Bladder Surgery and Transitional Cell Carcinoma

[coneja]

Hi everyone, my 15 year old female cat Luna was diagnosed with bladder cancer: transitional cell carcinoma (TCC). I have been working with a couple oncologists and right now Luna is on the NSAID meloxicam for inflammation and gabapentin for pain. I am strongly considering a partial cystectomy (partial bladder removal) for her after getting a second opinion because the mass, while large (3.5x2 cm) is in the apical region of the bladder and completely out of the trigone which makes the surgery theoretically straightforward. I am in the process of getting a consultation appointment with the surgeon to determine what that surgery would look like, whether it's possible or likely to have a good outcome, etc.

I wanted to see if others on the forums had experience with TCC and bladder surgery/partial cystectomies, or other treatments/palliative care. I read a couple of the threads that I could find, but always looking for more information. Apparently the bladder surgery is not as scary as it sounds; the oncologist said it would almost be like a spay in terms of recovery, with 1-2 nights in the hospital, followed by monitoring at home for 4-5 days after with sutures out in about 2 weeks. I'll know more after the surgery consult but wondered if anyone had experience with this type of surgery.

Thanks so much!

 

[FeebysOwner]

Hi. So sorry to hear about Luna's bladder cancer. I can't speak to the cancer, but I can tell you that Feeby had to have bladder surgery at the age of 5+ due to oxalate stones. While that didn't require actual removal of any part of the bladder, I suspect most other elements of the surgeries would be the about the same. I don't think Feeby's recovery time was much different than when she was spayed a few years earlier.

I would guess the biggest factors for you to consider is her overall health otherwise given her age, and knowing that the cancer hasn't spread elsewhere. I am guessing that she is in general good health and the cancer hasn't spread yet if the oncologist is recommending that you consult with a surgeon.

I have also heard that CBD oil is sometimes added to the current treatment regimen Luna is on.

Hoping other members see your post soon and have more informative input to offer you.

 

[fionasmom]

Fiona also had bladder surgery to remove stones when she was 9. She had repeated bladder infections with blood and when I took her to the ER on Easter morning they recommended the surgery asap. Frankly, the infections had been such a pain that I did not even research the surgery and she did fine and lived 7 more years. I hope that you are able to get some good advice and help your cat with this.

I am not really up on bladder cancer surgery in cats, so this might not be a logical question. Are they saying that there would be a clean margin or that the cancer would be removed with whatever was taken out and that chemo or radiation would not be necessary?

 

[coneja]

Thank you both for your responses... I know the surgical removal of stones is a lot more common and I figured it probably wouldn't be too very different from that in terms of recovery, except that her bladder will be smaller temporarily causing her to pee more frequently but honestly that's where we're at now... I guess apparently bladder can re-expand/stretch back to almost normal after partial removal, which is really promising.

As for her quality of life, I know it's at least an irritant and probably painful, though she still plays, snuggles, runs around the house occasionally and yells for food. All those are great signs. Other than this she is a very healthy cat despite her age with a really great coat and good weight. At my most recent appointment they looked at her whole abdominal cavity plus lymph nodes and lungs and the cancer is just hanging out locally in the apex of the bladder.

I work at a regional pet store chain with a focus on healthy food for dogs and cats and we do have CBD which I know a lot of people use and have had good success with... Definitely something I will bring up with a vet as a potential pain relief once (assuming) we get back to "normal"/"stable" after the surgery. There are some other supplements I'd like to put her on as well eventually, like Omega-3s (used to be on them way back when) and I guess Dasaquin which is normally a joint health supplement can also help with the bladder wall. These are all things my regular vet suggested, and I haven't broached with the specialist yet since the primary thing will likely be the surgery and I am planning to bring supplementation up at a follow-up appointment (again, assuming everything goes according to plan.)

Fionasmom, that's totally a logical question. They can't tell yet whether they'd be able to get it all out. They said it depends when they get in there how widely the tumor is attached at the base of the bladder wall (because they can't tell 100% on the ultrasound). If it has a narrow attachment point, they may be able to get clean margins and remove the entire thing. If it has a wide attachment, all they could do is remove as much as possible (surgically "de-bulk" it), biopsy the sample and then potentially follow up with additional chemo or radiation. To be honest both of those scare me, although the oncologist talked about low dose oral "metronomic" chemo designed to control the tumor's growth which sounds much more doable. Unfortunately TCC in cats is relatively rare and the most recent literature suggests higher mean survival times with surgery and NSAIDs and potential other secondary treatments as well but it is a very aggressive cancer, and even in cats with clean margins it often comes back. So, it is not something I expect to fix her. Maybe we thread the needle and get the whole thing gone, but statistics are not in our favor.

But I'm at a point where even though she seems mostly happy, I know she has pain and I have to take some sort of additional action. We've been on the meloxicam for awhile and I have been going back and forth about the surgery, partly because I wasn't getting a lot of info from my local oncologist. Basically they had never done the surgery and said "it's higher risk, higher reward" and couldn't give me much info beyond that. I recently went and got a second opinion from a different hospital that has had experience with TCC in cats and partial cystectomies and am so glad I did... That's who I'm working with now and they've been great. Only wish I had gotten that second opinion sooner but can't change that now.

I'm glad both your babies did well after surgery. It's a scary thing. Did you need to keep them confined at all after surgery? I don't want her jumping on things. One of my coworkers had a cat with intestinal lymphoma that they removed and she set up two large dog crates (the wire kind) to keep him in a smallish space with no ability to jump on things. I will ask the surgeon what she recommends at the consultation as well.

 

[FeebysOwner]

I don't recall restricting Feeby much at all, nor did I use a cone for either her spay or bladder surgery. But, Feeby has always been a rather subdued cat. And, keep in mind, Luna is older so healing time might be a bit longer/harder than with a younger cat? If you can't be with her during her healing phase, it might be an idea to give her a bit more restrictive space than otherwise. If not crates, perhaps segregate an area of a room and remove furniture to discourage jumping? For example, if she likes laying on beds, set a mattress on the floor for her to get up onto more easily, or create her own bed that all she has to do is climb into it?

A lot depends on the Luna's personality as to how much confinement she may or may not need, and how well she will or will not respond to a crated area.

Please keep us posted!

 

[fionasmom]

I confined Fiona to a large bathroom with everything she would need. As she aged, she was less able to jump and so I was relatively sure she would not jump on the counter but I kept it covered with enough items that there was not really room if she had wanted to. I have never had much luck with cones with any animal I have ever owned. I have a friend in PA who regularly confines cats who are ill to a huge dog crate if she thinks that they will not remain calm.

Thank you for your explanation; I can see exactly where you are and I am glad that you switched to a more informed practice. Supposedly chemo and radiation are easier on animals. I have never done either, but my dog had immunotherapy and had absolutely no reaction to it.

 

[coneja]

I am very glad I went to the new place. I felt a lot better talking to the new oncologist, and she was up-to-date on the current studies on feline TCC where the other oncologist wasn't (which I don't mean to sound like I'm slighting her; her area of experience with TCC was primarily dogs, where surgery is a lot of times not possible because in dogs the tumors generally occur in that really tricky trigone region.) I found this place by searching for "partial cystectomy" and they listed it on their website as procedures they perform. They're about 2 hours away from where I live and the other place is just up the road, but it's definitely been worth it even with all the back-and-forth I will be doing (although I know this will put a bit more stress on Luna.)

I am taking roughly a week off from work to be with her after surgery. She generally doesn't jump onto many things (except, oddly enough, in the bathroom! Her routine in the morning is to run in past my feet as soon as I open the bathroom door first thing and hop onto the closed lid of the toilet and "hold it hostage" until she gets her morning lovies and is satisfied.) So at least that's a good sign. Talking with my friend who confined her cat, I found out she wasn't able to be home with him to monitor so that's partly why she did it, plus the intestines (where they removed his tumor) are extremely delicate and liable to rip. She offered to lend me her dog crate so probably will take it at least for nights or to use as needed... But that's good to hear that both Feeby and Fiona did well with minor to no restrictions.

 

[fionasmom]

You are definitely doing the right thing is going to the oncologist who is more experienced. I take my dog to a specialty hospital in LA and have never regretted having made that decision. You are very kind to take the week off and that will also be a big plus for recovering and feelings of well being.

 

[coneja]

I work with some amazing people that are willing and able to fill in the gaps while I'm gone for what will be unfortunately a very busy week even with the COVID restrictions in my state. And I will feel much better being able to keep an eye on her right after she comes home so I am fortunate that I will be able to do that. I absolutely adore this little girl.

 

[coneja]

So I had to say goodbye to her on Monday... She went through the surgery fine but when they looked inside her bladder the tumor had taken over 99% of her bladder, just in the three-to-four weeks between the ultrasound when it was 3 cm x 2.5 cm to now. There was no way for them to remove any of it without basically removing her bladder so they just had to stitch her back up. The surgeon thought at the rate that it had grown, at maximum we'd have two weeks to maybe a month left before she became completely obstructed. I couldn't let that happen, and though I envisioned and hoped to have an at-home euthanasia, my local vet and the other euthanasia service in my area is experiencing a lot of delays of 4 days up to a week. And I knew she'd be in pain during that time. This last week before surgery it was a struggle to get her to eat, and she was having more bathroom trouble. I thought it was because I had to take her of the meloxicam in preparation for the surgery but now I know it was because the tumor had grown so large. I consulted with my local vet, my family and the surgeon and made the decision to euthanize her while she was happy on all the drugs and pain free. I buried her at my parents' rural home next to our trail through the woods and a favorite tree of mine. It really hurts and it is going to be so hard without her, but I know I did EVERYTHING I could and I don't regret trying the surgery. She's not in pain anymore and that's the most important thing.

Thank you both for listening and replying and giving me words of encouragement. I really appreciated it.

 

[fionasmom]

I am so, so sorry to read this. Hopefully there will be some small comfort in the fact that you did everything that could be done. This final occurrence was so much out of your hands that you did the right thing to let her go while she was sedated and relaxed. To be honest, that kind of release might be even more peaceful than home euthanasia as she probably just drifted off as opposed to someone even coming to the house which might have been more startling. I would have done exactly the same thing.

Her final resting place sounds lovely and I hope that over time your visits to her will be filled with happy memories of the love that you had for each other.

 

[coneja]

Thank you so much for your kind words. I wanted to be there, but was two hours away and if I chose to be there the euthanasia wouldn't have been by the surgeon I was working with and got to know, just whoever was on shift at the emergency center. While I'm sure they are all highly capable, I decided to ask the person whose expertise I trusted and who said such kind words to me. Not sure if that was the right choice or not, to not be there. The surgeon said she was so high, that she probably wouldn't have known much of a difference, and that me being there would be for me, not necessarily for her and that she wouldn't know what was coming so it would have been okay. She told them they pet them and talk to them and tell them they're beautiful and its very simple and quick and painless. They wrapped her up so nice for me. I'm glad she was at least at a place where the people cared for her, whether she knew that or not.

I know it will get better with time, it's just very hard right now. I am focusing on my other cat right now and just trying not to dwell too much on it and just try and get through this the best I can.

 

[fionasmom]

I completely agree that there was a time frame here and waiting for you, allowing Luna to regain consciousness and possible anxiety that might go with that, would not have been the right choice. The staff and doctor were exceptionally kind to Luna and she was comfortable which is the most important thing. Prolonging this would have been about you, and while many people do choose some final "theatrics" it is not the right thing to do. Give a lot of love to your other cat and each day will assure you that you did all that you could and made the right decisions.

 

[coneja]

Thank you, thank you for saying this... She had regained consciousness but wasn't very alert from my understanding... I didn't want to wait if the vet thought it wouldn't have made a difference to her, and I think she would be the one to know because she was there with Luna. I just have to trust her advice and that I made the right decision with the information I had. And in the end, Luna is not hurting anymore and that's the most important.

Thank you for your kindness.