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Possible Cancer in Cat: How to diagnose, treat?

Dear good people of Televets:
Hoping you can help with a stunning development in my household: My beloved cat Wizard may have cancer.
Here's the situation:
Patient is neutered male cat, born to feral parents, 11 yr old, formerly in excellent health. Four symptoms all arising within the last two weeks: 1. Loss of interest in foods formerly favorites (but some appetite remains). 2. Less active, but by no means lethargic. 3. Drastic weight loss from 20 lb to 13 lb (loss of 35%). 4. Abdominal tumor the size of a plum, discovered via palpation and confirmed on x-rays two days ago.
Also 5. CBC, chem 27 and T4 tests show what the vet yesterday called "numbers not helpful here." I take that to mean that they don’t establish the diagnosis but do show that various organ systems are still working well.
Questions: 1. What are the possible diagnoses and their likelihoods? (E.g., X% chance it's a malignant tumor arising from a lymph node, X% chance it's a benign tumor arising from intestinal wall.)
2. What to do next? Possibilities include (a) watchful waiting, (b) ultrasound-guided sampling of tumor for diagnosis, (c) exploratory surgery. Are their other possibilities? What are their pro's and con's?
I will be grateful for whatever help you can offer and will gladly pay any reasonable consultant's fee.
Gordon Bear
Ramsey NJ USA
gordon.bear@gmail.com

Symptoms: Lumps And Swellings, Weight Loss

• Veteran Advisor David says:

  September 15th, 2008 at 12:50 AM

  Hi, Im sorry to hear about this. Let me take your questions in turn

  1) To answer this properly it would be useful to have an ultrasound performed to localise where the tumor is growing. Lymphoma accounts for a third of all feline malignancies and here is a Televets article on this: http://www.televets.com/articles/cats/lymphoma-in-cats.html

  Splenic and stomach tumors in cats are rare. Most common tumors I see are lymphomas (intestinal), liver and occassionally pancreatic tumors

  2) related to my answer for 1) I think ultrasound is the best option and yes some kind of biopsy should be performed to get a better sense of what is going on and where. The pros of Ultrasound guided biopsy are that the procedure is less invasive, cons are that a representative tissue sample may not be gained. Exploratory surgery by far gives the best gross look at what is going on and biopsies are commonly excision biopsies (removal of complete mass for analysis). Cons with this are a longer anesthetic and more invasive procedure. If your cat is unwell i would definately opt for the less invasive method as anesthesia is ill advised in an unstable patient.

  Using Televets is free, I hope the info I have given is useful and I wish you both the best of luck. Let me know if you have any other questions. Cheers, David

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  Every Pet Should Have Pet Insurance

  Every day I see pets come into my clinic injured and unwell. Its always so upsetting knowing that treatment could be taken a lot further only if the owner had taken out pet insurance. You have health insurance, so should your pet... Dr Brooks

  

• Gordon says:

  September 15th, 2008 at 01:41 PM

  Dear Dr. Brooks: I am grateful for your prompt reply and appreciate your sympathy. What you kindly wrote guided a consult with my vet this morning. May I ask you more about this case, please? My vet raised the possibility of what I think is called empirical treatment: No diagnostic workup but just treat the animal as though this is lymphoma. Then see if the animal responds to the treatment, and if not try another treatment. The treatment that the vet suggested would be oral medication. I had expected him to specify drugs of the anti-cancer kind, which work (I understand) by killing dividing cells throughout the body and thus cause side effects in the GI tract, and while he acknowledged that he could supply those, he said we might start with good ol' prednisone. The hope would be that the animal's appetite would perk up, that the weight loss would stop - and that the tumor might even shrink. So my question is whether this is a reasonable course of action, an alternative to diagnostic imaging, to aspiration for the purpose of biopsy, and to exploratory surgery during which the vet might dissect out the tumor - or discover such extensive disease that euthanasia is warranted. I shall be grateful for whatever information and advice you might offer. Sincerely, Gordon Bear

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• Veteran Advisor David says:

  September 15th, 2008 at 10:37 PM

  It is fairly common to treat empirically because often the patient is too unwell to go through biopsy or exploratory surgery to further the diagnosis. So this is not an unreasonable option. Often excision of the lump doesnt actually mean anything for the course of the disease anyway due to spread already existing.

  Certainly prednisone is a good starting point and then more drugs can be added if necessary and if the patient is tolerating treatment well.

  If an inoperable tumor is found on exploratory that doesnt necessarily mean he has to be put to sleep on the operating table. He can be stitched up and then put onto prednisone and the other drugs as required.

  It really comes down to : If he is too unwell for a procedure (i.e he is not eating and is not stable for any kind of anesthesia) then really the best option is to go ahead with the prednisone to try to improve the situation (make him eat, gain weight and so on). If then you decide to go ahead with further diagnostics (biopsy / surgery) then he will need to come off the steroids for a while because these will delay wound healing.

  He should also have regular supportive care such as IV fluids to correct dehydration quickly, regular vitamin injections and good antibiotic cover if any other infections creep in

  Hope that helps, stay in touch

  David

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  Every Pet Should Have Pet Insurance

  Every day I see pets come into my clinic injured and unwell. Its always so upsetting knowing that treatment could be taken a lot further only if the owner had taken out pet insurance. You have health insurance, so should your pet... Dr Brooks