Owner
Veterinarian
Surgical Oncology Under Real-World Constraints
"Ruby"
Start
Mammary Tumours and the “How Big a Surgery?” Question
They are worried about recovery, pain, and quality of life, and they are sceptical about extensive surgery if you cannot promise it will change the outcome. You must decide how to plan surgery proportionately when biology is uncertain and disease may be multifocal.
Ruby is an older intact female dog with multiple mammary nodules. One mass is larger and ulcerated, and the owner is understandably distressed by the appearance and occasional bleeding.
Ruby also has a stable comorbidity that increases anaesthetic sensitivity. The owner requests that you “just remove the bad one” and wants to minimise time under anaesthetic and overall cost.
Next
Veterinarian
Clinical objections
Next
Veterinarian
A colleague says, “It’s mammary tumours, so remove the chain and move on.”
Talk through your differentials and risk ranking, including what makes you worry about aggressive biology versus benign or slow disease, and what features change urgency.
Veterinarian
Describe your stepwise approach
To diagnostics, staging, and surgical planning that fits the owner’s concerns and the patient’s comorbidity. Explain how you decide whether a limited procedure is reasonable or whether it becomes an oncologically unsound compromise.
Veterinarian
A colleague challenges you: “The owner only wants one removed, so that’s what we do.”
Explain how you would negotiate surgical scope while remaining ethically clear about what the surgery can realistically achieve.
Veterinarian
Describe the escalation triggers
Or stop rules that would change your plan, such as findings that suggest systemic disease, inflammatory carcinoma, or unacceptable anaesthetic risk. Include how those triggers would alter your recommendation and the conversation.
Owner
What would you do if it were your pet?
Next
Owner
Empathy
Start with an empathy statement that recognises how upsetting ulceration and bleeding are, and how reasonable it is to be concerned about recovery.
Owner
Explain what you can confidently say at this stage and what you cannot
Frame the purpose of any tests you recommend as a way to make a safer plan, not as “extra costs”.
Owner
Offer options that fit different levels of intervention and budget
Including a plan focused on comfort and local problem-solving, and a plan aimed at better disease control if the owner is willing. Make clear what each option is trying to achieve.
Owner
Answer, “What would you do if it were your pet?”
By describing how you would balance quality of life, the burden of treatment, and the chance of meaningful control, without presenting any option as guaranteed.
Well done
You successfully completed the challenge and addressed all of our questions, both from a professional perspective and as a pet owner
STS_M3_CDSC_03_Mammary Tumours and the “How Big a Surgery?” Question
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Created on December 23, 2025
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Transcript
Owner
Veterinarian
Surgical Oncology Under Real-World Constraints
"Ruby"
Start
Mammary Tumours and the “How Big a Surgery?” Question
They are worried about recovery, pain, and quality of life, and they are sceptical about extensive surgery if you cannot promise it will change the outcome. You must decide how to plan surgery proportionately when biology is uncertain and disease may be multifocal.
Ruby is an older intact female dog with multiple mammary nodules. One mass is larger and ulcerated, and the owner is understandably distressed by the appearance and occasional bleeding.
Ruby also has a stable comorbidity that increases anaesthetic sensitivity. The owner requests that you “just remove the bad one” and wants to minimise time under anaesthetic and overall cost.
Next
Veterinarian
Clinical objections
Next
Veterinarian
A colleague says, “It’s mammary tumours, so remove the chain and move on.”
Talk through your differentials and risk ranking, including what makes you worry about aggressive biology versus benign or slow disease, and what features change urgency.
Veterinarian
Describe your stepwise approach
To diagnostics, staging, and surgical planning that fits the owner’s concerns and the patient’s comorbidity. Explain how you decide whether a limited procedure is reasonable or whether it becomes an oncologically unsound compromise.
Veterinarian
A colleague challenges you: “The owner only wants one removed, so that’s what we do.”
Explain how you would negotiate surgical scope while remaining ethically clear about what the surgery can realistically achieve.
Veterinarian
Describe the escalation triggers
Or stop rules that would change your plan, such as findings that suggest systemic disease, inflammatory carcinoma, or unacceptable anaesthetic risk. Include how those triggers would alter your recommendation and the conversation.
Owner
What would you do if it were your pet?
Next
Owner
Empathy
Start with an empathy statement that recognises how upsetting ulceration and bleeding are, and how reasonable it is to be concerned about recovery.
Owner
Explain what you can confidently say at this stage and what you cannot
Frame the purpose of any tests you recommend as a way to make a safer plan, not as “extra costs”.
Owner
Offer options that fit different levels of intervention and budget
Including a plan focused on comfort and local problem-solving, and a plan aimed at better disease control if the owner is willing. Make clear what each option is trying to achieve.
Owner
Answer, “What would you do if it were your pet?”
By describing how you would balance quality of life, the burden of treatment, and the chance of meaningful control, without presenting any option as guaranteed.
Well done
You successfully completed the challenge and addressed all of our questions, both from a professional perspective and as a pet owner