cat intestinal lymphoma: prednisolone only as treatment?

hi! we rescued a feral (BBK) from one of our TNR colonies last july. he was quickly losing weight, losing fur, not eating much, just generally looked awful. his colony lives near a dumpster, and BBK often greeted us by jumping out of it — he spent a LOT of time in there, scavenging.

his initial bloodwork was ALL over the place, and he is FIV+. he was full of tapeworms (the less common ones) and was de-wormed a few times. he was anemic, and we initially treated for a blood parasite. he did horribly on that medication and the anemia pretty much resolved itself, anyway. we had a hard time getting him to eat, though, and his diarrhea was just awful. his lymph nodes in the abdominal region were pretty swollen, and his WBC count was climbing really high. we took him to a specialist for an ultrasound, which revealed very distorted, swollen intestines. the specialist said it could be IBD or lymphoma, but based on his FIV status, she wrote it off as lymphoma. at that point, we were a lot of money into this rescue and he was in pretty awful shape. he’s a big, tall cat, and he was down to 7 lbs. he was in no shape for exploratory surgery — or even chemo drugs, really. we were told our only real option (without doing surgery) was prednisolone. he has been on 5 mg daily since mid-august. he’s also been wormed several times since then for roundworm — we can’t seem to get a full grip on that. he is also on monthly vitamin B shots.

anyway, he gained weight pretty steadily thru to january — he’s around 12 lbs. now, shiny coat, a really happy and mellow guy. his weight and hunger fluctuates a bit, but again — we are still dealing with these pesky roundworms.

my question is this: if this were lymphoma, could prednisolone alone sustain him for this long? his specialist will not return my calls, because they would like to see him again (of course). I really don't like this dr., so I am planning to get him into my normal vet soon, but in the meantime — does this seem suspicious to anyone? or totally normal, if it’s a slow-growing lymphoma?

It's really hard to say.  Often, even with a biopsy, it is difficult to differentiate IBD from small cell lymphoma.  The longer he goes continuing to improve or hold steady with his weight the more likely it is IBD and the pred is keeping the inflammation in check.

my little snick was diagnosed with cancer, probably lymphoma, by our vet at one point. snick also had CKD (as well as IBD), so we were having blood work done every two months. she had very elevated calcium levels in her blood work. snick started on prednisone and continued on that until she became borderline diabetic -- which is a possible side effect of long term prednisone.

one thing that our vet told me during that time was that if it was cancer, snick's calcium level would continue to rise -- even with her taking the prednisone.

our vet is very, very good. as @Denice said, it can be very hard to differentiate (or accurately diagnose) IBD from lymphoma. in my snick's case, quite a few months after she had been tapered off the prednisone (and we continued to do blood work every two months), i noted to my vet that snick's calcium level had not continued to rise. after reviewing my girl's file at home over the weekend, our vet called me and told me she was changing snick's diagnosis to idiopathic hypercalcemia. i don't remember exactly how long after that it was, that my girl's calcium level dropped back to normal range -- and it never became elevated again.

so you/your vet might keep a close eye on your BBK's calcium level, because if it continues to rise then i would think that would tend to point towards lymphoma...but if it doesn't continue to rise, then i'd think there may possibly be another cause(s) for it.