Hemangiosarcoma and Yunnan Baiyao

What is hemangiosarcoma?

Hemangiosarcoma is a highly malignant cancer arising from cells that normally create blood vessels. Since blood vessels run throughout the body, hemangiosarcoma can develop anywhere. It most commonly affects the spleen, liver, right side of the heart, and the skin. Most hemangiosarcomas are both locally aggressive and have a high likelihood of spreading to other parts of the body. These tumors are typically filled with blood and rupture easily.

What are the signs of hemangiosarcoma?

The clinical signs will vary depending on the location of the primary tumor. Dogs with hemangiosarcoma inside the body have symptoms that relate to the severity of the internal bleeding that occurs when the tumor ruptures. Signs can be as subtle as lethargy, weakness and loss of appetite, or as severe as collapse, pale gums, trouble breathing and a swollen abdomen.

Tumors on the skin appears as red- to purple-colored areas of skin or a bump that bruises or bleeds spontaneously. When tumors appear under the skin, you may be able to feel a soft or firm swelling. Cutaneous (skin) hemangiosarcomas are found more frequently in light-skinned dogs and have been associated with sun exposure. It is impossible to tell from the appearance of a skin mass whether it is benign or malignant.

Dogs with tumors on the right atrium of the heart may have irregular heartbeats, muffled heart sounds and signs of heart failure. Some dogs may suffer sudden death due to the rupture of a mass and the subsequent internal bleeding into the chest or abdomen.

How is hemangiosarcoma diagnosed?

Abdominal ultrasound, X-rays, CT scan and an aspirate of fluid in the abdomen are all important tools that are useful in determining a definitive diagnosis, as well as assessing the extent of the disease within the body. An echocardiogram is an ultrasound of the heart and can help evaluate the size and shape of the tumor. Approximately 10 to 20 percent of dogs with hemangiosarcoma of the spleen will have metastasis to the heart.

An abdominal tap is a procedure in which a fluid sample is aspirated from the abdomen with a needle and syringe. If the fluid is bloody, it is likely from a ruptured splenic tumor. If surgery is performed, usually a splenectomy, a biopsy is necessary to confirm the diagnosis.

What is the treatment for hemangiosarcoma?

Surgery is the primary method of treatment for most dogs with hemangiosarcoma. These are aggressive tumors, and in most cases the cancer will spread to other sites, such as the lymph nodes, lungs and liver, within one to three months after surgery.

Chemotherapy administered after surgery may delay metastasis. The standard chemotherapy typically consists of the drug doxorubicin (Adriamycin) given once every two to three weeks for a total of five treatments.

What is the prognosis for recovery?

Despite treatment, the long-term prognosis for dogs with hemangiosarcoma is unfortunately poor. Average survival times with surgery alone range from 30 to 120 days. The addition of chemotherapy may double survival times. Although survival times are short, the quality of life after surgery is generally very good. New treatment options are constantly being explored.  Dogs with hemangiosarcoma of the skin may have a better prognosis after surgery, but this is dependent on the biopsy results and if the entire tumor could be removed surgically.

What is Yunnan Baiyao?

Yunnan Baiyao is a traditional Chinese medicinal herbal formula that is used in human and veterinary medicine. Yunnan refers to the Chinese province where the herbal formula originated. Bai means white and Yao means medicine, so it is a white medicine from Yunnan.

Yunnan Baiyao has been used for more than 100 years to help control bleeding. It originated in its current form in 1902 by a Mr. Qu, who developed this formula for a variety of uses, including wound healing, pain relief and to stop bleeding. This herb was used on the battlefield by Chinese soldiers during World War II and Vietnamese soldiers during the Vietnamese war.

Although the exact formula is a secret in China, it is made up of a blend of herbal ingredients. The main ingredient appears to be Panax Notoginseng, which is a type of Ginsenosides. The ingredients listed on a manufacturer’s label included Tienchi ginseng root, Ajuga forrestii Diels plant, Chinese yam root, Dioscoreae nipponica Makino root, Erodium stephanium and Geranium wifordii plant, Dioscoreae parvilora ting root and Inula cappa plant.

There are many brands available for purchase over the counter, although the quality and potency may be inconsistent. Yunnan Baiyao is often used topically and orally. It comes in a powder form, an aerosol spray and as a thick topical paste.

Yunnan Baiyao is usually available as a box of capsules, each containing .25 grams, or as a powder in a four-gram bottle. There is a little red pill along with the regular capsules. This pill is called the “emergency pill.” It is a higher concentration of Yunnan Baiyao and is intended to be given when there is significant shock or hemorrhage. The cost ranges from $15 to $40 per box.

Typical dosing is one capsule, or .25 grams, per 20 pounds orally two to three times a day. The dosage depends on what type of bleeding is occurring and how long it has been going on. The capsule contents can also be opened and sprinkled directly onto a bleeding site.

It appears to work by activating platelets, which are small circulating elements in the bloodstream that encourage the blood to clot and stop bleeding in injured blood vessels. This herbal formula also relieves minor pain and may inhibit infection.

How is Yunnan Baiyao used in veterinary medicine?

Veterinarians have used Yunnan Baiyao for a variety of bleeding disorders, such as hemoabdomen (bleeding into the belly), pericardial hemorrhage (bleeding into the sac around the heart), epistaxis (bleeding from the nose), and bleeding caused by cancer (such as hemangiosarcoma).

The actual mechanisms by which Yunnan Baiyao affects the coagulation (blood clotting) system are not fully understood. It has been suggested that it enhances the proteins on the surface of the platelets for better and faster hemostatic action.

Yunnan Baiyao is best known for its anti-bleeding properties. However, this herbal supplement has been used for its anti-inflammatory and anti-cancer effects. Recent evidence shows that Yunnan Baiyao can kill canine hemangiosarcoma cells, so it may provide medical benefits to dogs with hemangiosarcoma. By itself, Yunnan Baiyao is not more effective than the standard treatment protocol, which is surgery followed by chemotherapy, but it can be a safe and valuable addition to the anti-cancer therapy.

The side effects in dogs are reported to be mild. They include nausea, vomiting, diarrhea, rash, chest pain, itchiness and flatulence. These side effects usually resolve by administering Yunnan Baiyao with food or reducing the dosage. It should be used with caution in dogs with liver diseases, as it can cause an increase in liver-enzyme values.