Deciding when to euthanize a dog with hemangiosarcoma can be incredibly difficult. Dr. Erica Irish—a veterinarian who lost not one but two of her beloved dogs to hemangiosarcoma—understands. On the invitation of integrative veterinarian Dr. Julie Buzby, Dr. Irish wrote this blog to share her experiences and expertise with other dog parents who are facing the same heartbreaking decision.

You’ve just been told your best furry friend has cancer—news no one wants to hear. Perhaps you are learning this information from your vet after the biopsy confirmed your dog’s mass was a hemangiosarcoma (i.e. blood vessel cancer). Or maybe you’re trying to make sense of cancer as a potential explanation for why your dog has a lot of blood in his or her abdomen. In any case, your heart is probably breaking.

Hemangiosarcoma is one of the worst types of canine cancer. It has a nasty habit of showing up unexpectedly, and once it makes itself known, it tends to abruptly cut short the time you have with your beloved canine companion.

Maybe you are wondering, “Why does hemangiosarcoma result in such tragic outcomes? How long can a dog live with one, and how do you know when to euthanize a dog with hemangiosarcoma?” I’ve been in your shoes, so I hope to use the combination of my experience as a veterinarian, and as the mom of two dogs with hemangiosarcoma, to help answer those questions for you. 

What is hemangiosarcoma in dogs?

Hemangiosarcomas are tumors that originate from cells that make up blood vessels. Like most cancers, these tumors represent uncontrolled cell growth.

Hemangiosarcomas can grow on the skin (i.e. cutaneous hemangiosarcomas) or originate from the internal organs (i.e. visceral hemangiosarcomas). Cutaneous hemangiosarcomas usually occur as a single, solitary mass. They are typically benign tumors in that they do not spread (i.e. metastasize) to other parts of the body.

Visceral hemangiosarcomas most commonly affect the spleen, liver, and heart. These three organs are comprised of many blood vessels, particularly the spleen and heart. Splenic hemangiosarcomas, which are the most common cancerous splenic masses in dogs, can suddenly rupture and lead to intense blood loss within the abdominal cavity. This is a medical emergency known as a hemoabdomen. Heart-based hemangiosarcomas can cause similar bleeding, but within the chest cavity (i.e. hemothorax). 

Visceral hemangiosarcomas can remain quiet for long periods of time. But eventually they may start bleeding in very small amounts, or rupture so severely that a dog becomes pale and collapses from profound blood loss. Being able to recognize the symptoms of a bleed and intervene quickly can mean the difference between life and death.

What are the treatment options for dogs with hemangiosarcoma?

If a dog has a bleeding splenic tumor, surgery to remove the spleen (i.e. a splenectomy) is the main treatment. A dog can live without a spleen, but the surgery is still risky. Plus, sometimes the tumor may have already spread to the liver or other locations, which make the prognosis even worse. With surgery alone, average survival times are short (three to six weeks) for hemangiosarcoma patients. Without surgery, pet parents often end up euthanizing their dog with a bleeding hemangiosarcoma at the time of diagnosis.

If you decide to go forward with surgery, you can talk to a veterinary oncologist about your dog’s options for post-surgery chemotherapy. Today’s current chemo options may extend average post-surgical life expectancy to about six to nine months in some cases.

There are also veterinary companies that specialize in the creation of immunotherapy for dogs. Once a tumor has been removed and tested, the specialists can make a vaccination out of it. The vaccination boosts the immune system in a dog’s body, making it easier to detect and kill cancer cells. While this might not be a complete cancer cure, it could extend a dog’s life expectancy by a few more months.

If your dog’s hemangiosarcoma is not actively bleeding, you can also ask your veterinarian about Chinese herbs such as Yunnan Baiyao for dogs. This supplement can help decrease the risk of bleeding from small blood vessels. Even though it is not 100% effective against all bleeding, it may make the difference between a small amount of blood loss and a life-threatening hemorrhage. Using Yunnan Baiyao for dogs with hemangiosarcoma can buy you time while trying to figure out the next step for your dog. 

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For more detailed information on hemangiosarcomas, I urge you to read my other article, Hemangiosarcoma in Dogs: Symptoms, Treatment, and Life Expectancy.

How can a hemangiosarcoma impact a dog’s quality of life?

As you may be able to guess based on the description of cutaneous vs. visceral hemangiosarcoma, a dog’s quality of life will depend on the type of hemangiosarcoma present. Cutaneous hemangiosarcomas typically will not spread to other body parts. This means these tumors are unlikely to cause a significant decline in quality of life. Overall, they carry a good prognosis.

On the other hand, visceral hemangiosarcomas can metastasize to other organs within the abdomen or even up to the lungs. The presence of tumors on the lungs can cause difficulty breathing. Plus, if the initial tumor or any of the metastatic tumors rupture, the resulting free blood in the abdomen or chest can make it difficult for a dog to catch his or her breath.

Due to blood loss, there are less red blood cells available to transport oxygen to other internal organs. This means dogs with internal bleeding may appear to be more of a lethargic dog than normal or pant a lot more. They may be reluctant to go for a long walk or chase a tennis ball in this state. Internal bleeding can also be a painful experience, and your pup may not like it when you touch his or her belly for pats.

How do you know when it is time to euthanize a dog with hemangiosarcoma?

If internal bleeding gets to a certain point, it can be life-threatening. This risk of bleeding is one of the factors that determines how long a dog lives with hemangiosarcoma. In an emergency situation, when your dog is suffering from severe internal bleeding, you might need to make an immediate decision—do you proceed with surgery or say goodbye to your dog?

Some signs your dog is dying from hemangiosarcoma include:

• Pale gums
• Rapid heartrate
• Panting, difficulty breathing, or a dog who is breathing fast
• Weakness and collapse
• Distended abdomen (pot-bellied dog appearance)

If you see these signs at home, immediately head to an emergency clinic or your vet for an emergency vet visit.

In other situations you may have a bit more time to think about when to euthanize your dog with hemangiosarcoma. This may be the case when the bleeding is currently slow or non-existent or when your dog has already had surgery to remove the splenic mass and is now starting to decline.

After a hemangiosarcoma diagnosis, your veterinarian will perform a physical examination and qualitative assessment of your pup. Based on that evaluation, your vet can make his or her recommendations. Sometimes that involves telling you that it’s time to consider humane euthanasia.

But in other cases, your vet might ask about what you are seeing at home with respect to quality of life. So, how do you know what to look for? 

Ways to evaluate quality of life

Thankfully, there are several resources available to help you consider when it is time to say goodbye to your dog with hemangiosarcoma. One of my favorites is from The Ohio State University Veterinary Medical Center. On their website, they have a quality of life evaluation form that you can use to help gain some clarity.

It also helps to keep a log or list of your dog’s good days and bad days. To know which days are bad ones, ask yourself the following questions:

• Is my dog painful or having any issues with getting around the house?
• Is my dog having problems urinating or defecating? Is he or she having accidents in the house?
• Has my dog’s behavior changed? Is he or she fearful, aggressive, or confused at times?
• Is my dog having seizures or more intense seizure activity?
• Does my dog show any interest in eating or drinking?
• Does my dog enjoy the same things that he or she used to (e.g., walks, toys, treats)?
• Is my dog responding to current medical therapies or palliative care?

When bad days begin to outnumber the good, this may help you know it is time to euthanize your dog.

Considering the financial cost

Like it or not, another factor to consider is the cost of treatment. It is common for veterinarians and veterinary oncologists to discuss treatment options such as surgery and chemotherapy for these patients. However, these options can cost several thousand dollars. When it came time to make the decision for my pups with hemangiosarcoma, I was fortunate that I had the finances to cover the costs for the surgeries. I know that isn’t the case for everyone, though.

If you cannot afford treatment but think it is the right choice for your dog, there are a few avenues you could pursue. You might want to look into some sort of payment option like CareCredit or ScratchPay. Or perhaps you could start a crowdfunding account or apply for funds through a non-profit organization. If you already have pet insurance, that can help offset some of the costs for emergency surgery.

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Regardless of if surgery is financially feasible or not, never feel guilty about electing to put your dog to sleep to end his or her suffering if you think that is right. Just because you can afford surgery and chemotherapy doesn’t mean you have to pursue it. And just because you can’t afford it, this doesn’t mean you love your dog any less. Humane euthanasia is always a kind option for pets with discomfort and pain. 

Lean on the experience of others to help make the decision

One of the factors that makes decision making challenging is that hemangiosarcoma can be very difficult to predict. For many pet owners, you won’t know your pup has a hemangiosarcoma until the moment it ruptures internally, causing life-threatening blood loss and a heart-pounding journey to the emergency room.

Even when you’re armed with the information provided in this and other articles on hemangiosarcoma in dogs, it can be impossible to think in the heat of the moment. But sometimes it helps to read through some real-world examples.

I have experienced splenic hemangiosarcoma in two of my own dogs, and I would like to share their stories with you. One was a black Labrador Retriever named Lulu, and the other was a Kelpie-mix dog named Swiper.

Loving and losing Lulu

I acquired my Lulu in 2010, at the end of my first year in veterinary school. I had always avoided retrievers because I knew how intense and excitable they could be. But once Lulu entered my life, I knew that I was stuck on Labs forever! Our personalities were so similar—we loved people, and we loved food. And even though I have lots of different family members, Lulu was attached to me.

In the fall of 2019, Lulu began acting strangely. One morning, she was weak, and she didn’t want to eat her breakfast. When I noticed her rapidly panting, I checked her gum color. They were pale white. I already knew that Labradors had an increased risk of visceral hemangiosarcoma, so my thoughts immediately went to getting her to the vet clinic for an X-ray of her belly. Sure enough, there was evidence of a mass near her spleen, and it looked like there was internal bleeding too. 

Making the decision between surgery and euthanasia

At this point, I had two options. I could approve an exploratory surgery to determine if the bleeding was coming from the spleen or somewhere else. Or I could decide on humane euthanasia. The first option meant the surgeon might be able to remove the source of the bleeding if it was a splenic tumor. And then I could potentially take Lulu home with me while waiting to find out if the mass was malignant or benign.

However, I also knew the first option could cost a few thousand dollars, or even more if there was the need for intensive hospital care and/or multiple blood transfusions. At the time, I had the money to cover the cost of Lulu’s surgery. If I couldn’t have afforded the surgery, it would have been time to put Lulu down because it would have been unfair to let her continue to suffer the way that she was.

Lulu’s surgery revealed a large splenic mass and several lesions on her liver. Malignant cancers can metastasize, so I had a bad feeling that the testing would reveal a splenic hemangiosarcoma. Sadly, the biopsy confirmed this diagnosis. Lulu was able to come home, and we had a good three weeks of eating all the snacks a Labrador could wish for!

Knowing it was time to say goodbye

One afternoon, Lulu became weak and collapsed again. My family called me at work when this occurred, and I told them to check her gums. Once again, her gums were pale white. Knowing that liver lesions were present, I had a feeling she was bleeding internally again. Even in her weak state, she was so thrilled to see me at work!

Unfortunately, I confirmed my fear that she had another hemoabdomen. This meant she was reaching the end stages of hemangiosarcoma in dogs. Even with some of the newer therapies to improve quality of life for dogs diagnosed with hemangiosarcoma, I knew that the life expectancy for them post-surgery was about three to six weeks. As we say in veterinary medicine, Lulu “read the textbook” for what to expect.

I knew that it was time to say goodbye to her. It was a peaceful experience for my “Great Irish Hooley” (her nickname, referencing a lively Gaelic party), but it was one of the most difficult farewells for me. Lulu’s Labrador successor, Rosie, was adopted a few years later, and she has helped my little retriever-loving heart heal!

Supporting and saying goodbye to Swiper

Swiper’s previous owner was looking to re-home him in the summer of 2018. (They were moving and didn’t want to take him or their three other pets with them). Being a family of intense animal lovers, we took in all four animals at the same time—Swiper, his Labrador brother named Dozer, and a bonded pair of cats named Roxie and Darby.

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Swiper was an interesting fellow. He could be calm, friendly, and very cuddly. Swiper loved snacks and his nightly dental chews (every night at nine is “chew o’clock” in my household). But he was also an avid hunter of small prey, and he could streak across the yard with the best of them to chase squirrels and baby bunnies.

In the late spring of 2021, Swiper started getting picky about his food. He would eat a few kibbles, then just stand there over his bowl while everyone else ate around him. One weekend, he vomited a total of three times in the span of an hour. He then fell over and would not stand up again. Swiper also had a wide-eyed kind of appearance, which I interpreted as a sign of pain in dogs.

We quickly drove him to my veterinary hospital and admitted him for some fluid therapy plus X-rays. Like Lulu, he also had a mass present in the vicinity of his spleen. This was confirmed to be a splenic mass on ultrasound the following day.

Making decisions for Swiper

Once again, I had two options before me. I could bring him to surgery and, worst case scenario, hope for a few more weeks with him if this was a hemangiosarcoma. Or I could elect humane euthanasia to end Swiper’s suffering.

Our family chose the surgery, but unfortunately Swiper had a very rough recovery. It turns out he already had metastatic lesions in his chest, and he had to be on oxygen therapy for a couple of days before we could bring him home.

While his breathing improved slightly, Swiper had very little energy. He would only get up to walk outside for “bathroom” breaks or to go drink water. He had little interest in food, even the choice cuts of chicken and meats I purchased for him.

Swiper was home with us for about one week before he started having acute collapse episodes. When he would take a few steps, he would slip to the floor and start panting heavily. I interpreted this to mean that Swiper was throwing blood clots (i.e. thromboembolisms). Studies show that there is an increased risk of forming blood clots in the two weeks post-spleen removal surgery.

Due to these episodes and his intermittent breathing difficulties, our family decided that it was time to put Swiper to sleep. We were all very sad that we didn’t have as much time with him as we did with Lulu. But we felt good knowing that we had tried our best.

Preparing to euthanize your dog with hemangiosarcoma

If you know the time is approaching when you might need to say goodbye to your sweet pup, I would like to offer two parting pieces of advice.

1. Make a deliberate effort to treasure the time you have

The one thing that everyone can do is to make the best out of the time that you have left with your dog. If he or she enjoys drives or trips to the dog park, make a point of doing these things as often as you can. Take advantage of the “pup cups” offered at your favorite coffee drive-thru window. Toss a stick or tennis ball in your backyard. Buy a kiddie pool so that your doggie can splash around in it.

It’s still risky to give your dog fatty meats like ham and bacon because they can cause pancreatitis in dogs. But the occasional cooked chicken that falls from your plate will go to good use if you have lightning-quick scavenger Labs like me!

2. Plan your goodbye ahead of time

Another helpful tip is to have a plan in place when it becomes time to say goodbye. You do not have to wait to prepare for your dog’s euthanasia until your pup takes a turn for the worse. It helps knowing what to expect and how you want to care for your furry friend’s remains.

Some dog owners choose to go to their regular vet’s office while others prefer using an in-home dog euthanasia provider like Lap of Love. In both places, you will be asked if you’d like an at-home burial (which you would perform yourself) or if you’d prefer cremation services. Having some ideas in advance will be a great help for when the time arrives. 

Parting thoughts

Hemangiosarcomas are malignant tumors that occur commonly in dogs who are middle-aged or senior. My Lulu and Swiper pups were 10 and 11, respectively, when they developed their splenic tumors. These tumors can rupture, resulting in life-threatening blood loss. Hemangiosarcomas can also rapidly metastasize to other body parts. This is why a dog’s life expectancy is usually quite short once the mass has started to bleed.

Sometimes, surgery can get you some more time with your canine companion. But remember that humane euthanasia is a fair and kind option at any time. It is the last loving thing that you can do for your furry best friend when he or she has provided you with so much joy and companionship. In time, the pain and sorrow will lessen. And you will be left with lovely memories of your pup, as I have of my dear Lulu and Swiper! 

Have you been faced with making the heartbreaking decision of when to euthanize your dog with hemangiosarcoma?

Please share your dog’s story below. It is a great way to honor him or her and can provide peace and comfort to other dog parents in a similar situation.