Questions for cat with suspected GI lymphoma

My cat is strongly suspected of having gastrointestinal lymphoma. I have to decide if we are going to biopsy. Please help me by answering some questions:

1) Does Prednisone actually kill cancer, or does it just treat the symptoms/inflammation resulting from the cancer?

2) What difference would it make in outcome if we started treating with Prednisone alone and switched to Leukeran when the Prednisone stopped working, versus starting right off the bat with both Prednisone and Leukeran. Survival time?

3) What kind of quality of life does a cat have on chemo/Leukeran?

4) For those who were in a similar situation and proceeded with the biopsy, were you glad you did it? Would you make the same choice again knowing now what you do? What condition was your cat in when you had the biopsy done? How much did it cost? How long did chemo prolong your cat's life?

5) For those who were in a similar situation and refused the biopsy, do you regret that? How was your cat treated, and how well did the treatment work?

Thank you. I'm sure I'll think of more questions as I go...

I do not think I am in the exact situation as you but I will put my 2 cents in, hopefully it will answer a couple of your questions.

You can follow my thread about Artie, if that helps

My cat was suggested to have either IBD or lymphoma based on his symptoms, which he had for a long time. My own Vet explained it all to me, i.e.: IBD vs Lymphoma, treatments with and without a biopsy. So I was able to have at least some time to decide. Artie is 11 yrs old.

He saw an internal medicine specialist at an big hospital the next day. She went over things. She strongly suggested an ultrasound and possible biopsy. It would be an endoscopic biopsy opposed to an open one due to the findings on the scan.

I decided I needed to know, if not only for my own benefit selfish, I know, but for his also. I needed to prepare myself for the worse...

He had it done, and was miserable for a while. By a while, I mean at least a week. Immediately after, all he did was stay in his carrier, hiding. He was in pain. You could tell. I felt horrible. I was in constant contact with the specialist and the Techs. Not eating, giving me a painful look. I felt horrible that I had him go thru this. He refused his food, was losing more weight, but eventually turned the corner and started to improve. There have been many ups and downs. The people on this sight are wonderful. There is also a Facebook site called IBDKITTIES.

They are great also. 

We got the results back as IBD. I had an answer. He has had issues since I adopted him. We exhausted all possibilities and now we can treat him. 

I am glad I did that biopsy. I will not have him go thru it again. But I do not think he will ever have to. 

It is done and over with.

Artie is now on prendisolone and pepcid right now, with a probiotic. At one point he was on 5 medications.

The steroid does not heal, but it does help with inflammation--allowing the gut to calm down a bit. 

It has taken a few months, but I think Artie is on the right track.

Fingers crossed as I say that. 

I think the treatment for Gi Lymphoma and IBD are the same initially. The only difference is the option of taking the heavy duty chemo drugs. They will not prescribe those without a biopsy. 

The issue is once a cat has been on a steroid, in order to have a biopsy, you would have to stop the steroid for a while---bringing back the bad, initial symptoms. I did not want to do that to Artie. I would feel terrible, and he would suffer doubly. 

I was fortuanate for have pet insurance at that point. long story, will not rehash it. They did pay for approve 85 percent of the surgery. 

It is costly. I think the price tag was $1465....

If I can be of any more help, please feel free to ask...

Thanks for the reply. It seems I always ask very specific questions that receive few answers.

$1400...that's cheap! They're quoting me $3000- but that's for upper & lower scope. And I don't have insurance (I bet the increasing prevalence of pet insurance has resulted in increasing prices for the rest of us, too). I suppose I could get it done at the regular clinic instead of the hospital, but I'm sure the hospital has more experience and would be better prepared to address any complications.

So you did an upper GI endoscopy (scope down the mouth) only? They told me that that is an option, but it might not yield an answer. Upper GI scope only sees the stomach and the top of the small intestine. If cancer is in the lower part, the scope won't see it.

Another option is to do both the upper GI scope and the lower scope (rectal, a colonoscopy). The colonoscopy sees the colon and the bottom part of the small intestine. Of course, it is possible the cancer could be limited to the middle of the small intestine, and neither scope would find it. My concern is that my cat would have to do three days of a liquid diet before the colonoscopy; he is down to 5.5 lbs from over 10 lbs, and he can't afford to cut calories even for three days. He is 14.

There is also the option of a surgical biopsy, also $3000, which is riskier and involves a recovery time before starting treatment. It would definitely give us an answer, where the endoscopy and colonoscopy might not.

I know prednisolone is used in the treatment of lymphoma as well as IBD... but Leukeran is the chemo drug that really kills the cancer, and they won't prescribe it without a biopsy. If he has cancer, I want to treat it aggressively...but I'm really concerned about the risks with the biopsy.

How sick and underweight was your cat when he underwent the biopsy?

Thank you again for answering

I was one who didn't get the biopsy done.  Patches was very sick and had been having flares of undiagnosed therefore untreated IBD for six years while I was vet hopping.  I tried one more vet and at this point he was in fatty liver.  She did the ultrasound and then started him on Prednisolone and metro in addition to putting in a feeding tube.  Which ever way you go the biopsy has to be done before the steroid is started.  The steroid will skew the biopsy results.  Often the biopsy will come back as inconclusive. 

So much depends on whether he has lymphoma, IBD, or in the grey area in between.  For Patches it has been 4 1/2 years and he is still doing well so I think he had IBD rather than lymphoma.

MissKalamata said:

 
Thanks for the reply. It seems I always ask very specific questions that receive few answers.

$1400...that's cheap! They're quoting me $3000- but that's for upper & lower scope. And I don't have insurance (I bet the increasing prevalence of pet insurance has resulted in increasing prices for the rest of us, too). I suppose I could get it done at the regular clinic instead of the hospital, but I'm sure the hospital has more experience and would be better prepared to address any complications.

So you did an upper GI endoscopy (scope down the mouth) only? They told me that that is an option, but it might not yield an answer. Upper GI scope only sees the stomach and the top of the small intestine. If cancer is in the lower part, the scope won't see it.

Another option is to do both the upper GI scope and the lower scope (rectal, a colonoscopy). The colonoscopy sees the colon and the bottom part of the small intestine. Of course, it is possible the cancer could be limited to the middle of the small intestine, and neither scope would find it. My concern is that my cat would have to do three days of a liquid diet before the colonoscopy; he is down to 5.5 lbs from over 10 lbs, and he can't afford to cut calories even for three days. He is 14.

There is also the option of a surgical biopsy, also $3000, which is riskier and involves a recovery time before starting treatment. It would definitely give us an answer, where the endoscopy and colonoscopy might not.

I know prednisolone is used in the treatment of lymphoma as well as IBD... but Leukeran is the chemo drug that really kills the cancer, and they won't prescribe it without a biopsy. If he has cancer, I want to treat it aggressively...but I'm really concerned about the risks with the biopsy.

How sick and underweight was your cat when he underwent the biopsy?

Thank you again for answering

Click to expand...

Hey! Please pardon me if I come across uncaring or overly blunt. It seems to be that kind of day...I do not mean to come across like that..I apologize in advance.

I decided to have the biopsy because I needed to know. I also knew that once I started treatment, I could never stop it so that Artie would backslide into all the issues which we started with. I also had pet insurance, at that time, which helped considerably. The range for the biopsy was 1300 to 3000....a huge range. I guess it depended on how many sites they biopsied, complications, etc.....The doc could only biopsy part of the stomach; not the beginning of the small intestine. She was able to get the area which was abnormal on the ultrasound. Yes, it was the one thru the mouth...

I keep wondering why you are saying that your kitty has lymphoma? Is that a definite? or is it a suggestion from the Vet? Blunt question, but I think it makes a huge difference in everything. 

I was told by both my Vet and the specialist that it could be IBD or Lymphoma. They could only biopsy one area. So it is still not 100% definite that it is totally IBD. But Artie is responding to treatment, so I am grateful. He will not undergo another biopsy. 

I do not think you regular Vet would want/ nor advise to do the endoscopic (thru the mouth) biopsy. I think they leave that to the specialist because it is such a precise science and skill.

You are correct in what you have been advised about the limitations of the endoscopic biopsy. Artie had an abnormal ultrasound which showed thickening of the back wall of the stomach and part of the small intestine. They really could not get a good view of the rest of his bowel on the scan. He had too much intestinal gas which obscured the view, however, what they did see looked ok...

Artie was adopted by me, 3 yrs ago. He is a stressed out cat with multiple issues. He has been hard to deal with on food. He has always been slender and finicky with food. He hasa grad 4 heart murmur, early kidney disease, iFLUTD, stress related issues, IBD and now it was sugested that he may have herpes. He has also had 2 dentals in 3 years---bad teeth. 

He was sent to the Specialist because he stopped eating, was vomiting a lot, and was losing weight. He went from 11.3 lbs down to 10.9 in 2 weeks....

He also was looking at me for food but did not eat. He kept looking and crying for help. He was breaking my heart. That is when my Vet said that we have exhausted all possibilities; Now it was time to see an Internal Medicine Vet because she suspected IBD or  lymphoma. .

The above was exactly what the specialist told me. 

What is happening with you kitty for you to think/k now they have lymphoma and not IBD?????

Is there a mass??  I do not quite understand. I am asking the blunt question now....

I am always around if I can be of any help, although my journey with IBD started in May of this year. I am a novice, also........I just have a big mouth!!

Artiemom-

My cat is strongly suspected - not for certain - to have lymphoma. If we had a definite diagnosis, there would be no need for a biopsy. No, there's no visible mass, but given my cat's symptoms (severe weight loss) and test results (high platelet count, etc), lymphoma is the most likely culprit. The vets would not give me an exact probability, but it is over 50%. Severe IBD is also a possibility (fungal infection is the third, unlikely possibility).

I have decided to go ahead with the endoscopy and colonoscopy. It is a risk - I am quite worried - but I think -  fingerscrossedhopingveryhard - it's worth taking.

The vet who will actually be doing the colonoscopy would not put a number on his probability of surviving without major complications...and she scared me with stories of intestines getting perforated by the scope, and of clients not getting a definitive answer. And your story scares me - your cat was younger and a lot healthier than mine when he had the biopsy, and he still experienced complications. The hospital vet actually told me that if I wouldn't forgive myself if something were to happen during the biopsy, I shouldn't have it done. But what she doesn't realize is that I wouldn't forgive myself if I DIDN'T do the biopsy and he lived only a few months due to not having chemo.

I talked with my regular vet, and she seemed more confident than the hospital vet, and made me feel better. She said the overall rate of anesthetic complications for all cats and dogs of all ages is 1%. Of course that number will be higher for my cat, considering his being weak, malnourished, and having a history of seizures. But even if the risk is five times higher, I believe it's worth it.

The scope biopsy is at least safer than the surgery. I've been leaning towards the scope option all along, I just needed to deal with my worries first. If it's cancer, I want to treat it aggressively. My boy is a risk-taking trouble-making kind of kitty, and I think he'd want that, too.

Denice- I'm glad Patches is doing well now!

Edit: One other qualm I have, though - I've never tried a novel protein or raw diet for my cat. He did do two weeks on Z/D, but that didn't do much, and then he was switched to W/D for pancreatitis. I recall (before starting the Z/D) asking the vet about novel protein and raw diets. She said she's known a lot of cats with digestive issues, many of whom tried a novel protein, and many others who opted for a hydrolyzed diet. In her experience, more cats did better on the hydrolyzed diet. She was concerned about trying raw on my cat's weakened system.

I should mention that my cat has had chronic loose stool issues, which improved a little but never completely resolved when he began eating Purina UR for bladder crystals a few years ago. I should have looked further into different diets years ago, but I didn't. He seemed okay and maintained his weight despite the loose stools. Now I'm guilty - is he sick now because of my negligence then? IBD can turn into lymphoma.

I don't know - should I try a novel protein diet first? I don't want to delay the biopsy and have him get worse. He can't afford to get worse. Plus, he was given the W/D because he had high pancreas enzymes and is supposed to be on a low fat diet to calm his pancreas. The W/D says it's for gastrointestinal health, and for what it's worth, I think his diarrhea is a little less liquidy on it. Would it even be safe to change his diet at this point? If he has lymphoma, I assume a change in diet won't do much anyway?

If the food was the problem, the sensitivity must have worsened really quickly for him to lose so much weight so fast. That's what points to lymphoma instead of IBD. Although, I know, they're two ends of the same spectrum.

I don't want to fool around with different foods while he continues losing weight. He needs treatment ASAP. If that treatment is prednisolone, it's now or never for the biopsy.

I don't know. I thought I was decided, now I don't know if I'm overlooking an option, or if I'm an awful person for not treating his digestive problems earlier, or what. I guess I should talk more with the vet.

Oh, MissKalamata!! I am sending many ((hugs)) your way. Please do not beat yourself up over this..easier said than done, I know. 

You made a decision, I understand wanting to know.

Some cats do better than others. I understand how you feel. You have to have some faith. Faith in your cat and faith in the Vet. They do not want to do anything which will injure you kitty. They gave me medications both before and after the endoscopy. I was constantlu in touch with the specialist and/or her techs. It take 3 days for the results to come in. Once we found the results, we started the appropiate medications. They did work fast. It was not until his follow-up appointment a month later that the Vet insisted on novel proteins. Until then, I had taken Artie off of chicken, but he was eating better food. I had, just a week before the Specialist appointment, made the correlation between chicken and his vomiting. He has not vomited since I discontinued feeding him all chicken products. That was one of his symptoms. I did try so many novel proteins, on my own. I could open a store with what I have in the house. I chose what I thought he would continue to eat. 

Is you cat having both ends done at once? It sounds like a lot to go through, however it would all be done at once. That is up to the VET. 

Personally, I do not think I would have my guy go thru the open biopsy. 

Take a step back and think. Would you be able to live with yourself if you did nothing? Then go with that feeling. You made a decision. Do not question it.

Think about how many adult humans go thru these tests without any complications. When you undergo a colonoscopy, you are always give the 'issues' perforated colon, etc. How many times do you hear of that happening?? I have not in a very long time. And I worked in a hosptial. These Vets doing the procedures are experienced. Have some trust in their abilities. 

Do not play around with different foods right now. Give you kitty anything which they will eat. Whatever that may be. 

If you decided to go ahead with the scopes, then do that and then see what the outcome is...

I hope I do not sound too harsh.

I have a habit of thinking the worst on things. I am a complete pessimist. I really do know what you are going through. I have to work at being positive...

I honestly hope, with all my heart, that I have helped you a bit..

Unfortunately we all have to trust the professionals. We cannot do their jobs and ours also. Our job is to take as good care of out loved ones that we can. And to trust.

Things will work out, and if by some strange reason they do not.. please remember that you did all you could humanely do to provide the best treatment for your prescious kitty.....

((((((hugs)))))

Thanks again for the encouragement (and you don't sound harsh at all!).

Yes, both ends are being done at once. I don't want him going under anesthesia twice. The vet quoted a study of 18 cats with lymphoma where 39% had cancer in the upper part of the small intestine only, I think 45% had it in the lower part only, and 17% in both places (doesn't add up to 100...but close enough). So by scoping both ends we increase the chances of finding cancer if it's there. I feel the risk of not getting an answer with the scope is less than the increased risk of complications if we were to do the surgery. And I feel that the risk of doing the biopsy is less than the risk of treating with steroids alone when he might in fact need chemo.

You're probably right about not playing around with foods now...I will ask the vet about it, but I figure she'll say the same. If the biopsy comes up negative, and we go with the IBD diagnosis, then we can try different diets. I just wish I'd looked into different foods before my cat got so sick. The W/D he's eating has chicken and also carrageenan, which I'm reading is not good. But, of course, we have to treat his pancreatitis.

My concern about the food came from me surfing the IBDKitties site. Actually, one of my vets had been urging me to look up the IBDKitties site for my other cat. It wasn't until last night I finally did, because I just felt like the information was going to overwhelm me. And sure enough, it was overwhelming, but there is some nice and helpful stuff on the site. I should have looked earlier, and now I will have to delve further into their mass of IBD knowledge.

I'm glad you found the right food and medicine to treat Artie.

Thanks again!

Thank you for your kind words about Artie...Yes, he is doing much better...even correcting  me when I try to talk his language!



loads of good wishes coming your way!

I kind of know what you are going thru. The specialist was concerned because no matter what she did she could not visualize the stomach and proximal small intestine. She could not understand why. That area is a mystery to us because it was 'gassed out' on the ultrasound.   But, I am not even gong to think about that because he is responding to treatment and is in a good spot right now. 

BTW because he has ben fighting me so much over the compounded liquid Pepcid, tried both the fish (smelt like rotten fish) and the beef (no smell); I have decided to switch back to the pepcid in an empty gel cap. I was trying to give him one cc at one dose because I could not see myself bugging him at night for more dosing. I was lucky if Artie took 1/2 of a cc because he spit out so much of it. 

Now I am giving him just 1/2 the dose in the capsule. So far so good...three days now..

When do you think your kitty will have the scopes? And what is your kitty's name? 

Please keep us updated....

((hugs)))   

  

ps....sometimes reading too much can result in an information overload. Same with visiting too many sites... Too many people have so many different ideas. It gets to be overwhelming. I had to step back from it all and trust in the Vet's learned experience. I was armed with some information, but took a break from some sites. Facebook got to be a lot overwhelming with people telling me to do this or do that and questioning my Vets opinions...

In other words, I had to learn to take it with a grain of salt. 

sorry if I sound so negative, but I just wanted you to avoid what I went thru. People mean well, but sometimes it gets to be a bit much....

This site, and the people associated with it have been awesome. They are all so helpful and knowledgable. I am on here primarily.

Hi! This is in response to the original post, but some others may find helpful as well! 

First, re: your hesitation in going forward with a biopsy or trying other routes: I was in the EXACT SAME position as you are about a week and a half ago. (I just read your whole post, but I didn't see if you decided what to do yet and/or had the procedure done.)

I'll give you the abbreviated version of my case, just to let you decide if mine is similar to yours. My cat was having severe diarrhea for weeks - tried metronidazole a couple of times - didn't work - and we did the gamut of procedures BEFORE deciding on biopsy. Those included: blood tests, ultrasound, B12 enzyme test. Nothing serious came back on any of these until maybe 2 wks ago. My cat had lost a lot of weight (I believe you said yours did, too), but those were really the only 2 symptoms - weight loss and diarrhea. Those of course are significant issues, but when my cats have been sick before, they pretty much lay in my closet and won't eat at all. She was NOT doing that, so I really thought maybe it was not serious. So, jumping ahead to 1 week ago, I decided the only way we were going to figure out what was wrong was to go ahead with a biopsy.

This is what my vet told me, which may be helpful for you. There are 2 choices with biopsy that she told me about:

1- endoscopy - less expensive than full surgery and much less invasive- it is NOT a surgery, but does require anesthesia. With my cat, they needed to see the intestine, and I went this route, and it did give me the diagnosis. My cat DOES have lymphoma, sadly. But I am glad I opted for the biopsy, because now I know for sure. 

2 - Full surgery to view the entire intestine - very invasive and VERY expensive. Only real difference is that they can see more of the intestine, but with my cat, it was not necessary to do that big procedure. The Endoscopy was effective and it answered all of our questions.

If you are still going back and forth on whether or not to do biopsy, I hope this will help you in some way. It did help me make the decision 1 1/2 weeks ago. I am upset now at the results, but at least I know I made the right decision to have the biopsy done to get a full diagnosis.

Best of luck to you! 

Thanks for sharing your experience, Jenmeow. Is your cat getting chemo now? Were there any complications with the biopsy? Was it an upper scope only (through the mouth)? My Oliver is doing botht the upper and the colonoscopy.

Artiemom - My cat's name is Oliver. His biopsy is scheduled for August 11th... I wish it wasn't 3 weeks away, since he is weak and wobbly. I want him on pred ASAP. I'm still very worried about him.

Oh, The waiting for the surgery must be impossible for you.. I am sure you are going thru all the mixed emotions! Positive and negative...((hugs)))

  

How is Oliver doing now? 

Is he doing any better with eating food?

Could the producers  be moved a bit so they are done a bit sooner? I know it is a long time to wait. I had to wait 2 weeks for Artie's. 

It is nerve wrecking. 

I am here if you need anything. I am sorry I cannot be of more comfort, today. I am just emotionally wiped out....

Oliver eats a lot ... but it doesn't do much, it goes right through him. He looks even skinnier, although according to the scale, his weight hasn't gone down in the past few days (but my scale is unreliable), but he feels skinnier. He's around 5.2 - 5.4 lbs. He used to be 11 lbs... and if I had gotten him to the vet sooner, or weighed him regularly - which years ago I used to, but I got out of the habit - we would have been able to start treating him before he got so sick. All my fault, there's no denying it. He's skin and bone, and lies down most of the time.

I do know that, if he loses any more weight in the next week, I will probably cancel the biopsy. He can't afford to lose weight while waiting (I see that there is a way to give animals and people their nutrition intravenously... it's called Total Parenteral Nutrition...but it seems pretty rare, not a single thread about it on this site. I'm sure the vet wouldn't do it, especially for a cat who is eating... it's just that the eating isn't doing a lot - the nutrients don't get absorbed).

My family is trying to talk me out of the biopsy, and actually the vet herself seemed to try to dissuade me. I don't know. It's a risk, and I'm afraid. I wish the vet could put a number on the risk. But, as I see it, he more likely than not has lymphoma. If that's the case, prednisolone alone would only give him around six months to live. But if we add chemo - which we only can do with a positive biopsy - he might live two years - who knows? Maybe more. I feel like it's worth the risk if it gives him another year or two of life.

Then they tell me I'm thinking of myself, trying to prolong his life for my sake (and in part, I am). But I feel like most animals, like people, have a strong instinct to survive even if their life isn't totally comfortable. Who am I to say he would rather have a relatively unmedicated six months than a few years on chemo? I don't know how harsh chemo is, really. Isn't it worth a try, anyway? A family member (Oliver used to be her cat) is telling me I should simply keep him as pain-free as possible and not do any poking and aggressive treatments. I feel like, to not do the biopsy, is to prematurely give up. I don't want to give up, and I think Oliver doesn't want to give up, either.

I don't know; I'm still kicking myself and second-guessing myself and hoping things will be okay.

Update for anyone who cares - I did cancel the biopsy. Oliver had several more seizures despite being on seizure medication and lost a few more ounces. I talked to my housecall vet - whom I should have spoken to 3 weeks ago before I scheduled the thing, but instead I had only spoken with the clinic vet and the hospital vet - and she was very concerned about the risks of the procedure. More relevantly, she told me that there are in fact vets out there who will prescribe Leukeran (chemo) without a positive biopsy (it's not clear if she was including herself in that group...but I intend to find out). Both the clinic vet and hospital vet had refused to dispense chemo without a definitive diagnosis, but the housecall vet said not all vets have that policy. I realize that, if I went that route, I'd be running the risk of giving Oli chemo when he really doesn't have cancer, but this is nonetheless an option I'm willing to look into.

My cat has lymphoma which we are treating with chemo right now. I have noticed very few side effects with chemo, usually just vomiting 1x a couple of days after the procedure. Chemo has done wonders for her.. Prednisolone is what you would use for lymphoma, and although it is not officially chemotherapy per se, it has anti cancer properties and does kill some of the cancer cells. If your cat is in a weakened state, I would not hesitate giving prednisolone a try and see if it perks your cat up enough to have a scope done. Your vet should have 0 issues giving you the prednisolone, 5mg 2x a day with a little pepcid just in case it upsets their tummy.  I do not know specifically about GI lymphoma, but if you do get to the point of debating whether or not to do chemo, I would 100%, 

If they are also so anti chemo with no diagnosis, would they do a couple of treatments of pallative radiation? That may make your cat feel better long enough to get a diagnosis and get started on treatment as well.

MissKalamata said:

 
Update for anyone who cares - I did cancel the biopsy. Oliver had several more seizures despite being on seizure medication and lost a few more ounces. I talked to my housecall vet - whom I should have spoken to 3 weeks ago before I scheduled the thing, but instead I had only spoken with the clinic vet and the hospital vet - and she was very concerned about the risks of the procedure. More relevantly, she told me that there are in fact vets out there who will prescribe Leukeran (chemo) without a positive biopsy (it's not clear if she was including herself in that group...but I intend to find out). Both the clinic vet and hospital vet had refused to dispense chemo without a definitive diagnosis, but the housecall vet said not all vets have that policy. I realize that, if I went that route, I'd be running the risk of giving Oli chemo when he really doesn't have cancer, but this is nonetheless an option I'm willing to look into.

Click to expand...

I'm so sorry you are going through all of this, hugs and scritches to Oliver.  Have you ever heard of the Feline Lymphoma list on Yahoo?  There are some very wonderful people with lots of experience, including a vet who could give more input on Oliver's situation. https://groups.yahoo.com/neo/groups/feline_lymphoma/info  I lost my precious Tiger to pancreatic cancer earlier this month before I could pursue a biopsy after her ultrasound in February. Wishing you both the best.

MewCatMew-

When you say your cat is on chemo, are you referring to the prednisolone, or something else? My cat is now on prednisolone, but only 1.25 mg twice daily, which seems like a pretty low dose. While he hasn't gained significant weight (he may have gained an ounce or two over the week) and is still weak, the diarrhea is much more infrequent now.

When I said the clinic and hospital won't do chemo without a positive diagnosis, I was referring to the chemo drug Leukeran (chlorambucil). Leukeran plus prednisolone seems to be the standard and most effective treatment for lymphoma. The hospital and clinic will not prescribe Leukeran without a positive diagnosis...but my housecall vet might....and if not, there are vets out there who will. What I need is a closer estimate of the probability of my cat having cancer instead of IBD. If it's 50-50, I might stick with just pred. If it's closer to 75% or higher, I think it makes sense to do Leukeran along with the pred. The problem is vets aren't too fond of giving me numerical estimates.

The vet at the hospital said that on prednisolone alone, a lymphoma patient might live 6 months. When you add Leukeran, that survival time might extend to two years, maybe more. She quoted a study of GI lymphoma patients where the median remission time on Leukeran and pred was 19 months. She said a multi-modal approach was best...that it's better to hit cancer with both medications right off the bat versus doing prednisolone at first and adding Leukeran when the pred stops working effectively.

However, my housecall vet mentioned that one of her techs had a cat who was similarly suspected of having GI lymphoma. The cat was treated with prednisolone alone, and lived 3 years. So maybe it was really IBD instead of lymphoma? The cat was never diagnosed.

Hey, how much did you pay for the prednisolone? I got Oliver's from the human pharmacy, and it was $140 for fifteen 5 mg tablets (a 30 day supply)! I bet it's cheaper to get it from the vet?

RuthM - Thank you so much for the link! I am going to join that group...

My cat is on prednisolone, 5mg 2x a day as well as going through a cocktail chemotherapy protocol. GI lymphoma I believe has a different chemo protocol than other forms of lymphoma, and I am not dealing with GI lymphoma so you should do some research on the chemo protocol for it. I would not hesitate if it was lymphoma to do chemo, the side effects for my cat are barely noticeable. The prednisolone is probably based on body weight as well, but 1.25 seems really low based on what my cat is receiving. Prednisolone will not work for very long if it is indeed lymphoma (along the line of a few weeks-2 months). Chemotherapy does work, and it works very fast when it works well. You should see improvements within a few days. 

Here's the scoop on feline lymphoma. There are two basic kinds of feline lymphoma and really, they are two completely different diseases.

The first kind is called small cell, or lymphocytic, lymphoma. It is the low-grade form of the disease, is slow growing, and is the kind that you might think is IBD without a biopsy. Small cell lymphoma and IBD have the same symptoms and they look the same on an ultrasound (intestinal wall thickening and possibly some enlarged lymph nodes, but no obvious large masses). It is diagnosed via either endoscopic biopsy or (preferably, since endoscopy misses about 20% of cases) full-thickness intestinal wall biopsy. It is treated with daily prednisolone and oral chlorambucil (brand name Leukeran), either every other day or every two weeks.

You should not start prednisolone before diagnosis, as a "trial," because both diseases (IBD and small cell lymphoma) respond fast to prednisolone (so starting it does not help with differential diagnosis between the two diseases), and because prednisolone will make a later biopsy unreliable. Prednisolone by itself will help for some period of time if the cat actually has small cell lymphoma, but will eventually fail, often within a few months. Almost nobody wants to stop the prednisolone to do a biopsy once they've started - as they must if they want a real diagnosis via biopsy - once they see their cat feeling so much better on it, and this becomes an issue. On the other hand, treating with chlorambucil is not advisable without a biopsy, because although a relatively mild chemo drug, it affects the white blood cells (and thus immunity) and often causes nausea, which must be treated. So you do need to do a biopsy. This disease has an average full remission time of 2+ years.

The second kind is called large cell, or lymphoblastic, lymphoma. It is a faster-growing, aggressive disease that presents with a mass, or masses, seen on an ultrasound, so that it can often be diagnosed via a targeted needle aspirate into the mass (which is much less invasive, and less expsnsive, than the open surgery or endoscopic biopsy needed to diagnose suspected small cell - small cell can NOT be diagnosed by needle aspirate, unfortunately). This disease is treated with a cocktail of oral and injectable chemotherapy drugs on a weekly basis, usually for six months, and then stopped. (Leukeran is powerless against it.) Remission times are less than one year on average but in some cases can be much longer.

There are two excellent yahoo groups you can join to discuss these diseases: [email protected], as someone mentioned above, has more cats with the large cell form (but some cats with small cell as well). A newer and smaller group, feline_SMALLCELL_LYMPHOMA (with the caps), is strictly for the small cell form and has more information on that disease. If your cat has symptoms that are indistinguishable from IBD and an ultrasound that looks like either IBD or small cell lymphoma - meaning, it came on gradually and the ultrasound shows mainly intestinal wall thickening, and possibly enlarged mesenteric lymph nodes - then you could learn from the small cell group. If your cat has a fast-moving, aggressive illness and/or large, obvious masses (that are not mesenteric lymph nodes) seen on an ultrasound, the feline_lymphoma group may be better for you.

KittyLuvr222

Well, instead of making me feel supported, the Yahoo group has only increased my stress and has me questioning myself again. They all say I should have done (and still should do) the biopsy, that it's too risky to try chemo without a positive diagnosis, and that (contrary to what 2 of my 3 vets have said) a biopsy is extremely safe and I should not worry about the risks of anesthesia.

I don't know which vet to trust anymore... or if I can trust any of them at all.

I would really hate to have to take Ollie off the prednisolone and wait for weeks before the procedure. He's losing weight again, even with the prednisolone (but it's a low dose...1.25 mg twice a day...I've got to talk to the vet about increasing the dose)... and I don't know that he can wait weeks. My indecisiveness has already done him harm.

2 of my 3 vets, plus the vet on the Yahoo lymphoma group, are opposed to prescribing Leukeran without a positive biopsy diagnosis. However, I'm starting to feel that this is our best option. The online Yahoo vet said there is NO WAY to distinguish IBD from lymphoma without a biopsy, but my clinic vet pointed to multiple test results that she said were more indicative of lymphoma than IBD. Granted, the Yahoo group vet is an internal medicine specialist while my clinic vet is not. Then again, the Yahoo vet is a stranger to me, while the clinic vet is someone I know and more or less trust.

My gut is saying forget the biopsy, get the Leukeran. 3 of 4 vets disagree with me. What are the dangers of giving chemo to a cat with mere IBD (if that's the case)? Couldn't we try, and take Oliver off of it if he reacted badly?

The vets do agree that a multi-modal approach is crucial for cancer treatment. If he does have cancer, giving prednisolone alone until he becomes resistant to it and THEN starting Leukeran will not give him as good a survival time as giving both prednisolone and Leukeran from the beginning.

I wish StephenQ would comment, as I've read some of his posts on similar topics about biopsies and IBD vs lymphoma.

Thanks for the replies, and for putting up with my indecisiveness.....