Small Cell Lymphoma vs Inflammatory Bowel Disease: The great debate

stephenq · Nov 14, 2014

myrnafaye said:
I am thinking, if your cat is responding well to the pred, why would a vet recommend a chemo drug?? most cats tolerate pred very well, and it is for inflammation. Stephen, what do you think of Emily Ann's concern about Leukeran being less effective if administered later, if the cat is doing well on pred?

Like I said above I haven't been told that was an issue but I will try and research it and talk to some vets about it.

emilyann · Nov 21, 2014

@StephenQ If you find anything out please let me know. I saw my vet on Nov. 4th and she said that ideally she wouldn't want to wait more than a month to start him on the Leukeran if that's the route I choose.

emilyann · Nov 21, 2014

Fuzzycat said:
Hi Emily Ann, Sorry about not responding sooner. As far as bloodwork goes, my vet did send it out. I would have to check but I think it had to do with the ratio of immature white cells and the over all white cell count. Am not sure. I do know it took an extra day or two to run. When we did the ultra sound she read it herself, but she also sent it out for a second opinion. Basically, she said his bloodwork was far below what she saw in cats with full blown cancer and nothing definitive showed on the ultrasound. Part of why I had wished I had moved to the Leukeran sooner is Rikki feels good enough to be playful. I haven't seen that in a long time. He has finally put weight on, though i still think he looks thin. Plus, he had been having problems for a long time. But I waited until I felt I had no other real choice. I had gotten him off insulin, the diarreha resolved but still could not get weight back on him. Initially, when he first started having real problems, my first vet told me not to feed chicken. They didn't seem too concerned. Then after months, when I noticed he seemed hungry all the time and he had lost even more weight I went to them and insisted a full blood work up. I was thinking diabetes or thyroid. At that point they said he would be dead in a year and put him on a high dose of prednisolone. He continued to get worse and I made the switch to a different vet and saw the oncologist. It sounds like you are getting better advice than I did early on. In recent years I have run into some excellent vets and some bad vets. Don't be afraid to get a second opinion. I recommend you research the Leukeran. I read that some cats don't tolerate it well. It can cause problems. I haven't heard anything about pred reducing the effectiveness of the Leukeran. I recommend you double check that one. I do trust my oncologist. I have taken two dogs to her over the years. She has been at it for some 20 years now. This expierence has taught me the importance of diet. We had pulled Rikki off the pred. and started him on insulin. I had to control his diet at that point. My new vet told me about some useful web sites and I learned that it was possible to get diabetes in remission with a raw food diet . At that point I had nothing to lose. I was amazed when I was able to get his diarreha under control with just diet. And now his diabetes is in remission. Oh, and we did several rounds of B-12 shots. I would say they are a must. I see the whole IBD thing in cats like crohns in people. Crohns causes chronic inflation of the intestines which leads to cancer. One of the first drugs used with crohns is prednisone. They now has more advanced medications. The son of a close friend was diagnosed with crohns when he was about 15. He just passed from a super agressive form of colon cancer two weeks ago. He was on something called remacade (sp?). His doctors disagree on the role the remacade had on his cancer. One said it probably masked his symptoms early on, another said it could not have. Medicine is more art than science. Good luck. Fuzzy Cat.

I was curious about how exactly your vets were able to look at the bloodwork and see that it wasn't cancer. I mean you'd think that this option would be mentioned at some point. So I did some research and found this:

http://www.animalhealth.msu.edu/sections/immunohistochemistry/WEBCD.IHC.REF.001.pdf

I wonder if this is similar to what your vet did. This place is about an hour away from where I live so maybe I should look into getting an appointment.

damac · Nov 21, 2014

Am I crazy or do the same kinds of symtpoms cross over to so many different problems? That is what I take away from reading all the pamphlets at the vet and going through something similar with my 15 year old siamese right now.

For us it was barfing and becoming lethargic every 3-4 days that made us go to the vet after one night he crawled into a ball lifeless all night. We wasted time on first vet that just took blood, put him on some dry food and denamarin for high liver levels. denamarin gave him diahrea every day and the vet didn't help us with this and said keep him on it after a month and another blood test! how he maintained weight at that time and his appetitie I don't know but I knew this vet was full of it so we found I think a good one that works with on oncologist.

We had the ultrasound and aspiration there was fluid and a tumor around liver. mast cell of the spleen was found so we made the decision to get it taken out. but they mentioned it might not help our problems. they said cats can live without spleen for a while even if secondary lymphoma but that odds were better for us since they didn't see masses in the guts just some hardened areas, and since he was trying to keep weight on with an appetite.

So they checked him over, etc. while in surgery which he handled awesomely a few weeks ago. But they are thinking ibd but not positive after all the $$$?

We started him out on the pred a week after surgery at low does of 2.5mg/day. Overall he is showing a way better quality of life and has only barfed up one hairball, and another portion of food right after feeding which is odd compared to before. no diahrea but we did another test with denamarin and it only took 2 days to come back so we stopped completely.

I guess they are hoping inflamation around liver, etc. will settle down and for now its ibd? He weighed 6.8 pounds after surgery getting his spleen taken out and as of now weighs 8 pounds 3 ounces which is about his steady weight the year before we saw these barfing issues.

They also have us giving him pepcid ac and benadryl daily for now to help block the histamines that may have released?

Nobody has mentioned b12 injections to us, is this something you do regardless or only if the bloodwork indicates it.

Oh and for us he had 2 barfing fits the week after surgery while healing up so we figured the trend was continuing after the spleen was taken out and it was due to something else. Then we did the pred and started seeing results so I assume it was inflamation.

They also mentioned if everything was perfect you could possibly go on a maintenence dose of pred every other day so that the body would still fire and try and make something. Is there some set period of time after the initial dosing that you try this to see what works for you?

myrnafaye · Nov 21, 2014

I think many of us are frustrated with situations like yours, and the lack of clear diagnostics. Moreover, some vets want to do conservative treatment, ie, pred, B12, high quality food that is a novel protein, and perhaps a probiotic. Some want to go for the biopsy, ultrasound and heavier drugs. And here we sit , the consumer, with a cat we love, not knowing if he or she has IBS, IBD or lymphoma. It is very frustrating. What also seems frustrating is the fact that apparently there can be organ involvement with both IBD and SLC. There are few definitive procedures. The biopsy is the most definitive, but I have tbeen told that path results are not always definitive there either. Moreover, and this is a personal statement, I realize that veterinary medicine is expensive, and in human medicine, the same procedures are much more costly; but I also feel it is almost cruel that so many cats have GI problems, and the vet recommends biopsy, or ultrasound, or both; and the cost of these procedures are just out of reach for many of us.

My cat Obi had recurrent hairball vomiting that turned into mild pancreatitis. He is on pred now, 5 mg per day, B12 and Fortiflora. This is conservative treatment. He is doing well. I too wondered about a chemo drug but my vet did not think it was necessary as long as he responded well to the pred. We dont know if we are treating IBD or SCL, but it really does not matter because the treatments are the same as long as they are doing well.

chalupa · Jan 26, 2015

How is your cat now?

damac · Jan 26, 2015

I got a notification since I replied before. It's not my thread but figured I would share that my cat is doing well. He just weighed 9.5 pounds up from 6.5 before surgery.

He has been on half a pred pill daily since a week post op almost 3 months ago.

He has had diahrea only a couple times. Once he got into another pets food.

He barfed one bit of a partial feeding and a hairball and thats it!

He eats and drinks. They have him on same dry food for some kind of elevated liver levels from last few blood tests and classic fancy feast canned.

We had discussed the raw diet and I wish I was living with my mom to be able to help her but at this time she has family to take care of and cannot tend to the cats feeding schedule which seems to be every few hours with the wet, and sometimes she leaves, etc.

So its been a night and difference in the way the cat acts since his before surgery crashes for sure. Its hard to argue against the pred and surgery. Oncologist said we maybe gave the cat up to 18 months after the surgery on the high end and it would even make treating secondary lymphoma easier to treat?

We had no option with the mast cell being the first step and i'm not sure in our case we should try and back off the pred to every other day at his next appointment. And we aren't looking for other ailments until they come knocking and are obvious.

myrnafaye · Jan 26, 2015

Chalupa: that is a very sad story, I am so sorry to hear all this. It must have been heartbreaking for you.

I know what you mean about the specialty/cat only practices. I used to take my cats to one and it became exhorbitant. I love my cats dearly and want to do the best for them that I can, but $350-$500 for teeth cleaning is not what I consider reasonable. Also, I think tests and diagnostics are reasonable - if they will give definitive answers. As we know, often with cats - and dogs- there are not definitive answers, after spending a lot of money.

Also, the cat specialists are convinced that GI disease - IBD in particular - progresses to lymphoma. I understand the argument for this - but surely this is not the case with all cats.

I dont know who you addressed your question about how the cat was doing, but if you were asking about Obi, he seems to be doing well. He is on 5 mg pred; I give him Fortiflora daily, and a quarter tsp of metameucil. Recently I added in egg yolk lecithin again; I had tried that last summer and it did not help with the hairballs - but by then he had a mild bout of pancreatitis. He has recovered from that. Next week he sees the vet for follow up - its been 6 mos. I am sure she will run a CBC and chem panel, and I will ask her to check his blood sugar also.

@Damac, I personally feel B12 is very important . Other than the mild inconvenience of a weekly injjection - Obi gets his every 5 days - its bretty much a no brainer. It will not hurt and it will help. I have Obi on 5 mg pred and the vet has not mentioned reducing it. Sometimes I guess cats with GI disease just do better with a small maintenance dose. I am not too concerned about 5 mg. Obi is 16. 5 mg is not a lot, and 2.5 is even less. Cats handle it well.

chalupa · Feb 15, 2015

Hi, guess I want to know how all the cats involved are doing. Replied thinking this was a recent post to participate in and then saw it was from months ago. realize my cats situation doesn't really fit. Posted my story, what I learned, then deleted thinking it's too much. Then my computer started acting funny. Maybe someone can learn something from it. Seems one of you got a chance to read my original post. Sorry I think it's lost. Had this message sitting to be posted for long time. I'm glad to read all is good. Hope status still good. Did read reply just must have had connection issues then forgot sorry

fuzzycat · Feb 22, 2015

Hi all,

Sorry about being slow to respond. So far, Rikki is still holding his own. He will turn 15 on April 1. I will see if I can find a decent picture of him, but his is not a big poser. In fact, behaviorally he seems to be happier than I have seen him in a long time. He has started to get into things and has become a bit of brat - such as knocking things off of my dresser etc. I see this as a positive. He has become more possessive of the bed. He will now pressure my other cats off the bed, when I am there. Other wise I see him curled up with them. I guess I am trying to say he has become more interactive.

I am concerned he may have lost a little bit of weight and plan to take him in for a complete blood panel, but even those can be quite expensive. I have him eating the Science Diet CD. I did not put him on the CD for his benefit but because my feral had crystals and had become partially blocked. The two eat together. So what one eats, the other has to. Surprisingly, Rikki has done pretty well on it. At this point, it is a matter of what works and what does not. But even the CD is extremely expensive.

I am in complete agreement with Myrnafaye on the issue of the cost of health care. I have spent a small fortune on my cats in the past and I am not sure I did them any favors. The vets like me though. I think it is a balancing act between level of care and cost. I find it helps if I can find a vet who takes their time to give me information, the big picture, to help me decide what will work best.

I also completely agree with Myrnafave about the use of B-12. That is one thing that is cost effective and does seem to help.

Good luck all

myrnafaye · Feb 22, 2015

Fuzzycat: I have had to feed cats separately in the past, as one is a scarfer, and the other is a leisurely diner. If you dont want to keep your IBD kitty on CD, you can feed them in separate rooms. Personally I dont believe in free choice feeding, I believe it is good for cats (and for humans!) to be a little hungry. You can feed one in a room with a closed door, and the other in another room or space. Its not that difficult and they get used to it.

fuzzycat · Feb 22, 2015

I understand and have fed cats in different rooms when needed. I don't free choice. Actually, one of my big beliefs of general animal management is you can learn much about how an animal is doing by watching them eat.

For various different reasons it has worked out well to feed these two cats together. Rikki is doing well on the CD. I can only assume it is formulated to be highly digestible. My point was I was surprised that it actually worked.

myrnafaye · Feb 22, 2015

I know that there are questions about Hills food, but I had maintained a couple of cats on Hills formulas, and if I needed to, I would do so again - glad the CD is working for your kitties.

fuzzycat · Feb 23, 2015

I understand. I am not wild about Hill's either. But the more I research, the more I realize that all of the companies have their problems. I even tried making my own food for awhile. I bought a product called 'Balance It', from UC Davis, which has all the enzymes and vitamins etc. needed. I used a diet they prescribed. The diet itself was relatively simple but the 'Balance It' has an odor of its own and I could not get Rikki to eat it.

I have resolved myself to think that within each of the top brands there are individual foods that are work. In other words Hill's has some foods that are junk and some that are not terrible. The same goes for Royal Cannin etc. and even brands like Natures Variety etc.

riley1 · Feb 23, 2015

StephenQ said:
Like I said above I haven't been told that was an issue but I will try and research it and talk to some vets about it.

StephenQ,

I just researched Leukeran & am surprised that I was not offered this for my kitty. They found no masses with the ultrasound so I assumed there was nothing to take out. When I asked the internist why they could not start him on cancer drugs without the full thickness biopsy they said this was "unethical". However, they also said that because he was on Pred for so long they may not be able to determine whether he had cancer or not even if pred were stopped for a period of time. He had been on Pred for 2 yrs & had never been off of it. First he had two shots of it about 7 months apart and then Pred daily for about 4 months. Then they told me that he might only live 6 months after the chemo was started. I feel cheated that there was something I could have given him that might made a difference. The biopsy price was $3500 plus. At this point he was eating very little but had not lost any weight. I could not get him to eat any of the food the vet recommended & force feeding was not an option with this cat.

If the outlook I was given was not so dismal I would have gladly paid for the biopsy. I plan on calling my regular vet & asking why Leukeran was not offered. However, if you read my other somewhat "crazy" posts when I talked to him he said he did not want anymore vet visits or treatment.

stephenq · Feb 24, 2015

Riley1 said:
StephenQ,

I just researched Leukeran & am surprised that I was not offered this for my kitty. They found no masses with the ultrasound so I assumed there was nothing to take out. When I asked the internist why they could not start him on cancer drugs without the full thickness biopsy they said this was "unethical". However, they also said that because he was on Pred for so long they may not be able to determine whether he had cancer or not even if pred were stopped for a period of time. He had been on Pred for 2 yrs & had never been off of it. First he had two shots of it about 7 months apart and then Pred daily for about 4 months. Then they told me that he might only live 6 months after the chemo was started. I feel cheated that there was something I could have given him that might made a difference. The biopsy price was $3500 plus. At this point he was eating very little but had not lost any weight. I could not get him to eat any of the food the vet recommended & force feeding was not an option with this cat.

If the outlook I was given was not so dismal I would have gladly paid for the biopsy. I plan on calling my regular vet & asking why Leukeran was not offered. However, if you read my other somewhat "crazy" posts when I talked to him he said he did not want anymore vet visits or treatment.

i can't explain what your vet said about Leukeran. All three vets I consulted, at 2 different hospitals, primary vet, internal medicine specialist, and oncologist all said the same thing. Leukeran therapy is approved for severe IBD or small cell lymphoma, and can be started for either, if there is at least a diagnosis of severe IBD. After that, the next drugs like cytoxin can only be started if there is a positive diagnosis of cancer (sm cell lymphoma) or in my cat's case, it turned out to be Mast cell cancer so he was started on a specific dug for that, Palladia.

This article mentions the use of Leukeran for cats with IBD that doesn't respond to other therapies but note they use the chemical name "chlorambucil", Leukeran is the trade name. http://www.vet.cornell.edu/FHC/health_resources/brochure_ibd.cfm

Tihs was taken from the article near the bottom: "If none of these medications successfully controls the symptoms of IBD, more potent immunosuppressive drugs, such as chlorambucil or azathioprine, may be necessary. "

riley1 · Feb 24, 2015

StephenQ said:
i can't explain what your vet said about Leukeran. All three vets I consulted, at 2 different hospitals, primary vet, internal medicine specialist, and oncologist all said the same thing. Leukeran therapy is approved for severe IBD or small cell lymphoma, and can be started for either, if there is at least a diagnosis of severe IBD. After that, the next drugs like cytoxin can only be started if there is a positive diagnosis of cancer (sm cell lymphoma) or in my cat's case, it turned out to be Mast cell cancer so he was started on a specific dug for that, Palladia.

This article mentions the use of Leukeran for cats with IBD that doesn't respond to other therapies but note they use the chemical name "chlorambucil", Leukeran is the trade name. http://www.vet.cornell.edu/FHC/health_resources/brochure_ibd.cfm

Tihs was taken from the article near the bottom: "If none of these medications successfully controls the symptoms of IBD, more potent immunosuppressive drugs, such as chlorambucil or azathioprine, may be necessary. "

Stephen, thank you so much for the information. I just called the internist office & left a message for them to call me. Already have gotten pretty angry about this. If they give me the "unethical" reason again I am afraid I am going to react very poorly. Certainly hope this vet was not withholding treatment in an hopes of a $3500 biopsy. At first I thought this was something approved in other countries but I see that you live in the US.

stephenq · Feb 24, 2015

Riley1 said:
Stephen, thank you so much for the information. I just called the internist office & left a message for them to call me. Already have gotten pretty angry about this. If they give me the "unethical" reason again I am afraid I am going to react very poorly. Certainly hope this vet was not withholding treatment in an hopes of a $3500 biopsy. At first I thought this was something approved in other countries but I see that you live in the US.

I have replied to you by PM. :-)

Oh and I should add that they only allow Leukeran with severe IBD when the IBD is no longer responding to earlier treatments like Pred.

ldg · Feb 24, 2015

emilyann it's been a while since you were active in the thread, I don't know if you'll see this. Wondering how you and your kitty are doing? :heart2:

stephenq I read this whole thing while at the waiting room at the vet this morning. As you know, I have a kitty with intestinal lymphoma (small cell). I asked the vet about using Pred alone prior to moving to leukeran in the light of no definitive diagnosis as re: kitty being less responsive to the leukeran. She said what is meant is that the chances of the leukeran putting the cancer into remission are less if the problem was small cell lymphoma all along. The earlier you identify it as small cell lymphoma and treat it, the higher the probability the leukeran puts it into remission.

She also indicated, as you said, that 5 days off pred is not near enough time to help ensure a more accurate diagnosis, her minimum is four weeks, and she prefers six.

My Spooky was diagnosed with small cell lymphoma in August. Her blood work was normal, she'd been vomiting. So we had imaging done. X-ray saw that her intestines *may* be thickened. So we did the ultrasound. That saw they were thickened. We opted for full surgical biopsy as she'd not lost weight yet (so losing weight is NOT a requirement for thickening being lymphoma vs IBD, whoever mentioned that). With vet input, we felt this was the best option for a definitive diagnosis, and we wanted to treat the cancer if that's what it was.

Yes, the tests and surgery are expensive. For us, it was worth it, as we knew to put her on leukeran and not just pred.

Pred is NOT a treatment for small cell lymphoma. It is *part* of the treatment for it. It addresses only the inflammation, it is not a chemotherapeutic agent capable of putting the cancer into remission: leukeran is.

mina · Mar 24, 2015

I'm going through the same issue now with my cat Tigger. He is around 10 years old and started having inflammatory bowel issues about 18 months ago. We tried diet changes (hydrolyzed protein, hypoallergenic food) and different medications (cyclosporine, prednisone shots) to no success for about the first 9 months of his illness (during which he was having diarrhea constantly and grooming to the point of creating sores on himself), but thankfully, since August 2014, his symptoms are now being controlled on 3.5 mg of prednisolone orally each day plus Natural Balance Limited Ingredient duck and pea dry food and wet food. He vomits much less now (1-2 times/month), does not excessively groom anymore, and his stools are well-formed. He's got a great appetite and is active, energetic, and his usual affectionate self.

Unfortunately, when I took Tigger to the vet yesterday, I found out that he's lost 2 pounds since his August checkup. In August he was a slightly-overweight 13 lbs; now he is a somewhat-skinny 11. His gums also looked pale to the vet, so she suspects anemia. With the combination of weight loss and potential anemia, the vet immediately started talking about the possibility of a GI lymphoma and the diagnostic workup for that. We did a CBC, CMP, and TSH (the normal senior wellness package - we couldn't get urine, so no urinalysis) and are awaiting results. Obviously the bloodwork won't conclusively rule in or rule out anything, but if he is anemic the MCV should tell us whether we're dealing with a megaloblastic anemia (suggesting a B12 deficiency - which I guess doesn't have neurological manifestations in cats like in humans? but would make sense if his terminal ileum is being affected by IBD) vs. a microcytic or normocytic (or slightly macrocytic) anemia of chronic disease.

For those of you who've had kitties with a small cell lymphoma - did they have obvious symptoms/behavioral changes other than weight loss when they were diagnosed?

Small Cell Lymphoma vs Inflammatory Bowel Disease: The great debate

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