Urgent intestinal tumor. Is there hope?

I posted the following on the Feline Lymphoma email group. I'm posting it on this site in case anyone has any guidance or personal experience to offer:

My cat Tippy was diagnosed with intestinal lymphoma about a month ago. His ultrasound at the time showed thickening but no masses in his intestines. He was started on prednisolone, and he received three once-a-week doses of chlorambucil. He tolerated the first two doses well.

He received the third dose one week ago, and his appetite began to drop. I started him on Cerenia and Pepcid, but the past two days he wouldn't eat at all. He was admitted to the hospital today.

The doctor just called to tell me they did another ultrasound and there is a mass completely obstructing his intestine. It's either do surgery or he will not survive, and even the surgery doesn't have a good prognosis. He could possibly not make it through surgery, they might not be able to suture the intestines back together after removing the tumor, and once it is removed, chemo doesn't look promising given that this tumor grew during a month of chemo treatments. Maybe he could live for a while until the cancer grows back.

Is there any hope?

Tippy is 14. His kidney and liver values are good, although we know he has underlying kidney disease. He is frail ... down to 5 lbs from 7 just a few months ago.

I am inclined to try the surgery because it's his only chance of surviving. In spite of no appetite, he was still playing fetch with his ball just a few days ago. When I visited him in the hospital this evening, he was purring and getting around fine. I don't want to give up on him.

A family member said to me, "do you want him to die on an operating table surrounded by strangers, or at home in your arms?" I don't want him to die! I want to try and fight this thing, but the odds are frightening. Would I just be putting him through extra pain and suffering? Shouldn't we keep trying, if there's some chance of success?

Would stronger chemo drugs do anything if the Leukeran and prednisolone did nothing?

If we didn't follow the surgery with chemo, how long would it take before the cancer grows back?

Any guidance, personal experiences, veterinary knowledge are very, very, very much appreciated right now.

The surgery, if we do it, will likely be tomorrow. I'll visit Tippy in the morning and talk to the vet.

Please tell me there's hope!!!!!

In my limited experience, if he grows a mass so fast that it is blocking the intestine, it would be kinder to put him to sleep now rather than do the surgery.  You might buy him more time, but how much more time will he get -- he's not a young cat, and he will go through a lot of pain to pay for that time.  He has had 14 good years, and if he were my cat, I would hold him in my arms for that final shot, but I would not put him through the surgery.  But that is me.  You will need to make your own choices.  Let us know how it goes.

I'm so sorry you and your boy are having to go through this. I'm 57, lived in the country for 35 years, always surrounded by animals. I've had to deal with so much loss, it's never easy, every single one hurts like hell. The thing is you have to put the cat/dog/horse first. The prognosis you've been given is one no one wants to hear, it sounds like the odds are totally against you. I have to agree with RTR, surgery is traumatic and recovery can be miserable. The condition your boy is in, if he survived the surgery, recovery will be slow, he is not in the condition to fight such a huge battle. I, honestly envision a cat that's miserable. I've never heard of chemo that is pleasant.

Ask your vet what recovery would be like, and the physical effect of stronger chemo. Will he suffer? I want so badly to recommend hospice, to cherish time he could be comfortable, but I honestly don't think he has any time. Hold Tippy in your arms and ask him what he wants, sometimes the answer is in the eyes.
Myself, I would spend some time, cuddling, telling him how much I love him and then let him fall asleep (forever) in my arms. But that is me, you have to search your heart to decide what is right for you.

My heart hurts for you both, ((((HUGS)))) from my heart to yours. 

Red Top Rescue said:

 
In my limited experience, if he grows a mass so fast that it is blocking the intestine, it would be kinder to put him to sleep now rather than do the surgery.  You might buy him more time, but how much more time will he get -- he's not a young cat, and he will go through a lot of pain to pay for that time.  He has had 14 good years, and if he were my cat, I would hold him in my arms for that final shot, but I would not put him through the surgery.  But that is me.  You will need to make your own choices.  Let us know how it goes.

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I do have extensive, 65 years, experience in human oncology and this covers lymphomas - I am a semi-retired consultant physician in human, not feline, internal medicine but, sadly, I must agree with Red Top Rescue.

I personally would not put an aged cat through extensive bowel surgery when he is suffering from an aggressive lymphoma which appears to be resistant to chemotherapy, with all its side effects such as nausea and malaise. By far it is better to have him put to sleep in your arms with as little stress to him as possible.

With kindest regards,

Geoffrey

Please let us know what you decided. If you opted for the surgery no one will criticize you, we know what it feels like to want to try! I have done kitty hospice a couple of times. Some others might have just pts, but, IF I could keep him comfortable, I cherished the extra time. I have even tube fed, changed bandages,  given enemas, basic nursing stuff. I have never faced a situation like you're in. 

If you chose surgery, and he did make it, there are lots of folks here that have dealt with cancer and might be able to help you through it.

If you chose to let him go, you do not have to feel alone. We would be here for you.

Tippy died last night.

We did do the surgery. He was perky and purring the morning of, and there was no way I could have just euthanized a cat like that. He deserved a chance, even though it was a long shot. He made it through the surgery and seemed to be doing well, even eating a little. The day after, they told me I could take him home that night. But yesterday evening he began to decline rapidly, and by the time I rushed to the hospital he was already gone. The surgery and cancer were just too hard on him ... he fought hard, but it was too much for him. The doctor said it happened fast and he wasn't in any pain.

I don't regret doing the surgery, because it was his only chance and he deserved that chance and he clearly wasn't ready to give up right away.

I do regret putting so much faith in the TK (thymidine kinase) cancer blood panel. I was too afraid of anesthesia to put Tippy and my Oliver through biopsies, so both cats were diagnosed with lymphoma on the basis of ultrasounds, symptoms, and the TK results. The test did correctly identify cancer ... but it couldn't tell us if it was large-cell or small-cell. We just assumed small cell, for both cats, and for both cats that assumption proved to be wrong (unless the cancer morphed from small to large cell). Had we gotten the correct diagnosis, we could have treated Oliver and Tippy with stronger chemo, and they might both be still alive. I am sorry to both of them for not doing enough.

Tippy was a fun, sweet cat and my life will not be the same without him. He was playful, gentle, and came to be very brave after starting out his life as a fraidy-cat. He is the third 14-year-old cat I've lost in 8 months.

I only have my oldest girl left now. Her ultrasound two weeks ago showed abnormally layered intestines. I haven't done the TK test on her (yet). She had better only have IBD, because I don't think I can stand to go through this again.

I miss my Itty Bitty Tip Kitty.

I'm so sorry that Tippy wasn't able to come back from the surgery and that she has joined your other two 14-year-olds at the Rainbow Bridge.  My heart goes out to you specially because I know the anguish of having multiple losses, having lost 8 cats (kittens) to FIP in a year and a half.  It has been a little over a year since the last of those was lost and the pain has lessened somewhat.  Since you felt you had to give him a chance with the surgery, you can be assured that it was just his time, because if he could have stayed, he would have.  He didn't die from the anesthesia, but his body just couldn't bounce back from that major surgery.  Even though those of us who answered did all feel it would be too much for him, we would all have been delighted to be wrong and to see him have some more time with you.  I hope your oldest girl does better.  I'm wondering if they were litter mates and there was some genetic predisposition to this. 

Thanks for taking the time to come back and tell us what happened.  Of course we were hoping for a better outcome, but you gave it your best shot and it just wasn't meant to be.  We're very sorry for your loss of Tippy and fr the other two that went before her.  They are all together plaing at the Rainbow Bridge now, and you can pick them up when you go there yourself. 

http://www.thecatsite.com/t/5448/rainbow-bridge

I am so sorry for your loss. Its very hard to know what the right answer is. Sometimes our best isn't enough-its just the way things came out. I hope with time that you will be at peace and know that you did the very best you could.

Run Free at the Bridge Tippy 

I got notice of the update and so hoped there could be something positive. So sorry, I so wish the surgery could have given you both more time, real time. This way you really can look back and know you tried everything, no "what ifs". 

Any time you want/need to vent, cry, remember or just talk, please come here and we will give you a shoulder to lean on. If you like, I'd love to see pics of your babies. 

I am so sorry that Tippy has died.

We have had at least one cat at a time since we married in 1960, and of course we mourn them all. Our philosophy had always been to have another cat as soon as possible after the death of one of our cats, but when our last Siamese , ‘Rupert’, died in December 2015, we concluded that the time had come that we could not have another cat.

Our daughter had adopted ‘Polly’, a blue grey/white mother who had been dumped, pregnant on the vet. She then gave us Sukie, the only queen among Polly’s litter. Sukie (see my Avatar) is now 16 months old and we have been so busy with her that we have had very little time to mourn Rupert.

The message in this, of course, is that it helps immensely if you adopt another cat/kitten as soon as possible after your cat dies!

With all best wishes,

Geoffrey