Lymphoma Diagnosis via Ultrasound and Physical Exam

http://www.thecatsite.com/t/258086/ingested-decorative-straw-now-vomiting-x-10-days

Here is the link to Sparkle's original thread a few weeks ago.

After two vet visits, our long-time vet gave me no reason to proceed with an ultrasound and his blood work as "great" and physical exam was fine. Two weeks later, still vomiting. . . I took him to a cat only clinic for a second opinion.  Upon physical exam, the new vet felt at least one mass in his abdomen (enlarged kidney, thickened intestinal wall, tumor, cyst) and we immediately decided to continue with an ultrasound. Still, blook work is fine, but Eosinophils were slightly elevated.

The ultrasound was preformed in-house, where the vet and radiologist were present.  The vet said Sparkle had "very large lymphnodes consistent with lymphoma".  She also believed his intestinal walls shows signs of IBD. We opted not to do a biopsy/aspiration at that time because we had been there all day and he was getting squirmy.  Plus, I felt confident in the vet's diagnosis.  I'm sure I had the glazed over look on my face.

He is taking:

5mg of prednisone 2x day

5mg Pepcid A/C 2x day

1/2 tablet of Cerenia in the morning

2mg Leukeran (chlorambucil) once every 3 days. 

Tolerating all VERY well.  Appetite, energy, bathroom habits all back to 95% normal.

One week later, I'm having questions.  Obviously, I don't want my boy to have lymphoma.  I want to know if the lymphoma diagnosis is too aggressive?  Does the mass that she felt during the physical exam in conjunction with the ultrasound give a conclusive diagnosis?  I've read that intestingal small-cell lymphoma and IBD are basically indistinguishable via ultrasound. 

If you read my link above, you'll see near the end where the vet was hesitant to give him a 1 month refill on the Leukeran (thinking he wouldn't live that long) and reiteratted that "this" is invasive. Then she called back later in the week and asked to see him in one month for a follow up. . . We're getting mixed signals.

Advice? Tips? Anecdotes?

Thanks, y'all...

You can't get a definitive diagnosis on either lymphoma or IBD without a biopsy. Having said that, a biopsy is a tough thing to put a cat through. You have to ask if the treatment would be very different for one vs the other and how the prognosis might differ. I believe that Leukeran is used in acute cases of IBD, not just lymphoma. Since he is responding well to the treatment, I would continue and reevaluate in a month. Maybe the vet had second thoughts about what she said (which was unprofessional of her). I don't think the current course of treatment is invasive. It's aggressive, but to me invasive is surgical, like a biopsy.

One last thing, is he on prednisone or prednisolone? Prednisone has to be turned into prednisolone for use by cats, so it's generally better to give cats prednisolone.

Hey vball - he is on prednisolone. Thanks for your input - that is what I was hoping to hear from someone. We'll followup with the vet as scheduled.

A biopsy and pathology report (and I would get two opinions in this area) is important to find out what kind of lymphoma. Leukeron is only effective with small cell lymphoma. If your kitty has large cell lymphoma, the doctors would recommend a chemotherapy protocol. 

It is true that IBD and small cell lymphoma can be indistinguishable to the extent that IBD can morph into small cell lymphoma. And often they are both treated with leukeron

You will only be able to get closer to the answer you need by having a needle biopsy and then hoping they can get a readable sample that way.

In the case of my cat (His thread is titled "Toby losing weight and vomiting, otherwise fine") he was not able to be diagnosed until he had exploratory surgery. The mass on the xray was lymphatic tissue and fluid which were negative for lymphoma, but other samples from his intestine were positive for large cell lymphoma. 

I regret that I did not have more than one opinion on the biopsy, as you may have read that the most recent research indicates that pathologists tend to base their diagnoses on the basis of who they trained under and not a clear set of scientific guidelines. When a group were given the same sample, the pathology readings were almost split in half between large or small cell lymphoma. 

If you really want to know what is wrong with your kitty, do the biopsy, be aggressive and be sure to have a sit down with the ultrasound technician, the vet, and if you have a surgeon, also the surgeon. And ask for a copy of the pathology report(s), get the two opinions, and have them go through it with you.

Even if it is expensive, so is the Leukeron and you want to be sure you are treating the correct disease. Later on down the road will be too late. My boy died a week, ago after a year of chemotherapy and then rescue chemotherapy, and throughout we were never sure what he had as the pathology report was written in the direction of small cell lymphoma but the pathologist's diagnosis was large cell lymphoma.

Also, you need to know that once you have had your first ultrasound, you would be best to have subsequent ultrasounds done by the same group. Otherwise they will tell you that #2 cannot be easily compared to #1 as they were done on different equipment by different technicians.

LDG's kitty also had large cell lymphoma, Lazlo, and is doing well. She has a lot of information to share which would be helpful to you regardless. My thread too has a lot of information from many of the most experienced people on this forum in the area of lymphoma and IBD. Good luck. And get that biopsy (and two pathology readings).

First week update:

Sparkle has taken the Leukeran twice (2mg every three days) and honestly, it doesn't seem to phase him!  I am so relieved that thus far, he doesn't seem to be experiencing any side effects. 

Eating canned food twice daily and grazing on kibble throughout the day. (Natural Balance - either a Limited Igredient Diet or the Oceanfish and Temptations Crunchy treats.)

His weight has remained the same since his vet visit last Tuesday. (16.8 lbs)

In my heart, I honestly feel like his time with us is not over.  I understand that his condition could rapidly decrease, but for the moment, he seems so happy and healthy.  My only goal once we learned of his diagnosis was to get him eating and "smiling" again.  What a blessing! 

I am so glad to hear that Sparkle is doing well.

Hi Sparkle, I concur with Barb and would be looking at having a biopsy. It isn't as upsetting on our kitties as you think and it will allow treatment to be targeted. Cancer treatment can be so hit and miss (even in humans!) so knowing exactly what you are dealing with is paramount. My little girl only lasted 3 months on targeted chemo but I wonder if without the vet knowing what we were dealing with, we might not even have had that long.

Talk to LBD, she supported me during my journey and has a wealth of knowledge.

Huggs to you and your kitty
cailea