Large bowel cancer

This is a continuation of a thread I started months ago which has followed my cat Vivian's intestinal troubles since the end of last summer.

She has high folate and low B-12 but relatively normal pancreas function, she did have a tumor on one lobe of her thyroid gland which was originally thought to be causing her loose stool and weight loss.

She has tried probiotic, pancrezyme, B-12, Metronidazole, diet change (also thyroid surgery in Sept for diseased lobe), with no effect.

Most recently she had an ultrasound. I chose not to go with a biopsy b/c I didn't want to put her through the brutal prep and from what I could tell an ultrasound could do a pretty good job of identifying and differentiating between diseases of the intestine. Vivian's results show thickening and loss of layering in the small bowel toward the ileum, with the most dramatic changes in the transverse colon which takes on

a more "mass" like appearance. I don't think this is to say there is a mass in the colon but that the inflammation present gives it a mass like appearance, not sure. Anyway it's not good. Without a biopsy they won't give a diagnosis, only that the findings are consistent with infiltrative neoplasia of the distal small and large bowel, suspected diffuse - enlarged lymph nodes and spleen which vet says is standard with this kind of inflammation. To me it seems clear that Vivian has a significant cancer present throughout her lower small and large intestine. Here's the tough question that I need to answer before putting her on a steroid. The radiologist and vet continue to recommend a biopsy to confirm cancer. Would a definitive biopsy confirmation of cancer, as opposed to the ultrasound finding of almost certainly cancer, change the treatment plan for Vivian? How do folks who only went as far as ultrasound treat for cancer? How do folks who went as far as biopsy treat for cancer? My decision had been pretty much made on how I would proceed but I feel like I have to ask this question just one more time before proceeding, which I obviously need to do immediately. The vet sat on this information for a week because she thought the technician present at the ultrasound had given me a copy of the results - totally not their protocol for relaying information of this kind. Not relevant but I'm very upset about this delay. I didn't get the report directly from the radiologist because he wanted to charge me an EXTRA $145 just to talk to me face to face after the ultrasound. 

It really depends on whether or not you are going to do chemo if it is cancer.  With chemo they need to know what type of cancer it is to know which chemo drugs to use.  If you are not going to do chemo then the treatment is the same, steroids and also possibly Leukeran.  Vets seem to be divided on the Leukeran.  It is a chemo drug but it has also been used for severe IBD.  Because it is classed as a chemo drug some vets won't give it without biopsy results.

Is denying the cat chemotherapy and the services of an oncologist the same as denying her a chance at prolonged life?

I think you may want to consider finding a different vet and forwarding the records. You need a consult on what type of cancer this is and the severity. As well as a discussion on what treatment you want to go forward with.

If the cancer is too severe I see no point in continuing therapy other than to treat symptoms.

My cat has a lump on her tongue. It would be $1000 for diagnosis. $200 per visit to see the specialist, add in sedation, biopsy, whatever fee the pathology people charge, additional antibiotics, etc. If it is cancer, even with chemo, I've been told one year survival is around 10 percent.

So we're treating it with steroids as that seems to help. She is happy and appears healthy.
It has been a year since diagnosis so either we are lucky or this isn't cancer.

I've heard good things about the leukeran so I would look into that option if you can.

Cat Pal said:

Is denying the cat chemotherapy and the services of an oncologist the same as denying her a chance at prolonged life?

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Potentially, yes.

Sarah Ann's prognosis is completely unrelated to the potential prognosis of your cat. Cancers of the mouth are often (usually) completely different than those of the GI tract, so the comparison is moot.

The most common cancer in the intestines or colon in cats is lymphoma. Only biopsy can determine if low-grade (small cell) or high grade (large cell).

IMO you don't need a new vet. :dk: You need an oncologist, though it is my experience that you need biopsy results prior to the consult.

Some vets will prescribe leukeran without actual diagnosis. It treats small cell. It is usually really well tolerated by cats, and it is such a slow growing cancer, many kitties live for years on leukeran. According to our oncologist, if leukeran puts the cancer into remission, it stays in remission. My Spooky had full surgical biopsy to diagnose her thickened intestines. It's small cell, and she's doing great on leukeran.

If it is large cell, there is only a 50% chance it goes into remission. Treatment is more difficult as it involves a weekly treatnent for four weeks, skip a week, another four weeks of weekly treatment, then a treatment every-other week for four months. Again, most kitties handle the chemo just fine, especially with supportive care of anti-nausea med and an appetite stimulant if necessary. The travel is what can be so stressful for some cats. With large cell, average remission is only 9 months. We are fortunate and just celebrated three years in remission for our Lazlo. But I took a number of steps I felt would increase the chances of staying in remission.

Be aware, if you start pred it becomes very difficult to get accurate results from a biopsy. So best to have made the decision to provide the palliative care rather than treat the cancer before starting the pred. :heart2:

I'm curious - what is the brutal prep for biopsy? I'm not familiar with your earlier threads. Is she very frail now? We did full surgical, not endoscopic for Spooky. But she seemed fine and basically healthy. Lazlo was very sick and had lost a lot of weight, but he had a "massive" mass in his stomach, so they were able to diagnose via needle aspirate during his ultrasound.

LDG I appreciate the information and honesty. I didn't want to put my cat through the biopsy procedure, which would have been endoscopic down the throat and up the butt, in part because the prep involves 24-48 hours fast and enemas the night before and the day of. Although she still has an appetite, Vivian has lost significant weight, she's more fragile. She is also a very anxious cat and has a good sense when something is up and this tends to freak her out. It's not that I don't think she would survive the biopsy prep, it's just that I am trying to weigh the pros and cons of putting a fearful anxious cat through invasive procedures that may or may not turn up helpful information. My vet has told me that steroids are used as a chemotherapy and should help pretty quickly. And it seems she is willing with some reservation to prescribe Leukeran if steroid alone doesn't work. So essentially I'd be treating for small cell lymphoma without a definitive diagnosis for small cell lymphoma, according to the information you give on treatments for different cancers.  So it's interesting and important that you refer to this a palliative care. I guess I see it more like taking my chances that I'm treating the right cancer with the right drug without putting the cat through expensive invasive stressful procedures.  Also, the oncologist's office is nearly an hour and a half away, which would put a lot of stress on Vivian, and on me if we had to go there several times a month. What do you mean by full surgical biopsy - did they actually cut your cat open to biopsy her intestine or was it laparoscopy? If I did decide on biopsy, and Vivian's other human may be leaning in this direction,  I would try to have it done at the oncology place where they say they do diagnostics as well. I've heard endoscopy is not the most reliable method for doing biopsy, so hopefully they use a different method. I'm really stuck on this decision. When that cat looks me in the eye I hear, "Don't put me through it." But when I hear success stories like yours it makes me wonder if I would be remiss not to put her through it -

:heart2: Yes, there are many variables to consider. :nod: Ultimately it is about the quality of life for the kitty. IMO, length of life is secondary. :rub:

Our trip to the oncologist was 1.5 hours with no traffic. Lazlo was a total trooper. If it had been... Billy, we most likely wouldn't have done it. I say that because Laz used to freak traveling. I think he knew, and I think he wanted to fight. There are definitely cats that don't. I think you have to trust your gut and what you hear your cat telling you. :heart2:

I didn't realize it was such a long fast with an enema required. Yeah, that's brutal. Spook only fasted 12 hours. And yes, she was cut open. Based on the ultrasound, they took samples from a number of places. I was surprised at the length of the incision, and the hair isn't really growing back as she was diagnosed with small cell, and started leukeran right away.

Endoscopic biopsies take samples from four layers. I don't know how many there are. But surgical takes full thickness samples. Apparently this increases the chances of an accurate diagnosis. And with what's involved with endo as you describe it, I'm not clear on why "less invasive" is better. !!! Either way, anesthesia is involved. :dk:

As to the palliative care comment, I must have missed where leukeran might be used. Pred is a steroid that treats inflammatiin - and plays an important role alongside chemotherapeutic agents in the treatment of lymphoma. But it isn't a chemotherapeutic agent. It may slow down the cancer and it usually makes kitties feel better and perkier. But it isn't something that would put the cancer in remission. Not alone. But it does - or can - extend both length and quality of life.

In the end there are no "right" or "wrong." There is only risk vs reward, and the over-arching concern should be for our kitty's comfort and happiness. Our approach was to get the diagnosis and then make decisions. With Lazlo, given the potential stress, we decided to start, bearing in mind we could always choose not to continue. With Spooky, she hadn't been sick, and hadn't lost weight, so for us biopsy was a no-brainer. She hasn't been through any ordeal leading up to the point of the decision.

:heart2: My heart goes out to you as you navigate this process. :heart2:

After going back and forth between starting Vivian on pred and pursuing further diagnostics, I was convinced through conversations with those in the veterinary field, some who have posted here and one who is also very close to Vivian to give it one more shot to try and get a definitive diagnosis of cancer or no cancer. This time I wasn't messing around and I drove Vivian 1.5 hrs to a large specialized veterinary hospital with an oncology dept.

They did another ultrasound, this time with needle aspirate biopsy of the colon, where there is significant thickening and loss of layering throughout. Though these radiologists didn't agree entirely with the original radiologist's ultrasound report (and they tell me he's not "board certified" which I had never even thought of), they did agree that the appearance of the colon was consistent with what  lymphoma looks like. After examining the biopsy for a number of different cancers, however, they were unable to find any cytology evidence of cancer of any kind. On the one hand that's reason to celebrate. On the other hand, it is well known that small cell lymphoma is difficult to diagnose in both needle aspirate and endoscopy and sometimes requires full surgical biopsy. So we're kind of back to where we started.

Cancer or not cancer? The oncologist feels the biopsy did rule out  mast cell cancer and large cell lymphoma, so that's some comfort. The treatment for those is 21 weeks of chemo at this facility which I very likely would not have pursued beyond pred. As for more diagnostics for small cell lymphoma, I feel like I've put the cat through enough and will not pursue colonoscopy or surgical biopsy at this time. I just feel like it's time to get her some relief and started on some sort of healing regime. She had her first 5 mg pred yesterday. Per the oncologist and the primary vet, we will not

go the Leukeran route unless Vivian fails to respond or stops responding to pred alone. Which is exactly where we started out before spending close to $2000 on semi- inconclusive diagnostics. The oncologist did tell me that pred does have chemotheraputic properties beyond its anti-inflammatory properties and I have done some reading about this..."lymphocytes that have mutated in a small cell lymphoma decrease in number when exposed to prednisolone."  Others may disagree, but I have to decide to be comfortable with this for now. So I guess we try the steroid, monitor for side effects and look for weight gain and improvement in the litter box. If problems arise/persist, we go to Leukeran. This is what I was ready to do one month ago and forego diagnostics beyond blood tests that showed low B12/high folate and symptoms. I don't regret the diagnostics, I had the money and at least one person in Vivian's life feels better about how we proceed from here. But for those struggling with the decision of whether to pursue diagnostics or start meds, this is one person's experience with diagnostics - so far. 

I think all of us here who have a kitty who became very ill with IBD/small cell lymphoma have faced this decision about biopsy.  I too had the needle biopsy done, however it was on the liver.  It confirmed fatty liver and cholangiohepatitis but was inconclusive as to cancer.  My kitty has been on prednisolone for 4 years now.  There is a gray area between IBD and small cell lymphoma which makes diagnoses difficult if not impossible.

Thanks Denice

I think at the end of the day each of us has to do for our companion animals what we think is best for each of them individually. The goal is to help them as much as we can while not bringing upon them excessive or unnecessary stress and discomfort. These are very tough calls, and there is so much at stake. Fingers crossed for sweet Vvian!

I lost my Pedro to colon cancer.  After the diagnosis, I was told his prognosis was poor.  Surgery with chem was an option ,but I was told even if successful , he would probably suffer with bowel problems the rest of his life.   I chose palliative care; prednisone worked well for about 6 months and Pedro actually improved.   Then unfortunately, he lost his battle.    I miss him still.  I understand your pain.

Very sorry to hear about Pedro

After her first week on prednisolone, Vivian has shown  improvement. Her stool is firmer, not what it was, but the logs vs. pancakes are a welcome sight. There is still a small amount of blood on the ones I catch before they get covered. Will be looking for improvement there as well.

I have heard that pred often yields fast improvements which may or may not last, so it's a waiting game I guess. No other side effects that I can see. Her appetite has been good throughout, and I have made a canned food fiend out of her. She's howling for her food the minute I get up and again at dinner time. Occasionally when I'm not at work she hollers for it in the middle of the day too. I wouldn't say the pred has increased her appetite, rather that she has become a canned food convert and craves it intensely, that happened before the pred. She knows she won't get the evening meal until she's had the pill, and this has helped her to be a little more relaxed about getting pilled. She used to freak out and run away every time I gave her a pill. Now she's like let's just get this over with so I can have my stinky slurry (I mix a bit of water in). And she supplements that with dry kibble put down for her and her buddy Willis, who is not a fan of canned food.  Am really hoping for some weight gain, just a little would indicate she is absorbing some nutrition from all of this food she's eating -

Pedro came from a hoarding situation so he had many issues (heart murmor, allergies (food and environmental) hyperthyroid) due to environment/poor food/inbreding in his background.   I was told the pred does actually put some cats into a kind of remission for some time (sometimes a long time), but I think Pedro just had too much going on.    Praying,  your Vivian will be one of the lucky ones and thrive. 

Just come across this thread - your description of your cat's thickened bowel etc sounds identical to what we've just been told about our cat tonight at the vet we have been given prednisolone (2 weeks). Our main issue is that he has lost a huge amount of weight and so in terms of treatment I think we would need to be careful in terms of not adding extra stress.

Like yours ours is not a definitive diagnosis and at the moment we have not been offered the option of any other tests such as biopsies etc.

My Pedro's appetite did improve and he did gain back some of the weight he had lost while on the prednisone. 

Prednisolone is a pretty amazing drug that can help in many situations that involve inflammation and/or allergy. It is also an appetite stimulant in many cases and in this way helps the animal to put on weight.

My vet says and I have read that side effects of this steroid in cats are far less than in dogs, so that is some good news. You don't mention how you know your cat's bowel is thickened, did he have an ultrasound?

Are his bowel movements normal looking? You don't mention if he is eating or has lost his appetite. There are several possible reasons why your cat's bowel is thickened, one of them is food allergy and some folks have had luck with a simple diet change. I wasn't so lucky with Vivian. The only thing about starting with pred as your first line of treatment without biopsy is that now the biopsy results would be skewed by the pred so you might not get an accurate result and healing could take longer. That said, if you're not going to fork over the large amounts of money for biopsies that may or may not tell you anything definitive - and many people go this route, I ALMOST did - then pred is a good bet for getting inflammation reduced. But do keep the diet change in mind, it is a much easier fix than some of the other possibilities. Two weeks is likely not enough time to address all the damage that has led to this weight loss, but it'll be a good indicator if it's going to help. If it's inflammatory bowel disease you may be able to eventually get your cat off the steroid, but if it's a cancer he will have to stay on the steroid. And if it's small cell lymphoma there is a chemo drug called Leukeran that you can get through your regular vet that can help if the pred doesn't. (If it's a more aggressive cancer it could take its toll rather quickly and high test aggressive and very expensive chemo treatments through an oncologist are available, this is not a direction I am likely to take with Vivian, then again she did have the biopsy that presumably ruled out the more aggressive cancers.) This is where I'm at with Vivian. I am giving the pred 3 months or so and if symptoms aren't drastically improved I will move forward with Leukeran. Her appetite is very good, as it always has been, there is significant improvement in her bowel movements thought some trouble is still visible, and she is still thin - fingers crossed.

Just a word of caution from someone who has been going through this stool and weight loss problem with my cat for going on a year now. If there have been no diagnostics done such as blood tests, you might want to consider that to rule out problems with thyroid, liver, pancreas. Hypothyroidism causes significant weight loss as do liver and pancreas disease and pred won't address those problems. I'm thinking you may already know this

Best to you and your cat - one more thing, to encourage her to eat more and to aid in digestion I have started giving her canned food twice a day.

Sorry, I meant to write the HYERthyroidism causes weight loss - that is over active thyroid and can be detected by blood test - very common in "cats of a certain age". Vivian had that as well. Unfortunately surgery to remove the tumor on her thyroid along with half of her thyroid gland fixed the hyperthyroid condition, but didn't fix the weight loss and stool problem. I personally believe that the same auto immune condition that caused her body to attack her thyroid could be causing her body to attack her colon, but I'm not a vet. And that's important to remember about any advice you get in this forum. Though based in experience and knowledge and coming from a place of empathy and caring, it is not veterinary advice and is not a substitute for the work you pay the big bucks to your vet to do. But I have learned a TON about Vivian's condition and treatment on here and it has helped me to understand better what the vets say to me and to be a better advocate for my cats and an active participant in planning their treatment.

cat pal said:

Sorry, I meant to write the HYERthyroidism causes weight loss - that is over active thyroid and can be detected by blood test - very common in "cats of a certain age". Vivian had that as well. Unfortunately surgery to remove the tumor on her thyroid along with half of her thyroid gland fixed the hyperthyroid condition, but didn't fix the weight loss and stool problem. I personally believe that the same auto immune condition that caused her body to attack her thyroid could be causing her body to attack her colon, but I'm not a vet. And that's important to remember about any advice you get in this forum. Though based in experience and knowledge and coming from a place of empathy and caring, it is not veterinary advice and is not a substitute for the work you pay the big bucks to your vet to do. But I have learned a TON about Vivian's condition and treatment on here and it has helped me to understand better what the vets say to me and to be a better advocate for my cats and an active participant in planning their treatment.

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So, how is Vivian doing now?

Thought of putting down how I feel after reading a lot of such posts on kitties' chronic illness. I really salute these kitties' owners, you all have hearts of golds. The love for your kitties and go to the extend to do wahatever for them for their recovery or extend their lifes. It is something that I admire most. I now have my first and only kitty. If my kitty has chronic illness esp cancer and/or any organ illness, I think I may let him go without specialist's treatment. The vet bill here is very high and I can't afford it. I'm a single mum. I can imagine myself breaking down for letting my kitty goes as I love him very much. But to think of him suffering in his illness and I can't give him the best treatment will even torture me. There is no cheap or foc vet in our country. People here thinks having dog or cat are expensive and even some have pets just let the animals be even they are sick. ...