My dog has elevated lymphocytes and ALKP - is it Lymphoma or Cushing's?

Question: 

If a dog is diagnosed with lymphoma, should its blood test show a high level of lymphocytes (type of white blood cell) and ALKP (liver value)? It’s my understanding that an elevation of serum alkaline phosphatase (ALKP) could be a symptom of Cushing's. My veterinarian diagnosed lymphoma from conducting the needle test on a lymph node (all of which are swollen). How do I know it’s not something else (like Cushing's disease) or another liver ailment?

Answer: 

Lymphoma is a serious condition and is understandably causing concern and worry. If a cytology has not been officially submitted, the first recommendation is that to have the diagnosis confirmed. With respect to other possible diagnoses for enlarged lymph nodes, it is possible to see infectious or immune mediated disease causing enlarged nodes but the most common cause for enlarged nonpainful nodes is indeed lymphoma.

Cushing's disease is not generally associated with enlarged nodes but could be seen secondary to infectious diseases secondary to immune suppression from the Cushing’s disease. This is very unlikely although some dogs with lymphoma have incidentally been diagnosed Cushing’s disease.

It would be best to have a consultation with an oncologist before making any final decisions regarding therapy. Working with your veterinarian, the oncologist can further define the lymphoma and offer treatment options for you and your dog depending on the situation. Seeing a board certified oncologist as soon as possible is best.  

With respect to the question regarding lymphocytes, atypical or abnormal lymphocytes may be seen in the complete blood count if there are circulating cells coming from the bone marrow or possibly from the spleen. Bone marrow involvement defines stage v disease (based on a 1-v system) but is seen in only a minority of patients. If stage v disease is identified it has been associated with a more aggressive form of lymphoma. Treatments are similar but the prognosis is more guarded with stage v disease.

In conjunction with your regular veterinarian, a Board-Certified Veterinarian is the best clinician to treat your dog for Lymphoma. The closest ExpertVet certified hospital to you is listed at the bottom of this page. For additional locations, click here.