye problems on all types of animals. The trailers were lined up when I got there, with uveitis, sadly, being top of the list yesterday. The staff at this equine facility were very skilled and experienced; we had vets and techs floating around all over the place, everyone knowing their job, but keeping a sense of humor when needed. So I would feel very comfortable and relieved that my guy would get good care if we get the SCC diagnosis and he ends up in "eye camp" for 14 days.

Jingles for my oldster, please.....

I'll post biopsy results when I get them.

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Re: Ocular squamous cell carcinoma?--UPDATE: yep, confirmed

Postby texsuze » Wed Nov 14, 2018 5:55 pm

NEW UPDATE: biopsy results came back positive for SCC. No evidence of lymph or vascular invasion and no cells in the submucosa per path report.

The 5-F chemotherapy ointment has been ordered and plan is to take my gelding to the equine clinic on Monday (2 hours away) for what I am calling "eye camp", where the vets/staff will apply his chemo 4x/day for two weeks. The vet ophthalmologist will evaluate after this first round of therapy. This weekend I'll start packing up his feed, hay, blankies, fly masks, peppermints for his camp stay. My plan is to visit him a few times each week.

My horse has never been away from the ranch more than 5 days at a stretch in the 10 years he's been here, but I'm hoping he'll think this is an adventure. Going for the cure on this one, so I'm putting out a 'Give Thanks for your Equine Partner' jingles request, please!

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Re: Ocular squamous cell carcinoma?--UPDATE: SCC confirmed

Postby heddylamar » Wed Nov 14, 2018 7:44 pm

Lots of jingles! I hope your guy has the same great results Mom’s dude experienced.

In my experience with medical hospitals, the staff will be well versed in calming anxious horses. He’ll have stand-in caretakers to see to his every whim :)

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Re: Ocular squamous cell carcinoma?--UPDATE: SCC confirmed

Postby texsuze » Sun Nov 18, 2018 6:58 pm

Thanks, heddy! I got one of the UV super duper fly masks from the website you listed above. Almost too nice to wear ;) Might order a second one to have in reserve.

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Re: Ocular squamous cell carcinoma?--UPDATE: SCC confirmed

Postby Chisamba » Sun Nov 18, 2018 9:01 pm

Jingles

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Re: Ocular squamous cell carcinoma?--UPDATE: SCC confirmed

Postby Sue B » Mon Nov 19, 2018 10:55 pm

Jingle, jingle, jingle

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Re: Ocular squamous cell carcinoma?--UPDATE: SCC confirmed

Postby texsuze » Tue Nov 20, 2018 4:44 pm

Thanks for all jingles. Took my guy to "eye camp" yesterday. Met one of the vets I had not met before. The entire staff plus vets (except for a dental specialist vet) are gals, so lots of touchy-feely around! Two veterinarians live on-site while they complete an internship there, so lots of eyes presumably translates to lots of hands-on. I plan to make visits maybe every other day (2 hours each way) when I can work them in. I left my horse standing in a paddock, munching from his hay net, keeping tabs on a 3-legged sheep near the vet clinic hay barn ;)

This a.m. went to my barn to let out the chooks and saw an empty stall with the door open where my guy would normally be, and that was it. I cratered. Even my hens sense that something isn't quite right. Chin up.....

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Re: Ocular squamous cell carcinoma?--UPDATE: He's home!

Postby texsuze » Wed Dec 05, 2018 5:33 pm

Brought my oldster home from "eye camp" yesterday after a final exam from the ophthalmologist vet. Heck, what a day. Vet was pleased with the response to chemo (despite having received only half the prescribed dose for the first week of treatment--see my post in Obs...). The normal pigmentation (? iris) looks to have returned where the lesion was; vet feels this indicates absence of ca cells there. Area is flat now with only a tiny pinpoint 'bump' where the lesion had been. Eyeball overall looks less vascular, more quiet.

Going forward: 2 weeks with no rx, then, begin Round 2 of 5-F chemo ointment to eyeball (only 2x/day this time) for another 2 week period, then recheck. I'm keeping my horse at home and will be administering the chemo myself this time. Vet reminded me to keep an eye (no pun intended) on my guy's other eye for any irregularities, and keep his fly mask on during the day, which I do anyway.

So, guarded optimism that the SCC won't return, but only time will tell. I expect to hear from the clinic owners at the end of the week re: some type of compensation for the treatment screw-ups and the substandard care during my horse's hospitalization.

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Re: Ocular squamous cell carcinoma?--UPDATE: He's home!

Postby Josette » Wed Dec 05, 2018 5:42 pm

Wishing your guy a speedy recovery and for you no more stress.

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Re: Ocular squamous cell carcinoma?--UPDATE: He's home!

Postby heddylamar » Wed Dec 05, 2018 9:33 pm

Fantastic news on all counts!! G's SCC chemo went like that -- intense round, eye looked great, short break, then a second round. Fingers crossed the same outcome happens for your guy.

I'm so glad he's back in your care, and you're in charge of round two. Substandard [anything] always makes me suspicious -- what else are they screwing up that I don't see?

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Re: Ocular squamous cell carcinoma?--UPDATE: He's home!

Postby Chisamba » Thu Dec 06, 2018 4:32 pm

Good jingles for his recovery

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Re: Ocular squamous cell carcinoma?--UPDATE: He's home!

Postby piedmontfields » Thu Dec 06, 2018 6:21 pm

Tons of jingles for you and your fellow, Sue. Hope round 2 at home does the job.

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Re: Ocular squamous cell carcinoma?--UPDATE: He's home!

Postby texsuze » Mon Dec 10, 2018 6:44 pm

Thanks for all following this saga and lending jingles. Question for those who've been in this boat: is eye pain to be expected post-chemo? My oldster is still highly sensitive to anything near his treated eye. Also, the exterior edge of the eyelid looks cracked and crusty, he has eye boogers in the corner, and the lid is about 85% opened. I did a gentle, warm compress on his eye this a.m. and he seemed to like that.

I'll send photos to the vet ophthalmologist to get his input, but he didn't make mention of pain or pain management during this period between the rounds of chemo.

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Re: Ocular squamous cell carcinoma?--UPDATE: He's home!

Postby Josette » Tue Dec 11, 2018 2:34 pm

I agree and would consult with vet for eye pain management. It does sound like he is dealing with some discomfort from your description.


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