Cancer or IBD?

I have a 3.5 year old male cat who I got from the SPCA with what was claimed to be IBD just about a year ago and he has recorded issues going back about a year before this. He has been doing fairly well all things considered and has had a few flare ups but has seemed to be doing well for the most part. Last month he had his second flareup since he has been with me and has had issues with throwing up, appetite, and stools and it has been lingering in one form or another since then. I took him in for an ultrasound and the report is below but the vet is concerned it is cancer and thinks we should cut him up to do a biopsy and see what is there. I am no expert but would be surprised if cancer would just hang around for a few years without just destroying him. Given this condition has been around for 1.5 - 2 years would you guess IBD or cancer? I really have the idea of cutting him up but I am not sure there is a choice.

Thanks for any incite.

Ultrasound report

Sonographic findings:
- The small intestinal wall is diffusely moderately increased in thickness, measuring up to 0.41 cm (ileum) with marked
altered wall layering, the muscularis and mucosal layers being thicker than normal. In the ileum, there is an asymmetric
thickening of the mucosa over approximately 3 cm. The right colic and jejunal lymph nodes are mildly irregular and
heterogeneous however remains within normal limits for thickness, measuring up to 0.36 cm. The colon contains a small
volume of fecal material. The colonic wall is within normal limits for layering and thickness, measuring 0.1 cm. The
gastric wall is at upper limit of normal for thickness, measuring 0.31 cm, however the stomach is empty potentially mildly
overestimating this finding. The gastric wall layering is considered normal.

- The left and right kidneys are mildly irregular with mild hyperechoic renal cortices. The rest of the renal architecture is
considered within normal limits bilaterally. The left and right kidneys are within normal limits for size, respectively
measuring 3.93 and 4.37 cm in length.

- The liver is within normal limits for size, echogenicity, echotexture and contour. There is no evidence of hepatic
lymphadenopathy. The gallbladder is within normal limits for size and content. The gallbladder wall is circumferentially
within normal limits for thickness (0.1 cm). The visible portion of the common bile duct is unremarkable

.

- The spleen is within normal limits for size, echogenicity, echotexture and contour.

- The left and right adrenal glands are within normal limits for thickness, respectively measuring 0.35 and 0.36 cm.

- The urinary bladder contains a small volume of anechoic urine. The wall of the urinary bladder is circumferentially within
normal limits for thickness, measuring 0.16 cm. The visible portion of the urethra is unremarkable. There is no evidence
of medial iliac lymphadenopathy

.
- The rest of the visible abdominal lymph nodes are within normal limits for thickness, echogenicity, echotexture and
contour.

Conclusion:
- The small intestinal wall changes are suggestive of inflammatory bowel disease or round cell neoplasia. The jejunal and
right colic lymph node changes are most likely compatible with reactive lymphadenopathy. Early dissemination of a
round cell neoplasia to the jejunal lymph nodes and right colic lymph nodes cannot be excluded.

- Despite the normal appearance of the pancreas, a chronic active/inactive pancreatitis cannot be ruled out.

- The renal changes are considered non-specific. Incidental fat infiltration may explain the hyperechogenicity of the renal
cortices.

Recommendations/procedures:
- A consultation with an internal medicine specialist and/or full thickness biopsies/endoscopic biopsies of the intestines +/-
biopsies of the jejunal lymph nodes should be considered.

IBD symptoms can be a precursor to intestinal cancer. Cancer would be rare in a 3.5 year old; but, not completely unheard of.

Has your kitty ever had an ultrasound done before? Just wondering if there is something to compare to.

It's certainly worth considering doing a biopsy as this is also the only definitive way to diagnosis IBD.

Also, what does your kitty eat? Canned/dry, brand?

I personally wouldn't go forward with a biopsy if this was my cat unless you really feel the need to know the answer. I know you have other threads going but what exactly are you feeding him? I think ultimately you need to get the vomiting under control by narrowing down what he reacts to. The simplest food is the best choice, either homemade or a LID canned food that's high quality. Merrick LID or Nature's Variety are good choices. I would not feed him any kibble. I'd also suggest probiotics. I'm sure someone else already recommended this but this site has a wealth of information. 

http://www.ibdkitties.net/

There are some people here who got the biopsy done and others who didn't.  I chose not to.  At the time I had finally found a good vet who made a good diagnoses beyond he is just a sensitive cat whatever that means.  Unfortunately by the time I got him there he was in fatty liver.  He did have the ultrasound and she did a needle aspirate biopsy on his liver.  That came back as having two types of hepatitis, cholangiohepatis and fatty liver and inconclusive for cancer.  The report said there weren't enough cells for a yes or no on cancer.  We went ahead and started a steroid because he was so sick.  They can't get reliable results from a biopsy while a kitty is on a steroid.

missmimz said:

 
I personally wouldn't go forward with a biopsy if this was my cat unless you really feel the need to know the answer. I know you have other threads going but what exactly are you feeding him? I think ultimately you need to get the vomiting under control by narrowing down what he reacts to. The simplest food is the best choice, either homemade or a LID canned food that's high quality. Merrick LID or Nature's Variety are good choices. I would not feed him any kibble. I'd also suggest probiotics. I'm sure someone else already recommended this but this site has a wealth of information. 

http://www.ibdkitties.net/

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All of the food was in the other thread, it is all moist and all of it was from recommendations from the IBDKitties site. When I started the last thread he was fine other than his stools were very loose but he was eating fine and had not thrown up for a month. I have gone though more than 50 flavours of food from that site and have another 20 or so in the kitchen that I have not tried. His favourite was some of the Fancy Feast classic pate flavours which did him really well between these flareups but for the last few weeks he was eating the Natures Variety LID venison. He is overweight and at one point he was given a food and it had pretty much every ingredient that the IBDKitties site say to avoid and he did react to it so I took him off of it. He had been eating the Natures Variety LID venison for a week before this last episode when he started to throw up anything that went down the hatch. 

The vet is paranoid that if we treat him with steroids and the issue is cancer and not IBD that the steroids will change things so many of the tests will be skewed and they won't have accurate results when treating the cancer. I gave in and said do the tests so at least we know exactly what we are dealing with and and can treat it and get it under control. Just because it has been around for so long I think it is IBD but I don't really want to gamble so I will just put the money down and let them do the biopsy. Thanks for the input though, everything helps.

Instinct doesn't make and LID Venison food. Their Venison formula contains pork liver (as well as flaxseed, peas and carrots.)

I know the Instinct LID Duck was too rich for my Lucky; he mostly ate the LID Turkey formula. I've had good results using this formula with IBD kitties.

I hope you are able to get some answers soon and are able to find a food your kitty does well on.

You are correct, it is actually Natural Balance venison and green pea.

Ok. The Natural Balance is pretty high in carbs with the peas and does contain carrageenan. I wonder if that could be causing the issues you are seeing?

That Guy said:

 
All of the food was in the other thread, it is all moist and all of it was from recommendations from the IBDKitties site. When I started the last thread he was fine other than his stools were very loose but he was eating fine and had not thrown up for a month. I have gone though more than 50 flavours of food from that site and have another 20 or so in the kitchen that I have not tried. His favourite was some of the Fancy Feast classic pate flavours which did him really well between these flareups but for the last few weeks he was eating the Natures Variety LID venison. He is overweight and at one point he was given a food and it had pretty much every ingredient that the IBDKitties site say to avoid and he did react to it so I took him off of it. He had been eating the Natures Variety LID venison for a week before this last episode when he started to throw up anything that went down the hatch. 

The vet is paranoid that if we treat him with steroids and the issue is cancer and not IBD that the steroids will change things so many of the tests will be skewed and they won't have accurate results when treating the cancer. I gave in and said do the tests so at least we know exactly what we are dealing with and and can treat it and get it under control. Just because it has been around for so long I think it is IBD but I don't really want to gamble so I will just put the money down and let them do the biopsy. Thanks for the input though, everything helps.

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Why not try homecooked? it's pretty easy and you can avoid all the things that may be trigger him. I'd be very specific about avoiding all foods with veggie fillers like peas or potatoes which can be very triggering to IBD kitties. Yes you may need to work to get him to eat some of the LID or homecooked foods but add a few FD treats on top to entice him if you need to. You might want to hop over to the raw and homemade thread and see about making your own. I make raw, but I tried homecooked too and it was very simple as there are mixes you just add to the cooked meat and you're done. My senior cat has some mild IBD, which ma or may not actually be because he was diagnosed with hyperthyroidism recently. I've had a lot of success using slippery elm and raw food, but i feed the rest of my gang some of the Merrick LID foods which are very simple ingredients, they only have chicken, turkey, duck and salmon, though. 

Even if you rule out cancer vs IBD you still need to get him to eat, and if you can find a good simple food now it will only help you in the long run. If you're looking for venison you could try Ziwipeak. It's pricy but it doesn't contain any veggies or other meats. 

CatPack said:

Ok. The Natural Balance is pretty high in carbs with the peas and does contain carrageenan. I wonder if that could be causing the issues you are seeing?

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Good catch, I missed that and carrageenan is one of the do not feed so he won't be eating that. It is on the IBDKItties site so there are some cats that do well on it.

missmimz said:

 
Why not try homecooked? it's pretty easy and you can avoid all the things that may be trigger him. I'd be very specific about avoiding all foods with veggie fillers like peas or potatoes which can be very triggering to IBD kitties. Yes you may need to work to get him to eat some of the LID or homecooked foods but add a few FD treats on top to entice him if you need to. You might want to hop over to the raw and homemade thread and see about making your own. I make raw, but I tried homecooked too and it was very simple as there are mixes you just add to the cooked meat and you're done. My senior cat has some mild IBD, which ma or may not actually be because he was diagnosed with hyperthyroidism recently. I've had a lot of success using slippery elm and raw food, but i feed the rest of my gang some of the Merrick LID foods which are very simple ingredients, they only have chicken, turkey, duck and salmon, though. 

Even if you rule out cancer vs IBD you still need to get him to eat, and if you can find a good simple food now it will only help you in the long run. If you're looking for venison you could try Ziwipeak. It's pricy but it doesn't contain any veggies or other meats. 

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Food is a hard one and I have tried a lot of foods to find one that he will eat when he is not feeling well which is hard. He is either not hungry and doesn't want food but can keep it down or he is eating and then throwing up within 10 minutes. When he is not feeling well is when I need to find something he really likes which is when he basically gets Fancy Feast otherwise he just won't eat. He also doesn't drink water so when he stops eating he also dehydrates which compounds the issue. I tried raw with my last IBD kittie and although he would eat it the food did not sit well with him and burned the flora out of his stomach. When I took him to the vet she had said she does see some issues with some cats so it is really a case by case basic which makes me a little gun shy with raw. I will certainly look into the raw and cooked neither of which would be an issue to prepare.

Thanks for input.

That Guy said:

 
I tried raw with my last IBD kittie and although he would eat it the food did not sit well with him and burned the flora out of his stomach. When I took him to the vet she had said she does see some issues with some cats so it is really a case by case basic which makes me a little gun shy with raw. I will certainly look into the raw and cooked neither of which would be an issue to prepare.

Thanks for input.

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I'm pretty active in the raw and homecooked threads and familiar with all the raw sites (like catinfo.org) and I've never heard or seen anyone ever mention anything about raw burning flora out of the stomach. I don't even know what that means? Like issues with digestion? When you feed you should always add a good quality probiotic. Some cats don't like raw, and some have issues digesting it or need to be transitioned slower.

You could always try commercial raw like Rad Cat first, or even freeze dried raw like Primal. I do understand how tough it is to get finicky sick cats to eat, for me at least the winner is using treats my cat loves on top of the food. I have to change the treats all the time to keep him on his toes, of course. Good luck. He's lucky he has you, not many people would be so dedicated to him