To Enucleate Or Not

When I left Tijuana about five years ago, the only thing I took with me was my best friend - a 2 year old Grey cat that I rescued as baby after being bit on the head from a dog.

After finding him injured behind behind a house, I found homes for his brothers, sisters and mom (after getting them fixed) but nursed Greyman back to health. He was only a couple months old, and most of the damage was to his eye that was blood red for weeks and slowly got better. The vet that gave him his kitten shots in Rosarito only said that he was very lucky, and even though I figured he couldn't see out his eye I was relieved that it healed enough that it was rarely noticed and Greyman's life was great (awesome, actually).

He was a couple years old when I brought him to a vet here in Laveen, AZ for a check-up The doctor confirmed that he couldn't see out of his eye and that he should be just fine. A couple years later (a couple weeks ago) when I brought him back to the same doctor for a check up, he told me that "it's nothing to be too concerned about and no emergency" but cats that have damage to their irises have a higher chance of getting cancer in that eye. He didn't even "recommend" enucliation as much as suggest that I consider it. I asked a few questions and left with the words "nothing to be too concerned about" ringing in my ears.

Now I've read as much as there is available on the internet about Trauma Induced Feline Ocular Sarcomas. The worst part is that the younger the cat the more likely to develop the sarcoma. I've learned that the average time for a trauma induced sarcoma to develop is 5 years, but that is because it can happen any time between 1-10 years. Most reports refer to this cancer as rare (it is somehow similar to an injection site sarcoma)... what I don't know is how rare it is?

This is a tough decision for me. Greyman is a fantastic young dude with no physical limitations. I'm actually horrified of subjecting him to the trauma and risks of surgery and I have to admit that the cost is a real hardship and will be a tough one to manage.

The more I think about it and as I write this I fell more and more like I can't leave a ticking time-bomb (if that is what it is) in his head. Still, any information from anyone that has had experience in any aspect of this would be appreciated. I realized that my big question "will my cat eventually get cancer?" is going to be an impossible one to answer, maybe I'm just hoping to better weigh the risks.

I've attached a picture of Greyman. This photo doesn't tell the whole story though, if you looked into the bum eye with a light, instead of black or a reflection you would see a mottled grey shape (that hasn't changed in the year or so that I've actually been paying attention to it).

Thank you for any help in this challenging time.

Correction, it was almost 3 years ago that I let Tijuana for Arizona... so Greyman is almost 5 years old.

A very difficult decision. All I can offer is moral support and a heads up to other members. Bless you for saving him he I'd adorable. Mamanyt1953 any advice?

Thank you - perhaps I should add that the damage is actually to his lens (not the iris as I stated in my original post) which is why the eye doesn't work.

How are you doing? I flagged your original post and sent out a general call for help on it. I'm going to see if I can track down the member with a one eyed cat. Hang in there we'll get you some more support . Do you have any more photos of your gorgeous
Greyman?

He's a beautiful boy, isn't he? I've been out with flu, and just getting back online. Forgive the delay. Look, if it were Hekitty, I would not even hesitate in taking the eye. If he had vision in the eye I might...might...hesitate, but I think my decision would remain the same. The surgery is pretty straight-forward. Eyes come out fairly easily and with very little physical trauma involved.

I know that you said cost is an issue for you. It is for most of us. Here are a couple of sources that may be able to give you a hand with this, they are certainly worth checking out!

No Money For Vet Care? How To Find Help And Save Your Cat's Life
When You Can't Afford A Veterinarian
Financial Help For Cat Care.

His eye doesn't look very damaged, I'm sure the risk of cancer is low. It sounds like one of those weird things that can happen, but not common. I probably wouldn't. But if he can't see out of that eye, it doesn't matter to him, so make the decision based on how comfortable you are with the various risks involved.

Just a thought, --my apologies if this was already mentioned but is there any way you could contact a different veterinarian and get a second opinion? Or even a human eye doctor maybe? I'm not a vet so I have no idea if the human eye and the feline eye are at all the same.

The vet I spoke with told me that the condition is unique to cats, and that is backed up by what I've read online, although I doubt that it has been studied comprehensively in regard to species. Cats are special in that damage can lead to cancer.

It's true that his eye doesn't look that bad at first, but in reality his lens is all torn up and looks pretty messed up when you look at it in the right light. It also doesn't reflect any light.

One study I read "Clinical and Morphologic Features of Post-traumatic Ocular Sarcomas in Cats" stated that out of 13 cats studied with ocular sarcomas, 5 had a history of eye trauma. The study is pretty clinical though and I can't say I totally understand it. here's a presentation of findings that are scary because it certainly applies to his type of injury, but again it doesn't really hint at how likely he is to develop a tumor (warning: There are some photos of damaged/diseased eyes that are not extreme but don't get any less disturbing the more I pour over the information)
https://www.vetmed.wisc.edu/pbs/dubielzig/pages/coplow/PowerPoints/Feline_PTS_2012.pdf

Thanks for the advice to get a second opinion, I should take another crack at it. I put in two calls with my original vet asking to talk more about the situation and was told twice that the doc would call me back, but two weeks later I haven't heard anything. I called another vet who told me that she would need to see Greyman but would then have to refer him to an eye specialist anyway, so I decided that might not be the best bet for a second opinion. Other than a lack of communication (maybe I should actually schedule another appointment?) I trust the vet and his website shows off surgical skills and professes a passion for understanding cancer in cats.

There is a good chance all I need to hear is that a Doctor has performed enough of these surgeries to put my mind at ease about the whole ordeal. It's the "what if something bad happens for a surgery he didn't even need" thing that is really messing me up. I read that a risk of having an eye removed is losing eyesight in both eyes!

Thanks for the replies and I appreciate the "what would you do" input from catsite members because most people I've discussed this with think I'm crazy for considering an relatively expensive and dramatic measure for something that "isn't a problem". I also appreciate the request for more photos of Greyman!

Grey_Tuxedo said:

Cats are special in that damage can lead to cancer

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Yes, but it's still not super common. How many cats get injection-site sarcoma? The AVMA says: "Reports indicate that they occur at a rate of about 1 case per 10,000 to 30,000 vaccinations." So if it's a similar rate for the eyes---1 in every 10,000 damaged eyes will develop cancer---I'm not sure I'd opt for surgery unless/until an abnormality is detected in the eye.

Grey_Tuxedo said:

out of 13 cats studied with ocular sarcomas, 5 had a history of eye trauma

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Sure, but 13 out of how many cats? How common is ocular sarcoma among cats with eye trauma?

Grey_Tuxedo said:

It's the "what if something bad happens for a surgery he didn't even need" thing that is really messing me up

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Yeah that would be my issue with it too. Maybe schedule a consultation witht he vet and ask straight out "what are his chances of developing ocular sarcoma, and what are the chances of surgical complications?"

Mamanyt1953 said:

He's a beautiful boy, isn't he? I've been out with flu, and just getting back online. Forgive the delay. Look, if it were Hekitty, I would not even hesitate in taking the eye. If he had vision in the eye I might...might...hesitate, but I think my decision would remain the same. The surgery is pretty straight-forward. Eyes come out fairly easily and with very little physical trauma involved.

I know that you said cost is an issue for you. It is for most of us. Here are a couple of sources that may be able to give you a hand with this, they are certainly worth checking out!

No Money For Vet Care? How To Find Help And Save Your Cat's Life
When You Can't Afford A Veterinarian
Financial Help For Cat Care.

Click to expand...

Grey_Tuxedo said:

The vet I spoke with told me that the condition is unique to cats, and that is backed up by what I've read online, although I doubt that it has been studied comprehensively in regard to species. Cats are special in that damage can lead to cancer.

It's true that his eye doesn't look that bad at first, but in reality his lens is all torn up and looks pretty messed up when you look at it in the right light. It also doesn't reflect any light.

One study I read "Clinical and Morphologic Features of Post-traumatic Ocular Sarcomas in Cats" stated that out of 13 cats studied with ocular sarcomas, 5 had a history of eye trauma. The study is pretty clinical though and I can't say I totally understand it. here's a presentation of findings that are scary because it certainly applies to his type of injury, but again it doesn't really hint at how likely he is to develop a tumor (warning: There are some photos of damaged/diseased eyes that are not extreme but don't get any less disturbing the more I pour over the information)
https://www.vetmed.wisc.edu/pbs/dubielzig/pages/coplow/PowerPoints/Feline_PTS_2012.pdf

Thanks for the advice to get a second opinion, I should take another crack at it. I put in two calls with my original vet asking to talk more about the situation and was told twice that the doc would call me back, but two weeks later I haven't heard anything. I called another vet who told me that she would need to see Greyman but would then have to refer him to an eye specialist anyway, so I decided that might not be the best bet for a second opinion. Other than a lack of communication (maybe I should actually schedule another appointment?) I trust the vet and his website shows off surgical skills and professes a passion for understanding cancer in cats.

There is a good chance all I need to hear is that a Doctor has performed enough of these surgeries to put my mind at ease about the whole ordeal. It's the "what if something bad happens for a surgery he didn't even need" thing that is really messing me up. I read that a risk of having an eye removed is losing eyesight in both eyes!

Thanks for the replies and I appreciate the "what would you do" input from catsite members because most people I've discussed this with think I'm crazy for considering an relatively expensive and dramatic measure for something that "isn't a problem". I also appreciate the request for more photos of Greyman!

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Oh he is so beautiful His coat is like our Gypsys! You should post the 2nd photo in the 'Show us the Whiskers' thread.

I am a human doctor, not a vet. Feline eyes are similar to human, and indeed to all mammalian, eyes except that sarcomata in humans after trauma are very rare. I qualified in 1954 and have never even heard of this happening.

Many years ago my Burmese female was shot in her eye by an unknown sadist with an air gun. I was a friend of the vet and he invited me to assist him with the removal of the eye. It was a relatively simple procedure, under general anaesthesia, he pulled the eye slightly out of the socket with a pair of forceps, cut the muscles, then the ocular artery and vein and the ocular nerve and sewed up the eye lids with soluble sutures. That was it. Susie recovered well and was eating and active the next day; I didn't even have to remove the stitches! She lived another six years or so and died eventually of renal failure. During her life she behaved completely normally and had five Tonkinese kittens.

Greyman is a beautiful cat. He would of course have a cosmetic disability if the eye were removed but I doubt that he would notice very much as he is already blind on that side. I am not trained as a vet so you should check this with your vet, but when making your decision, Greyman would not develop any malignancy if the eye were removed before any malignancy developed,

With all best wishes,
Geoffrey

When I do a google search for "traumatic" "occular" and "sarcoma" the only results that are returned also contain the word "feline". I've come to believe that while the mechanism might be similar to injection site sarcomas the prevalance of cancer in significantly traumatized eyes is higher (one study had a scary line that read: "8% of traumatized globes removed prophylactically have early FOPTS" under the heading "spindle cell variant" ...whatever that means), and in Greyman's case it may be more so because of the very young age that he received the trauma (a risk factor sited in some studies).

It certainly makes sense to monitor his eye for changes and then get help if any occor, but once the cancer is there...

My plan is to discuss my concerns further with the vet, as we never had as comprehensive of a talk about it as I would have liked (although, they were quite ready to schedule a surgery date following blood work). I'm going to ask straight out "what are his chances of developing ocular sarcoma, and what are the chances of surgical complications?" (as suggested by Willowy). I will keep you posted in any developments and certainly appreciate any further input.

Before I paste a bunch of words from one of the papers I discovered about the subject I'd like to thank everyone who posted on this thread. Geoffrey, that's great you participated in the removal of an eye and your cat was up and at it again the next day - and DustyDiamond, Greyman has a striped tail just like Gypsy! only a bit less pronounced.

A bunch of words from a paper I read on the subject:

"Feline ocular sarcomas are malignant intraocular neoplasms that are often associated with a history of ocular trauma. Cats appear to be the only species predisposed to the development of this neoplasia and the mean age is 12 years. Affected cats often have a history of penetrating ocular injury resulting in the perforation of the lens, but trauma is not necessary. The duration of ocular disease prior to the detection of the neoplasm ranges from several months to years.

Although this neoplasia appears to be rare, any cat with a history of ocular trauma or chronic ocular disease should be evaluated if there are any changes in the eye. Abnormalities include white discoloration (opacity), bulging and firmness of the diseased eye. Sometimes cats show blindness and neurological signs resulting from neoplastic infiltration of the optic chiasm and brain via the optic nerve.

Feline ocular sarcomas are locally invasive and have metastatic potential. Tumors occupy the posterior iris and expand diffusely into the ciliary body, posterior chamber, retina and choroid. Extraorbital invasion is common and may begin at the limbus or occur through the optic nerve. The lens is invariably destroyed and significant inflammation accompanies tumor growth. Whether this occurs because of the initial traumatic event or is secondary to ocular neoplasia is unclear. The specific histologic diagnosis of tumor types is variable. While fibrosarcoma is the most common diagnosis, osteosarcoma or undifferentiated sarcoma may occur. There does not appear to be any variation in biologic behavior for different histopathologic types. While the cell of origin has previously been unknown, Zeiss CJ et al reported recently that some of these tumors are of lens epithelial origin while others are of myofibroblastic origin. Lens epithelial transformation appears to be limited to cats as these tumors have not been identified in dogs and humans. Also, according to this study, feline ocular sarcomas demonstrate morphologic similarities to feline vaccine-associated sarcomas. The suggested links between the two diseases include trauma, chronic inflammation with cell proliferation, and neoplastic transformation.

Enucleation is the treatment of choice for feline ocular sarcoma. However, these are very invasive tumors; surgery may be ineffective in cats with extensive local spread. Imaging is important to identify good surgical candidates. When performing enucleating surgery, care must be taken to avoid placing strong traction on the optic nerve. Several anecdotal accounts suggest that animals can become blind due to optic nerve dysfunction in the remaining eye following a routine enucleation. A working hypothesis for this unfortunate outcome is mechanical damage to the contralateral optic nerve at the level of optic chiasm due to surgical traction.

After surgery, metastasis or extension involving the central nervous system can be seen. Radiation therapy may have a role in advanced, invasive ocular sarcomas, although the high dosages that are necessary require sophisticated computer planning equipment to minimize damage to the CNS. Chemotherapy has not proven effective in the treatment of soft tissue sarcoma to date. Doxorubicin and carboplatin could be offered for palliation. However, euthanasia is often elected for affected cats due to the neurologic signs and poor prognosis."

-by Kyunga An, ECFVG Student
-edited by Dr. Pam Mouser, ADDL Graduate Student

Hi, I just wanted to pop into see how you are doing. I know we have some others with one-eyed cats but I haven't tracked them down yet, wish they would feature this thread on the Home page. Gotta go, be back later.

Thanks for checking in, I just called my vet and was told that the best way to really have a dialog about my concerns is through email... why didn't I think of that? I guess the doctor's not actually going to be in until Friday, so I'm not sure when I will start getting a clearer understanding about the situation... but that's the plan!

Grey_Tuxedo said:

Thanks for checking in, I just called my vet and was told that the best way to really have a dialog about my concerns is through email... why didn't I think of that? I guess the doctor's not actually going to be in until Friday, so I'm not sure when I will start getting a clearer understanding about the situation... but that's the plan!

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Keep us updated, did you check out the financial aid sites? Sending good vibes

Did you get to talk to the vet yesterday?

I wrote an email to the vet and I did get a reply that answered my questions ...unfortunately though, my most pressing questions were difficult to answer. Here's some of what I learned: as for the frequency of FPTOS (Feline Post Traumatic Ocular Sarcomas), there are no statistics. FPTOS is only studied after it has been discovered and "very few cats present themselves in [greyman's] situation" (according to the doctor) so it wouldn't surprise me that there haven't been any studies tracking a group of damaged eye cats to see what happens and doesn't happen.

Interestingly, the doctor said that the mechanism between FPTOS and FISS (Injection Site Sarcomas) are not the same, even though I read some (10 year old studies) that said they most likely were. Perhaps more is known now? He reasoned that there is a greater risk for FPTOS (in cats with risk factors) than for FISS because ocular sarcomas are not as uncommon as FISS and perhaps up to half of occular sarcomas are accompanied by a history of trauma.

He said it is difficult to actually quantify the risks (comparing surgery vs. cancer) although enucleation is the recommended preventative action for FPTOS in cats with an eye like Greyman's.

He also said that he has performed hundreds of enucleations and that "the surgical risks are exceedingly low". Also, out of the hundreds of operations he's performed none have experienced contralateral blindness (I asked if he'd ever heard of cat's losing site in both eyes after having one removed), a complication he was aware of (it's caused by too much tension on the optic nerve). So at least that's one less (slightly?) irrational fear.

I still haven't decided what to do, but I'm leaning toward getting his eye removed. I would be elated to have a happy-as-ever one-eyed Greyman and not have the worry of looking in his eye every day to monitor changes. The back of his eye is actually pretty complicated looking and takes some deliberate observation (usually with a flashlight). Whatever the risk, it scares me to look at it.

It's still scary either way... one bit of rational I'm using is that a more responsible and able owner would have had his eye removed at the time of injury (it certainly would have been recommended), and that it's probably time to do what should have already been done.

I did check out the links regarding financial aid and there's some good info there. My plan is just to save up the money (I've been quoted $1,200 which I think is somewhere in the median price range) and get it done.

I also learned that FPTOS are highly malignant and are among the most likely of eye tumors to spread and reoccur. Once the tumor develops a surgical cure is no guarantee.