Questions for cat with suspected GI lymphoma

A chlorambucil trial is useless. It takes several months for the drug to even have an effect, and during that time, your cat probably *will* "react badly" to it at first. Most have some degree of nausea. "Reacting badly" is not a reason for stopping and not a guage of whether or not the drug is working. (There are effective anti-nausea medications that usually completely eliminate the nausea. But you have to give them. You have to deal with all that.) You can't just "try" chlorambucil (leukeran). You have to make a commitment to it, based on a diagnosis. It is a serious drug with serious repercussions on the immune system, bone marrow, appetite, etc.

Those are the risks and trade offs you make if you know your cat has cancer. The side effects of treatment are not as bad as the cancer. But they are worse - much worse - than a non-cancerous disease, which your cat may just have, and which you have no way of knowing - ZERO - without a biopsy.

I don't know who the "online Yahoo vet" is but he is right. There is no way to tell IBD from lymphoma via bloodwork, an ultrasound, or anything else failing a biopsy. If two out of your three vets agree with that, they know what they're talking about.

Biopsies are safe procedures, within the context that every surgery is a risk. The risk with this particular surgery is minimal.

If you have started the pred then I think you should continue with it.  Your kitty is on a very low dose.  Patches started on 10 mg a day when he was very ill and was tapered down to 2 1/2 mg.  In the last few months he began to loose weight again so we had all the non invasive tests done including ultrasound and went back to 5 mg a day.  I can tell that he  has picked up a little  weight.

As  I said earlier I am one that did not have the biopsy done and it was 4 1/2 years ago that Patches was very sick  and we started him on the steroid.

I know what the studies say about Leukeran.  To be honest what I have seen here the results from Leukeran has not been good.  I know that is very  small  number and very much  anecdotal.

One thing to remember if you take him off the steroid he may not respond to it as well if you go back to it again.  I have seen that caution here twice from two different vet techs.

Leukeran is an extremely effective, mild chemotherapy drug that has put small cell lymphoma cats into full remission for an average of two-plus years. If a cat with lymphoma is given just prednisolone it is usually effective, but typically only for a matter of months. During that time the lymphoma gains ground and spirals out of control. You don't want to take that risk. The person whose cat went 4 1/2 years on prednisolone alone clearly did not have lymphoma. But that was a matter of sheer luck. If you play that game of Russian roulette, you are running the risk of lymphoma being present and reaching a point where it is uncontrollable while you are giving just the pred. Of course, you may win the Russian roulette because your cat only has IBD. You just can't know without a biopsy.

KittyLuvr222 said:

 
 The side effects of treatment are not as bad as the cancer. But they are worse - much worse - than a non-cancerous disease, which your cat may just have

Click to expand...

If there is no difference in the symptoms of cancer and IBD, how can the side effects of chemo be less bad compared to one condition and worse compared to the other? If Oliver has IBD, he has it life-threateningly bad.

 
 Biopsies are safe procedures, within the context that every surgery is a risk. The risk with this particular surgery is minimal.

Click to expand...

This is not what my vets are telling me. I'll copy-and-paste what I wrote on the Yahoo group:

I talked to three vets about my concerns with the biopsy (it would have been an endoscopy/colonoscopy; the full surgery was too risky). Here's what they said:

1) The hospital vet, who would have done the scoping herself: said that they take every precaution, but things can still happen. She has had intestines get perforated during this procedure on two occasions, requiring emergency surgery (but the scope biopsy is still safer than the surgical one). She would not give me an estimate of Oliver's chances of surviving the biopsy without serious complications, would not even say greater or less than 90%. She did say, "If you feel like, if something were to happen to your cat during the biopsy, you wouldn't forgive yourself, then you should opt out of this procedure and do steroid treatment instead." I ignored that statement until I spoke to vet #3.

2) The clinic vet was more optimistic: She said that for all cats and dogs of all ages undergoing anesthesia, the overall risk of complications is 1%. For Oliver, that risk would obviously be higher, but she felt pretty confident in the hospital's abilities and precautions.

3) The housecall vet wasn't so confident: She said, "yes, you might get the answer you want, but you might also get no answer at all (I knew this already...but I felt the risk-to-benefit ratio of doing the scope was better than that of the surgery)... and you could end up with a dead cat." She was blunt about that, and said she knows of a number of animals who underwent similar procedures whose results were inconclusive. She had a patient who died undergoing anesthesia for a CAT scan.

So, two out of three vets I talked to consider the risk of the biopsy more than "minimal"
 

 Bear in mind there is wide variation between vet competency out there. Vets who tell you there is risk are doing their job. Vets who advise against a biopsy based on risk are, IMO, guilty of malpractice. Your cat may die based on that advice.

I think that's all I have to say, and can say, about this. You just need to make a decision.

.I didn't answer this question, so this will be my last post on this topic, which I think has been more than exhausted:

"If there is no difference in the symptoms of cancer and IBD, how can the side effects of chemo be less bad compared to one condition and worse compared to the other? If Oliver has IBD, he has it life-threateningly bad."

That's not true. Cancer is terminal. IBD is not.

Biopsy results often do come back inconclusive.  The most reliable ones are the ones that involve surgery rather than a scope.  A scope may not get cells from the right area and in truth the ones gotten from surgery may not either.  There is a huge gray area between lymphoma and IBD which is why biopsy results are often inconclusive or one vet pathologist may say it's  IBD and another may say it is lymphoma.  That and the fact that my kitty had gone into fatty liver by the time I got him properly diagnosed is why I chose not to get the biopsy done.  My vet, a certified feline specialist, recommended  not going the biopsy route as well.  That may well have been because of the fatty liver.  He did have a needle aspirate done on his liver which confirmed two types of hepatitis including fatty liver but was inconclusive as far as cancer goes.

It's true that endoscopy misses around 15% of cancers. A full-thickness surgical, however, is not only 99.99% reliable (and even for the remaining .01% there are add-on tests that can be done to confirm - clonality, immunihistochemistry, etc.). Also, I would have preferred not having the debate here over safety of endoscopy vs safety of full-thickness surgical. But actually endoscopy can cause rupturing of the intestine and requires more surgical and diagnostic skill over a surgical biopsy, which basically can be done safely and successfully by any competent veterinary surgeon.

And let me add: there is no "gray area" between IBD and small cell lymphoma. One is cancer - the other is not. One is terminal (i.e., your cat will DIE if not properly treated) - the other is not. One results in excess of lymphocytes in the intestine due to cloning out of control - one results in excess of lymphocytes due to infammation. It has never been proven - only suspected - that IBD can turn into lymphoma. Never proven. The only "gray area" is in the difficulty of diagnosing one disease from the other. Full surgical is nearly 100% reliable for that. Unfortunately, there is no other way besides biopsy.

KittyLuvr222 said:

 
 You just need to make a decision.

Click to expand...

I did make a decision. I decided to cancel the biopsy and pursue Leukeran without a definitive diagnosis.

And then I joined that Yahoo group, and they undermined my decision and plunged me back into extreme uncertainty and frustration. As soon as I decide something, another vet comes along and tells me I should be doing the opposite.

Re: IBD not being "terminal." The way my cat is losing weight, he will die if he doesn't start getting better treatment, be that chlorambucil or just a higher dose of pred. I would think that's a further indicator of it being lymphoma instead of IBD. I would think that, the more severe the weight loss, the more likely it is to be cancer. But I guess the vets don't see it that way.

Good luck with this. Everyone who's ever been there knows how hard it is. That's all I can say. One of the people I trust most in my life "undermined" a bad decision I'd made once. I really wanted to strangle her. But she put a bug in my ear. I couldn't deny what she was saying. And I changed my decision. Suffice it to say, I'm no longer angry at her. I feel she saved my dog's life.

My advice is sleep on it and admit to yourself whom you really trust here. Fear of a surgical procedure goes with the territory. It's normal. But it is most likely not warranted here. Your bigger fear should be inappropriate treatment.

Take it easy.

MissKalamata said:

 
I did make a decision. I decided to cancel the biopsy and pursue Leukeran without a definitive diagnosis.

And then I joined that Yahoo group, and they undermined my decision and plunged me back into extreme uncertainty and frustration. As soon as I decide something, another vet comes along and tells me I should be doing the opposite.

Re: IBD not being "terminal." The way my cat is losing weight, he will die if he doesn't start getting better treatment, be that chlorambucil or just a higher dose of pred. I would think that's a further indicator of it being lymphoma instead of IBD. I would think that, the more severe the weight loss, the more likely it is to be cancer. But I guess the vets don't see it that way.

Click to expand...

Sorry, but I have not been following this thread for a while. I just caught up. 

Yes, you did make a decision. Now you stick by it and please do not second guess yourself.  If Oliver is having seizures, than going through the biopsies is a lot scarier for you. I understand. 

Yes, I think Denice wrote that it is sometimes difficult to get good biopsy results. Actually, Artie's biopsy was not able to be taken in a few areas where the Vet wanted it to be done. I read the pathology report and it came back as mild IBD, however based on our specialist's observations, (She did the endoscopic biopsy herself and saw the stomach herself.) she feels he definitely has IBD. 

I was second guessing myself for the entire 10 days after the biopsy. Yes, Artie was that sick. He was breaking my heart; both before and after the procedure.  Once we got the results back, and he responded to treatment, I felt so much better about having him go through it. But I know exactly how you feel. I told both his regular Vet and the specialist that I would not allow him to go through that again. They assured me he would not. The specialist told me there is absolutely no way of knowing how the biopsy will effect a cat.

I do think kitties can die from IBD. That is why it is important to start treatment. I think the time frame is about 2-3 years because they keep having flares. 

I want to re-iterate this:

Trust YOUR gut. You know Oliver. You have to deal with, I mean take care of him. You know how things effect him. You love your cat and do not want to do any harm. Please respect yourself and your decision as much as you respect the thoughts of others. Believe in yourself. I know it is so hard to do, especially when your head is spinning. But trust your gut..trust your heart....that is advice I am trying to do myself. I know things will be ok, if I follow my heart. Hard to remember in very difficult times...but try...

I really do not think leukeron is not allowed for kitties without a biopsy. I think some Vets would prescribe it, even without a biopsy. I think you just have to try the protocols first.

Some Vets would not prescribe the chemo, because I heard that the side effects are very tuff. I was also told that some people who have cats with diagnosed with small cell lymphoma do not even try the chemo, because of the side effects.

It is your cat. Oliver is your guy...

Do what you think is right for you and Oliver. Do not listen to everyone on that Yahoo group..You have to find your own way..

You have gotten some great advice and support here. 

(((hugs))) to you and ((hugs)) kisses and crinches to Oliver.

I am not a veterinarian, and cannot give you an answer on IBD vs Lymphoma. What I can tell you from personal experience dealing with a cat who has lymphoma of the kidneys right now is that when chemotherapy works, it works FAST. My cat saw a great improvement within the first 48 hours of chemotherapy. Cats generally tolerate chemo quite well with very few side effects. If this turns into life or death, I personally would just go with the chemo and see if it works. If it does work, you know it is lymphoma. If it does not work, either he is not responding to chemo or it is IBD.

The only side effect my cat has had from multiple rounds of IV chemo was vomiting 1x a couple days after the chemo on a few occasions. If it is lymphoma, the prednisolone will not work for very long, weeks to a couple of months at best. As for the biopsy, I am not sure how invasive it is. They do have anastesia for senior cats that is easier on the body. If your main concern  is the cat being put out for a bit, you may discuss options for sedation, and make sure they give it based on the cats lean body weight, not current weight if the cat is overweight.

If all of us had "trusted our guts" we would all have cancelled our cats' biopsies out of fear. I, and almost everyone I know, is looking for a way out of it. Yes, of course some vets will prescribe chlorambucil without a biopsy. "Some vets" will do a lot of things.

MewCatMew is wrong in her general statement that chemotherapy works fast. MewCatMew's cat had IV chemo. That is the typical treatment for large cell lymphoma. Chemo works fast for large-cell lymphoma. Large cell grows fast and responds to treatment fast.

Chemo is notoriously slow for small cell.  Small cell is slow-growing and typically takes a month or more to respond at all and 3-6 months to reach full remission. With large cell, you see tumors the size of lemons shrinking overnight to nothing after one dose. That's not how small cell works.

There's no such thing as a chlorambucil trial.

My advice would be to listen to your gut, and then trump that with the facts.

I forgot to add in about the steroid.

I use a compounded liquid for my guy. I am paying $40 for a bottle of it at the hospital. He seems to take it well. I am giving him 0.5 mg once a day. I could get it compounded at a private compounding pharmacy for a bit less.

I asked the pharmacist there. He said it comes in different strengths, and would cost anywhere from $30-40 a bottle. 

You can also get it in compounded chew treats, which are somewhat cheaper and which most cats eat with gusto.

KittyLuvr222 said:

 
If all of us had "trusted our guts" we would all have cancelled our cats' biopsies out of fear. I, and almost everyone I know, is looking for a way out of it. Yes, of course some vets will prescribe chlorambucil without a biopsy. "Some vets" will do a lot of things.

MewCatMew is wrong in her general statement that chemotherapy works fast. MewCatMew's cat had IV chemo. That is the typical treatment for large cell lymphoma. Chemo works fast for large-cell lymphoma. Large cell grows fast and responds to treatment fast.

Chemo is notoriously slow for small cell.  Small cell is slow-growing and typically takes a month or more to respond at all and 3-6 months to reach full remission. With large cell, you see tumors the size of lemons shrinking overnight to nothing after one dose. That's not how small cell works.

There's no such thing as a chlorambucil trial.

My advice would be to listen to your gut, and then trump that with the facts.

Click to expand...

I have to disagree with you. I was informed with all the information from my Vet and from the web regarding the biopsy. I thought about it overnight. My "Gut" told me to go through with it. 

You seem to have a lot of knowledge about lymphoma. 

If I may ask, what is your background?

Are you a Vet? or are you just speaking from your own experience?

I guess you could call me curious.

KittyLuvr222 said:

 
You can also get it in compounded chew treats, which are somewhat cheaper and which most cats eat with gusto.

Click to expand...

My cat is on a special diet for his IBD. He cannot have treats.

LOL. Good point. Your gut was good on this.

No, I'm not a vet. I've just had several cats with this over the years, and a good vet, and I learned a lot.

MewCatMew said:

 
I am not a veterinarian, and cannot give you an answer on IBD vs Lymphoma. What I can tell you from personal experience dealing with a cat who has lymphoma of the kidneys right now is that when chemotherapy works, it works FAST. My cat saw a great improvement within the first 48 hours of chemotherapy. Cats generally tolerate chemo quite well with very few side effects. If this turns into life or death, I personally would just go with the chemo and see if it works. If it does work, you know it is lymphoma. If it does not work, either he is not responding to chemo or it is IBD.

The only side effect my cat has had from multiple rounds of IV chemo was vomiting 1x a couple days after the chemo on a few occasions. If it is lymphoma, the prednisolone will not work for very long, weeks to a couple of months at best. As for the biopsy, I am not sure how invasive it is. They do have anastesia for senior cats that is easier on the body. If your main concern  is the cat being put out for a bit, you may discuss options for sedation, and make sure they give it based on the cats lean body weight, not current weight if the cat is overweight.

Click to expand...

I am glad things are working out great for you....

good points on the anesthesia...

((hugs)) to you and your kitty