FIP vs GI lymphoma... what to do

[Grey Mist]

I posted a thread last week about our cat's ultrasound results showing GI lymphoma. The vet said she had masses in her stomach and intestines (and inflammation around her kidneys). We were just waiting for the fine needle aspiration results to show whether she had small cell or large cell.

It turns out the results are inconclusive because there was blood in the sample. The vet said that the masses could be granulomas which would indicate FIP.

So now we need to do an endoscopy or surgical biopsy. I don't know if we should skip those procedures and treat her as if she has cancer. I am not too thrilled about subjecting her to anesthesia. If she has FIP there is nothing we can do so why subject her to invasive medical procedures?

We are on a waiting list for one oncology practice but another one won't see us unless we have an official cancer diagnosis. I also have an appointment for next Monday with a holistic vet. I set up the appointment when I thought she had cancer but now I am hoping he might be able to run some lab tests that will help us make a better guess. I realize there is no official diagnostic test for FIP but maybe some testing might help us lean in one direction or another.

I want to do everything possible for my cat but I also don't want to traumatize her if there is no benefit for her.

Any suggestions? Has anybody else been through something similar?

 

[FeebysOwner]

Hi. I guess I would be curious to know what tissues were drawn for the FNA. I would also like to know why if there was blood in the FNA - and, I take it there should not have been - why the practice that performed the FNA is not responsible for re-doing the ultrasound/FNA. Perhaps, I am misunderstanding something. Are they saying that because blood appeared in the FNA that it would be less inclined to be lymphoma as opposed to something like FIP? How old is your cat? I did not see it mentioned in your previous thread (sorry if I missed it).

Is this supposed to be wet or dry FIP? Have you seen this article on FIP and testing (see link below)?

From personal experience, I also know there is a test called PARR (PCR for antigen receptor rearrangements) that I think should be run on any FNA tissue to help focus in on lymphoma, but it seems that it isn't run as often as I personally think it should be. I was told because Feeby's FNA was inconclusive, without more suspicion for lymphoma being apparent in the cells that were analyzed, that the pathologist didn't see the need to run the PARR.

If you can get to the bottom of why the FNA shouldn't be re-done, and you can get another one done, I would also ask about the PARR test. See 2 more links below for more information about this test. It is merely done in tandem to the other analyses of the FNA tissue - not a separate procedure for your cat to go through. .

Diagnosis of Feline Infectious Peritonitis: A Review of the Current Literature - PMC (nih.gov)
Microsoft Word - Avery PARR.doc (delawarevalleyacademyvm.org)
PCR for Antigen Receptor Rearrangements (PARR) | College of Veterinary Medicine at MSU

 

[Grey Mist]

Hi FeebysOwner,

Thank you so much for all the helpful info! I really was hoping for some other options besides invasive testing and your post is exactly what I was looking for.

Grey just turned 11 so she is not that old. I was very upset and frustrated with the vet yesterday because she told us to have further testing and then just left us on our own. She told me that the intestinal masses could be granulomas and that could be FIP (dry form). I had to ask her if FIP is the only cause of granulomas because the way she was talking it almost made it sound like there could be other explanations besides cancer and FIP. Only by really pressing her did I find out that it is either one or the other. There was no explanation as to why there was blood in the sample and no explanation as to why we could not obtain another sample through FNA. All she said was that the sample was contaminated. I have already been feeling like she has not been proactive enough in helping Grey but yesterday's lack of information was so unsettling. Now you have confirmed for me that I was not overreacting.

It sounds like I need to call the vet's office. I will also read through the information you sent me. I spent all afternoon yesterday researching FIP and diagnostic tests and endoscopy and I am at such a loss. Thank you so much for your helpful information!

 

[Grey Mist]

I called the vet's office and the assistant said that a sample was taken from the lymphoma area but all they got was blood. Then she said (it sounded like she was reading from notes) that the vet had recommended fine needle cytology or surgical biopsy. I know with 100% certainty that the vet did not mention FNA yesterday so now I have a vet who changes her story on top of all my other problems. I always take detailed notes when I talk to the vet and she made it very clear that our only options were endoscope or biopsy.

Anyway, the assistant talked to the vet and she wants us to have an ultrasound and FNA at a specialty hospital so they can get a better sample. So now I need to start making some calls for that.

I am so glad I posted here because I was convinced we would have to do a procedure under general anesthesia. I am not accusing the vet of malicious motives...she might have changed her mind about best approach when she was writing her patient notes. But I know beyond the shadow of a doubt that FNA was never presented as an option and I spent all day yesterday stressing out over what to do. I had told the assistant last week that I did not want to do a surgical biopsy so I wonder if a conversation with the assistant triggered some thoughts in the vet's mind and she re-considered the option of FNA. I am just so frustrated because this is already stressful enough without the added difficulty of a vet who is a poor communicator.

Thanks FeebysOwner. You saved the day!

 

[FeebysOwner]

I hope in some way that I have actually helped. Please do keep us posted.

 

[Grey Mist]

I have an update on Grey. We saw a holistic vet and he did not think it would be worth it to do another FNA. I finally found a hospital last week that would do an ultrasound and FNA and we were scheduled for this Wednesday. This new vet said there was a 3 cm mass and if the other vet could not get a sample the first time around then it would be a waste of time and money to try again.

He also thought FIP was highly unlikely. I was discouraged because I got the feeling from him that the cancer is probably more advanced and has spread (based on what he read in the ultrasound report) but he did not rule out chemo completely.

His surgeries are scheduled on Thursdays so we have an appointment for a week from Thursday. I am not too crazy about putting Grey through a biopsy but it seems it is the only option if we want her to get the best cancer treatment.

I also feel weird starting a biopsy with a brand new vet but I was able to go into the office and have a conversation during the exam and that was tremendously helpful. The other vet still does everything over the phone while you wait in the car. The other vet who did the ultrasound sent the images to a hospital for a second opinion and I appreciate that, but overall it seems that I got better info (albeit more discouraging info) today.

 

[fionasmom]

Please let us know what happens.

 

[Grey Mist]

A new update on Grey...

We originally had a biopsy scheduled for June 2, but an oncology appointment opened up for May 31 so I postponed the biopsy. On May 30 I got a call from the hospital saying the oncologist wanted us to meet with the internal medicine specialist first.

We met with the internist today and she re-did the ultrasound. Her reason was that she wanted to see if anything had changed and she wanted to interpret the results herself. Based on what she saw on the ultrasound, it is her belief that Grey has large scale lymphoma. (This is based on the "architecture" of the intestinal wall.) She sent a sample to the lab and we should get the results Friday.

The oncologist at the hospital already gave Grey her first chemo treatment and we have an appointment with the oncologist next Tuesday.

This is not the news we wanted but I am so grateful we did not have to put Grey through an endoscope procedure or surgical biopsy. I was really hoping we could talk to an oncologist first and get a second opinion before rushing into a biopsy and that is how things worked out.

Grey had a really good day yesterday and was interacting more than she has in quite a while. She also begged for breakfast which is something she has not done in at least a month. Things would have been better if I had pushed for an ultrasound back in March (see my other post) but we are hoping the chemo will still give us some time with Grey.

 

[FeebysOwner]

Thanks for the update. Things looked like they turned in Grey's favor - at least in terms of timing. I am glad to hear she is doing pretty well!! And continue as you can to keep us updated.