Splenomegaly and Mast Cells- perspective

[pjhan]

Hi all,

Problem:
So my cat has an enlarged spleen, swollen lymph nodes, pleural effusion, and some GI issues. A fine needle aspiration found mast cells (unsure whether or not they're well or poorly differentiated (in a foreign country atm and not entirely fluent)). My cat apparently moved too much so they couldn't gather a cell culture to test the lymph nodes.

She's been itchy for a bit (since last summer, which I idiotically chocked up to either the weather or just cat stuff) and has recently been vomiting daily. She's also been hiding more. With meds, she's been holding in her food. Other behaviors- grooming, playing, etc- seem normal.

Advice needed:
So I'm trying to decide what to do. MCT confirmed yesterday. I don't believe I'm the only one that's been in this situation so I'd love to hear about other people's experiences to help guide my own.

Issues:
The S.O.P seems to be, and the vet recommended a CT scan and a splenectomy with/without chemo. The vet is entirely new to me. The usual one I go to wasn't apparently a cat specialist hence recommended to this one on Saturday. A few issues for me-

1) If the mast cells have metastasized, then the prognosis is extremely poor, so what would be the point of surgery? Surgery and post-surgical care with recovery time does not seem pleasant and I do not want my cat's last few months to be filled with pain. She was unsure about the state of metastasis because of the failed lymph node aspiration which doesn't inspire confidence.

2) Risk of death during surgery. Which the vet said her clinic never experienced, but others have (which makes me a bit suspicious about that clinic - new vet)

3) The median survival rate post splenectomy was said by the vet to be 1 year. Online figures seem to concur (14 months) From what I've been searching online (which I know isn't rigorous, but it's been difficult finding raw numbers and when the vets only quote the median figure, it doesn't exactly inspire trust), the average seems to be in the months.

3) Cost is prohibitive. And if this bought my cat years, then it'd be a no-brainer. But given the poor prognosis, the unknown state of metastasis (rather the likelihood of metastasis given the enlarged lymph nodes), quality of life issues post surgery and with chemo, I am at a loss of what to do. The alternative seems to be a course of anti-histamines until she passes. Which also sucks.

She is 5 years old. Maybe 6 (a rescue). I did not see this coming.

Thank you in advance.

 

[misty8723]

I am so sorry you and your kitty are going through this, and I'm sure there are some knowledgable people on here based on the issues your kitty has who will come along. I can only tell you my story. I had a sweet little calico (Cynthia) who itched a lot, which the vet attributed to allergies,.but she was otherwise healthy. One day she was on our bed with us and suddenly urinated. That was definitely not like her, and I thought possibly a UTI and took her to the vet. Some of the worst words I've ever heard was when the vet was palpatating her stomach and said "I feel a mass." The fine needle aspiration didn't find cancer cells, but the vet warned me it could still be cancer because they get such a small sample. We decided to have a second aspiration, but went to another vet because they could do it sooner. This one did find cancer but couldnt determine what kind, and that second vet said probably 3 months, don't put her through surgery, take her home and make her comfortable. I left there in tears and headed for my usual vet, who said Cindy was otherwise healthy and a good candidate for surgery, which whould be the only way to find out the type of cancer and to see if/what kind of treatment. I knew there was a chance she could die in surgery, but I was at peace becaise I knew we had no other alternative if we wanted to try to save her. The surgeon was very highly rated, and he allowed us to wait in the clinic while he did the surgery. When he came out with thumbs up, we were elated. He said he had removed a large mass from her colon and got all of it. But we still had to wait for the biopsy to see what kind of cancer, which turned out to be mast cell. Apparently that is a very rare cancer in cats, but he recommended chemo and she did start to thrive. She lived nearly two years, but started to decline with GI issues that they really couldn't define, just gave us meds and special foods. Up until then I believe she had a good quality of life and even though it cost a lot of money, I didn't regret it, although there are things I would have done differenty. She was also a rescue and we didn't know how old she was, but probably not more than your baby. It's one of the worst things in the world to go through and try to make the right decisions, and to go from thinking she was healthy to cancer 3 months is devastating,

My heart goes out to you and whatever you choose, I know it's going to be a hard road, but I know you will do whatever you feel is best for your kitty.

 

[FeebysOwner]

Hi. I read through your post and am sorry you and your cat are facing this. And, I really don't have much to offer - bur, rather some thoughts and related questions. This is a long post, so please bear with me and accept my apology for it.

Although I recognize cancer can originate in the spleen, many times cancer has metastasized in order to be found in the spleen. I also believe that 'mast cells' in general can be either benign or malignant. The issue with whether or not they are well or poorly differentiated then comes into play. Well differentiation means there is a greater chance of malignancy, but that doesn't necessarily guarantee cancer. The next step then is to FNA lymph nodes, which is what they were unable to do with your cat.

My questions would be: Does the vet think the 'cancer' originated in the spleen? If yes, how did they determine that? If no, why remove the spleen without verifying whether or not there is cancer in other locations - such as the lymph nodes, for example? What is the benefit in doing so? Would a follow up ultrasound/FNA of both spleen and lymph nodes be a possible next step? And, find out if they could perform a PARR assay (PCR for antigen receptor rearrangements) on the aspirated tissue. This test usually helps to clarify the actual type of cells involved. I've included a document (see link below) - while it is a bit on the 'technical' side, it does help to explain the PARR test better than I can.
Microsoft Word - Avery PARR.doc (delawarevalleyacademyvm.org)

I know much of this due to Feeby having recently been through a couple of ultrasounds. The first one denoted a 'thickened' spleen, but with no decision to do an FNA. A follow-up ultrasound was done - for unrelated reasons - and the spleen remained unchanged, but there were some enlarged lymph nodes in the intestinal area - and an FNA was done, which came back inconclusive in terms of actually identifying cancer cells. As I learned later, the PARR likely should have been performed on the lymph node tissue to better determine if there were signs of malignancy. So, at this juncture, Feeby will be undergoing a 3rd ultrasound, with FNA and I am going to press for the PARR at that time.

Again, sorry for the length of this post.

 

[pjhan]

Misty- thanks for your kind words and I'm glad that you had a few extra years to spend with Cynthia. She sounds lovely and I can't imagine the heartbreak what you went through. Well, I guess I can...haha. Your story is very appreciated.

Feebysowner- Thank you for the information and I hope things go well with you and Feeby. And luckily, I am very comfortable with technical terms. Mobius (my cat) had an ultrasound which showed an abnormally enlarged spleen. The vet wasn't specific with the results of the splenic FNA, but I was able to see the results and the mast cells involved appeared well differentiated. I did not know about the PARR so that is extremely useful. The results of the ultrasound and xray also showed an enlarged lymph node. The vet had no comment on the metastatic state of the tumor even after being asked and simply recommended the splenectomy as a standard operations of procedure thing, which was less than confidence inspiring. I'm heading into a different vet with the test results today to figure this one out, though from my thinking, I doubt it's confined to just the spleen, given the mast cell count in the FNA (from what I saw- I am not an expert), the enlarged lymph node, the symptoms that led me to see this vet in the first place (mainly frequent vomiting likely as a result of histamine release), and state of the spleen. I do not remain hopeful and am thinking more about palliative care. But hey, maybe the other vet missed something or maybe I'm jumping the gun. We'll see

Anyway, thank you again for your kind words

 

[Bayleaf]

Hi PJ - I am so sorry you are dealing with this. Our amazing cat Dimitri experienced a similar situation. When he was about 8, he had two incidents of small mast cell lumps near his shoulders, which our vet removed. After those surgeries, he developed diabetes. I gave him insulin shots twice a day and we put him on canned food only. About a year and a half later, his spleen started to enlarge. Our vet has many years of experience and is a good surgeon. She also tells it like it is and never tries to "upsell" her services. We discussed having the spleen removed but as you mentioned, the recovery is hard and the survival rate is usually not very long. She felt that in all honesty he would not survive the surgery. We decided not to do that, even though it was a very hard decision. I researched it extensively online and really only found one vet who seemed to think it was a "standard" surgery, no big deal. I could not bear the thought of Dimitri suffering and possibly dying that way. We continued the insulin and adjusted his diet to include higher quality people-grade proteins like chicken every day. (yes I was cooking for a cat) His spleen continued to enlarge slowly over time, but he was still interested in life and able to do most of the things he enjoyed. He made it almost 6 years after his diagnosis. Shortly after his 14th birthday last May, he stopped eating or drinking water, and we had to have him euthanized. I still wonder if we made the right choice about the splenectomy, but our vet said he lived longer than most of her kitty clients that had so many health issues. It's not easy to have to make the tough calls. I hope that whatever you decide and whatever the outcome, you know that you are doing your best for your cat.

 

[sos2484]

Hi… I’m so sad to hear all of these stories. Oliver had an ultrasound with an FNA of his spleen in November. The oncologist said it was histiocytic sarcoma. It is so rare in cats that information is hard to find. The oncologist wouldn’t do anything for him unless I had a biopsy. Oliver is 14 and I chose not to. I took him off of the prednisolone and he got better, gained weight, eating well, no vomiting or diarrhea. My vet was very confused because usually off of all medication, a cat wouldn’t get better. So we decided to wait until a symptom of something appeared and at that time we would do another ultrasound. In the meantime, Oliver was playing with his toys, alert, eating and everything was looking good.
Last weekend he started regurgitating water. Not usually food, always water with just a few pieces of food. We went to the ER. They put us right in with the internist. Another ultrasound sound a dark spot on the spleen which they think was where the first FNA was done. The did another FNA and no cancer cells showed this time. He did have a kidney infection and now showing signs of kidney disease based on bloodwork. I’m still a little confused about what they found and didn’t find. Right now he’s not on any medication. I’m not sure what to even do going forward. His regular vet is on vacation this week so we will go over everything when he gets back.
My heart goes out to everyone who fought, is still fighting and just beginning the fight.