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Discussion Starter · #1 ·
My 12.5 year old female cat ‘spooky’ has a ‘mystery’ mass in her abdomen and I am unsure of next steps for her after a week of inconclusive diagnosis with an oncologist.

Sorry this thread is long…

Spooky has a long history of hairballs and has always thrown up once/week. Starting about a month or two ago her vomiting frequency increased and got the point she was throwing up once/day, sometimes white foam, sometimes a small amount of food.

Last week of February we took her to our vet. They found a very large mass in her abdomen and determined she had lost 1.5 lbs since last summer and was down to 7.3 lbs. We did an ultrasound and the vet said the mass was in her small intestine and was cancer and referred us to a specialty clinic with an oncologist. In addition, one of her kidneys was not working well as seen on the ultrasound. The vet did some blood work and found only abnormality was that she was anemic. He was pleasantly surprised and was expecting it to be worse.

The next week at the oncologists they did x-rays, an ultrasound and stated the mass appeared to be an extremely enlarged mesenteric lymph node and was measuring 6 cm in size. She also had a sternal lymph node and a portohepatic lymph node that that was slightly enlarged. Her spleen was ‘swiss cheese’ consistency. Her bowel wall was slightly thickened and there was infarct in both kidneys. Oncologist suspected lymphoma and recommended aspirate biopsy of the mass and the enlarged lymph nodes.

Two days later, the results came back inconclusive, so another aspirate biopsy was performed of the spleen and another lymph node. These results came back last Friday and were unfortunately inconclusive. The oncologist said two pathologists looked at the results and were baffled, as was she. She said it doesn’t look like lymphoma as the cells in the mass were heterogeneous and should be homogeneous if lymphoma. The only concerning thing found was some spindle cells in the mass, which could indicate spindle cell cancer but they never found a spindle cell tumor anywhere. I asked if this was bacterial infection and she said no. She also stated other types of cancer had been ruled out. I asked are they for sure this even cancer and she no, and they aren’t 100% sure the mass is the mesenteric lymph node.

She gave us three options:
1) biopsy. I was very against doing this given Spooky’s already been to the doctors 4 times in the past two weeks and her energy level is definitely down and she isn’t eating as much. Spooky seemed to take a small step change down after the last aspirate biopsy- they had to sedate her – so I fear a full on biopsy would really hurt her. So because I was initially against a biopsy I didn’t ask a lot about it and told the oncologist I thought this was too invasive given Spooky’s condition.
2) Proceed with chemotherapy and see if it works. It is fairly successful for lymphoma but not so much for spindle cells. She agreed chemo was somewhat of a ‘crap shoot’ at this point. I was heavily leaning towards doing this as I feel we’ve spent two weeks diagnosing and I want to start some kind of treatment.
3) Euthanize. Spooky has definitely slowed down but isn’t at the end yet at least from what I can tell.

The oncologist gave us prednisone and anti nausea meds for over the weekend and Spooky hasn’t thrown up since starting them.

I am at a loss at what to do next. After thinking about it more I’d like to know more about the biopsy – would it definitely tell us the problem? Does the vet think Spooky would survive it? I wish I had asked more about it. I hate doing chemo if it is a ‘crap shoot’. We went ahead and scheduled a chemo treatment for Tuesday just to get an appointment but oncologist said we could cancel. My oncologist is out until next Friday so I am thinking of calling Monday (tomorrow) and trying to talk to another oncologist to get more details on the biopsy.

I am so lost at this point, looking for any input anyone may have.

Thanks, Jessica
 

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I think you need to ask more questions for sure. I know it's hard putting your cat through all that and not knowing what the out come may be. I would ask more questions and see what they think the out comes may be for both. It's just had to see your cats go through all that and it ending badly. I have seen cats with cancer go through a lot and I really wonder sometimes If it's worth it but if the vet says that the out comes look good I would at least try! Good luck to you and spooky. Hopefully the vet can make things a little clearer for you.
 

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I would do the biopsy. It's really the only way to know for sure. We just went through a similar situation with Ziggy where he was losing weight, stopped eating, etc. The vet took an ultrasound and found some masses. I said to try the aspirate since it wasnt invasive, but like yours, it came back inconclusive. The next step was biopsy, which determined it was cancer. All the while, the vet was saying she didn't see any reason to think it was cancer, until it was. The surgery for biopsy was a month ago and his incision has healed up nicely. His fur hasn't really grown in yet but I'm hoping it will.

One thing though, I'm curious why you would want to start your cat on chemo without knowing whether he actually has cancer. I decided not to put Ziggy through chemo and just let him live out his time at home. It has been almost a month since he was told he had a couple of weeks, maybe a month or two left and he has improved from the skinny sick cat who wouldn't eat. One thing to look into would be assist feeding. They really made a difference for us and can get your cat through times when he doesn't want to eat. We haven't had to do one in almost a week as he has regained his appetite.

Good luck.
 

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Wow...sorry you're having such a rough time.

When faced with these decisions I always ask myself what info we hope to get by doing a test. Will that info change the treatment plan? And do we have the chance of curing (or creating long term remission) or will the outcome remain the same? I know it's hard to look at it from a purely logical standpoint when you're in the middle of something like this...
 

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Discussion Starter · #5 ·
Thank you all for the input!

lucas718 - we were pushing for chemo without knowing the cause of the mass as the oncologist said that some of the types of cancer that couldn't be treated with chemo were ruled out (mass cell), and since they suspected lymphoma or spindle cell cancer, chemo was the appropriate treatment. I asked her what they thought they would find in the biopsy that wouldn't push us to do chemo anyways and she said 'something weird'. I guess I just felt like if we do the biopsy and it is inconclusive or tells us some type of cancer, we'd do chemo anyway. Chemo seems less invasive to our cat (cats apparently don't have the bad side effects like humans and she wouldn't need to be sedated), it wasn't too costly ($500), only took a few hours to administer and we'd know if it worked within a few days. But the more I think about it if we do the chemo and it doesn't work I'll always wonder if the biopsy would have found some smoking gun that would have told us to do something other wise.

Another kind of kink in all this is I am 8.5 months pregnant with twins (our first kids). I will probably deliver in a couple weeks and I would like to get this resolved before then. I have never wanted to be one of those people that 'threw away' my cats when I had babies but realistically the first couple months the babies are here we won't have much time to do any extensive care for our cat. It is just bad that the timing of this coincided with their birth as the last 12.5 years with spooky we had all the time in the world for her, and should again after the kids are a few months old.

I just called the clinic and the other oncologist on staff is there today and will try to call me back. I have a list of a bunch of questions about the biopsy but maybe I can get another opinion out of her.
 

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Did they send the slides to a pathologist? I worked for a group of Oncologists, with over 300 docs around Texas now, and our guys always looked at the slides AND had a pathologist look at them. The more eyes, the better.
Have they spoken to anyone at A&M?

What are the drugs they intend to use?

Consider this training for having kids (congrats BTW), they never get sick when it is convenient. Ever.
 

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Discussion Starter · #8 ·
marsha - i am pretty sure slides were sent to a pathologist. The oncologist received a lengthy report from the pathologist and talked to the pathologist for awhile. She said two pathologists looked at spooky's case for 30 minutes and were baffled. They even told the oncologist if she figured out what the issue was to call them back b/c they were curious to know the outcome.

I do not know if they talked to A&M, I am guessing no. This clinic has 3 oncologists listed online, one went to A&M, and the A&M oncology website lists a link to this clinic so I assume they are A&M endorsed. We thought about taking spooky to A&M but it is 1.5 hour drive, and I can not make the drive in my state right now. This local clinic is about 15 min from our house.
 

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lucas718 - if you don't mind me asking, what type of cancer did they find in your cat? what treatment options did they suggest for it? also what is assisted feeding?
To be honest, my mind went blank when the vet said cancer. I'm pretty sure she said carcinoma and that because it was throughout his liver and pancreas, there wasn't much that could be done. She mentioned some treatments that were somewhat experimental but I just didn't want to put him through it. So I made the decision to let him live out his life at home sitting in his favorite chair or on his little bench by the window where he can watch the birds.

Assist feeding is feeding your cat her food via a syringe. You basically squirt the food in their mouths to force them to eat. Go to YouTube and search on "force feeding a cat" and watch a few videos to see how it's done. They really helped me when I was getting frustrated. If you do need to do it, it will be messy.

Good luck.
 

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Have you considered the effects the chemo could possibly have on you/your unborn child? I know that many chemo drugs are very dangerous, and after receiving treatment many animals have to be isolated and their waste products handled very carefully. I am not sure if it is a risk that I would want to take. I hate to sound negative here but it may not be a bad time to start thinking about euthanasia. If you are able to keep her from vomiting with the anti-nausea drugs, I would just let this play out until the time has come. And you will know when that time is, you will feel it.

These cancers that get into the mesentery are very nasty and often don't respond well to treatment. Having the biopsy done, in my opinion, is just putting the cat through needless pain, because more likely than not it will just tell you what type of cancer it is, but it won't change the outcome in the end.

I am so very sorry you are going through all of this, at such a time as this. You and Spooky are in my thoughts and prayers.
 

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I have talked with several friends who have done chemo on their cats and dogs and the consensus is they would never put their companion animals thru that if they had to make the decision over again.

Bottom line is quality of life. I've seen nothing but poor results from chemo. Cats have a very difficult time going thru it and the life on the other side of treatment hasn't been much longer.

I surmise it would be better to make its days with you full of love, playing, treats, special foods, and bonding time. Then when they are starting to fail, you help them transition on to their next life, with dignity.
 

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Discussion Starter · #12 ·
Thank you all for the input! The day after I made my initial post, I had a lengthy discussion with the oncologist. She said the biopsy would be full abdominal exploratory surgery. Surgeons would go in and take out what ever they needed to for a biopsy or remove any masses they found and most likely remove the spleen. The oncologist said spooky could be in the hospital for several days recovering. She also was frank and said given spooky's fragile condition pre-surgery even if they found something they could treat the surgery could make her weak enough that she couldn't be strong enough for treatments... and there is no guarantee whatever the find could even have a treatment option.

I initially got the impression that chemo was not that invasive but the oncologist said it could be as hard on her as the surgery.

So after discussion with my husband we decided not to proceed with either the surgery or chemo. The surgery just seemed way to rough on a fragile/underweigh 12.5 year old cat. I would be so upset if she ended up spending her last days in the hospital trying to recover.

Some good news... we put spooky on predisone and anti nausea meds daily 2 weeks ago (cerenia and ondansetron) and immediately her vomiting has pretty much stopped - compared to daily before going on them. She is still eating/drinking daily and a couple days she seemed like her normal self but most days she does have a lower energy level. She has been so spoiled lately and we're pretty much letting her do whatever she wants and she gets a ton of attention. I know the end is near but I'm glad for the decision I made as i'd rather see her spend her last days at home comfortable then in a hospital. We'll euthanize when we feel the time is right. I just don't think she is quite there yet.

Also, I haven't delivered my twins yet but should in the next couple weeks. I'm trying to line up a professional pet sitter to administer her meds while we are in the hospital.

Thanks again everyone for the input and well wishes.

Jessica
:catsm
 

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Jessica,

I am in a somewhat similar situation with my boy, Noddy. Noddy has not been diagnosed with any sort of mass, but he has demonstrated symptoms which my vet and I assume are probably those of either IBD or cancer. I suspect he has intestinal lymphoma, but I am unwilling to put him through a surgical biopsy to get a definitive diagnosis. Even with a cancer diagnosis, I wouldn't put him through chemo. So I opted to treat him with prednisolone and metoclopramide (to control vomiting). I also syringe feed him several times a day, since he won't eat enough on his own to maintain weight, and I administer subQ fluids twice daily (which he actually loves) to maintain proper hydration. He's doing well on this regimen and so far is having many more good days than bad. He does, however, have the occasional day when he's clearly feeling pretty oogy, and those days scare me. I have no idea how long I'll be able to maintain a good quality of life for him. All I can do is all I can do, love him deeply, hope for the best, and be prepared to set him free when the time comes.

The one suggestion I have for you is to ask your vet to switch Spooky to prednisolone instead of prednisone. According to Plumb's (the veterinary drug reference used by most vets), "Use PO [oral] prednisolone in place of prednisone in cats whenever possible as they do not absorb or convert prednisone to prednisolone as well as dogs."

My own vet doesn't stock prednisolone (he only stocks prednisone), so I had to have him write me a script for prednisolone so that I could order it from a veterinary pharmacy for Noddy.

I hope that the protocol you are using will keep Spooky comfortable and enjoying life for a considerable time to come.

Laurie
 

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Discussion Starter · #16 ·
Hi all, I wanted to update that we had to put Spooky to sleep today. She was not doing well and had slowly deteriorated since the mass was first found in late Feb. I am very glad I did not put her through the exploratory surgery and instead let her live out her last days at home. She had a good final month. Luckily I have been working from home since early Feb so I was able to spend a lot of time with her. Our vet came to our house to put her to sleep. Thanks for everyone's help.
 
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