Bowen's Disease

babiesmom5

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That is great that you heard from your vet, and even better news that the SCC is IN SITU. Rather than worry at this point about the nosepad or foot, I suggest you consult with a good Vet Dermatologist ASAP. That vet can look at the nosepads, foot, and/or all over the body to determine if those could be at different stages or not. I tend to think not, just based upon my cat. Hers are in multiple places, but the biopsy was on the head which was In SItu. Since then, all the lesions in various places have been treated...and most importantly contained In Situ.

I would focus on getting an appointment with a good Vet Dermatologist who can advise forward. Your vet may be able to give you a referral, possibly at a vet teaching hospital, or specialty clinic. You might have to try at a couple places to get an early appointment. Be prepared to travel if necessary to a city or outside a city. I travel 1 1/2 hrs each way to my vet dermatologist, but totally worth it. Keep us posted.
 

SilveredFox

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She got a lick of the cream in >< Even though I was watching her I wasn't doing a good enough job. The one on her nose is probably one of the most important spots to get under control but it's being a hard place to keep watch on, and I've been on absolute empty so I'm not as on my game as I should be.

Her neck is also a mess but I'm going to see if they can find me an e-collar that I can try if I can keep it on without causing damage to her barely healed stitches. It's been 3 weeks but since the area was so raw it's still pretty tender looking to me. Maybe it's fine I'll try and ask when my vet's office opens in the morning.

I might have to take her back in to get her foot cleaned up because I can't even get the cream on her pawpad - the scab looks like it got dislodged a little bit and seems to be hurting her if I try and touch it so we'll probably have to go in for that, in addition to maybe antibiotics if they think she could need them. I don't know how safe, or smart, or maybe helpful antibiotics could be with the imiquimod since it's so undocumented for cats and I'm worried they won't know much either.

I'm also worried about applying it anywhere that's not fully healed up, but I can't quite tell what I'm rubbing in and I don't want to keep delaying because these need to be dealt with. The report said something about the cells looking concerning even though it was in situ so I'm guessing that's why the suggested initial dose is every day but I'm so worried about how little we all know. If it was 'this is what they did in the trial so let's try that' or 'we're really concerned about these areas so lets get them under control ASAP' or a little of both.
 

SilveredFox

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My vet talked it over and consulted with some specialists to be better able to advise the treatment coarse so I went ahead with starting the imiquimod (even just as a temporary patch while I find more advise) She said that it was an oncologist who recommended going ahead and trying it if I felt comfortable, and I think that doing something might be better than continuing to do nothing especially now that we know that the cells are looking a bit concerning, but I feel horribly unprepared for all of this still.

So the current treatment recommendation is from as best as I could understand her someone who does specialize in histopathology, oncology and earlier a dermatologist. I will still look around but for now until I can find someone I'll follow her advice since the alternative is continuing to wait and do nothing which makes me as anxious as worrying about side effects from the imiquimod.

Treatment of Imiquimod once a day and we'll test her blood in a month, and I'll keep them informed of how it is going is the current suggested plan. She tolerated the first dose yesterday and licked the little bit today making my nerves be even more shot than they already were, but she's actually fully allowing me to try and rub it in.

I tried to ask more questions but my vet is flying by the seat of her pants with this since Imiquimod hasn't really been used in cats so she's just doing her best to help me ask questions (so she can ask specialists) and then try and help me get answers which I appreciate a lot.

I'm also going to try and pull together a just in case emergency kit since I should have one of those *anyway* and I feel better taking healthy steps instead of just being stressed.

-Pet first aid is something I've wanted to look into but things always came up, but I definitely will feel better with as much extra knowledge as I can have put together. One of the sites I went past mentioned a good well set up for a pet emergency kit.

I do have various just in case supplies, but not a set up ready to go kit yet. And with everything going on I feel like this is a good time to just go all out in full pet parent preparedness. That way I'll hopefully never need it, but if I DO I'll have it and won't have to try and think when I'm a wreck of emotions. I don't know if it's overkill but I was thinking of trying to have a printed out copy of all of her info (CBC, histopathology etc) in case something happens in the middle of the night I won't have to rely on thinking clearly, or an emergency vet having midnight access to her charts. They probably already have ways to get them but I don't want to assume.

Do you think that's reasonable, or am I just worrying in the wrong direction when they should have ways to find out these things if needed?
 

fionasmom

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The idea of an emergency kit is a good one. If you have to run someplace immediately, night or day, you will feel much calmer if you can just grab the kit and your cat and go. Don't feel it has to be 100% organized. As you get new results, for example, just add a copy to the bad. My cat who has HCM/kidney issues has a file which is about an inch thick and I have it in one place, easy to access. If we had to go to a new doctor, I would just grab and go. This will also be helpful for you as everything will be in one place, if only for your own convenience.

Using information from the trials and from specifics about your cat is probably what the doctors are doing, but that is not bad. It really is the most cohesive information that they have at this time and is what human oncologists would do as well.
 

AlexaB

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Hi all,

Just saw SilverFoxed’s posts and thought this would be a good time to share the rest of my experience. It will be a long read, I hope you will have the patience 😊.

What I want to mention from the start is that I am not a vet and this is my personal experience, it’s what worked for my cat and it does not mean it will be the same for yours. I studied human medicine so I understand a bit more from what a vet tells me but I had no knowledge about the disease before this chaos started.

As you probably saw, I joined this club last year and the posts from the other fellow cat moms helped me a lot (thank you again for that, ladies). I was just as panicked as you are but I feel I now can say more about it and I hope it helps bring some light and some positivity to you. Yes, our cats have cancer but I feel we drew the longer straw. Cancer in animals usually has such a bad prognosis (1-3-6 months to 1 year even with treatment) but Bowens seems to be easier to manage. As you probably saw, Babiesmom’s cat has been living with it for 4 years and she is 19 and a half!!

My cat just turned 16 and she also has a mild case of chronic kidney disease – stage II probably (this is important for anesthesia). I also have 2 other cats (15 and 7) and to answer your first question – they lived together since they were all kittens (I bottle fed all of them because I do some volunteering) and none of them show signs of Bowens. Living with a cat with Papilomavirus does not necessarily mean the others will get it. So do not stress more then you need to.

Also, I can relate to EVERYTHING you wrote. I had ALL of those questions too. Should I stress her with all those procedures or not? What could I have done better, what if I insisted more? All of it, really! So let me tell you our story.

We went to the vet because she started peeing blood. They did an echo and said it was a bladder infection, got 2 weeks of antibiotics and she was fine. What I noticed then because they shaved her belly, was a black spot on her belly. It was in the summer after the pandemic started so I took her to the closest vet, not to the ones that I knew were good. I asked what it was and they said it was nothing, just a mole like we humans have – go home. Months have passed and I noticed another very small black spot on her head. The one on her belly grew a little in size so I started to worry. I took her to the vet we usually go to - I know he is specialized in oncology – so I asked him if it was melanoma. He literally told me he does not know what it is but it is not cancer. It was exactly at the time they took some blood and discovered her renal disease. He told me I should be more worried about that and that he does not want to put her under anesthesia to remove those spots and send them to pathology because he does not think it is cancer, because cancer grows fast and it’s not the case here. After 3 months we had to go in and repeat her kidney labs. I told them that she has some more crusty lesions on her back. They scraped those areas and sent them to the lab. It came back as a bacteria and that is when the whole chaos started. We tried different antibiotics, baths and what not. The lesions were still there, in the same spots.

In my desperation to figure things out, we went to another vet, recommended by a friend. We did the whole thing all over again, adding some immune supplements etc. Finally, when that did not work, they have sent us to a dermatologist.

The dermatologist said immediately it was Bowen’s, took some biopsies and told me to start with the Imiquimod. They biopsy came back and he was right, it was Bowen’s.

I saw from the start she was not well with this treatment and read a lot online. I saw a better option was the CO2 laser. We had to go to the dermatologist once a month and I told him after we started the Imiquimod she was not well and I want to try the laser. He kept saying we will talk about it later, after the lesions have stabilized. I listened and did it, until she started having some neurological signs – she seemed dizzy, could not keep her balance etc. Her lymph nodes were swollen, she had lost a lot of weight, she was not eating and she was literally miserable.

When she had those balance issues, I rushed her to her regular vet, the one that sent us to the dermatologist. When she saw her, she said we should stop the imiquimod immediately. Her labs came back and her liver values were a mess. She was on IV treatment for a week, she almost died. But she got better, started eating again, her liver values dropped and she was acting like herself again. Lesson 1 : if you do Imiquimod, check liver values every month and watch your cat’s general status.

The vat said we should do an abdominal echo to see if the Bowens had progressed, to do a full cardio workup to see if her brain was not getting enough oxygen and so on. We did all that and everything was fine.

We went to the dermatologist in the meantime and he was pissed we stopped the Imiquimod. It was before we had her echo and cardio back. He said we do not know it was because of the treatment, that maybe it has progressed and metastasized to her liver, that he never saw cats having such a bad reaction etc and that we have no options available - because she has so many lesions, no vet will operate on her. I asked him to just give me the name of a dermatologist from outside of the country (because we do not have CO2 laser where I live) and we will see. He agreed and gave me the name of someone in Austria mentioning again that nobody will operate on her because it was too bad and that I should continue with the Imiquimod and maybe some liver supplements. Lesson 2 : follow your gut, don’t do what you see is not working. If you read my previous posts, you will see I was worried that it did not seem to work- lesions did not get smaller or disappear and it just made my cat miserable.

This is when I decided that I will do whatever I can to get her to someone who has CO2 laser and that I will not go back to him, whatever happens. I do not want to say he is a bad vet, we just had different visions on the subject.

I wrote an email to the doctor in Austria, they said they also do not have CO2 but she gave me the name of a dermatologist in Germany that was working with this technique. Long story short (hahaha, I already wrote an essay) we went to Germany in March and my cat had all of her lesions removed with CO2 laser. Lesson 3 – do not believe everything you are told, write an email to someone else, someone who knows the disease, you might get a different opinion.

Now, very important : the doctor in Germany was a dermatologist that was using CO2. She knew the disease and what needs to be done. She was not an oncologist. You do not need one! What you need is, and I cannot stress this enough, a dermatologist that knows the disease and the latest treatment options. Those are cryotherapy and CO2 laser, depending on the extent of the lesions.

And now I will share what she told me. Her lesions were indeed very extended (see picture 1, 4 days after CO2 surgery). She also had some spots that looked suspicious for multifocal SCC - those were removed SURGICALLY, with a scalpel and sent to biopsy. Indeed, out of the 6 that looked suspicious, 2 came back as multifocal SCC. She told me that multifocal SCC tends to stay localized longer and a surgical removal “with margins” should prevent it from spreading. The cat does not need chemotherapy or any other oncological treatment. She said she thinks she removed them with margins and we should watch those 2 areas. If they do not heal or if they come back fast, they should be again removed surgically. It is not the case (for now at least). So, for us, it was a combination between laser and classic surgical removal of the lesions, done simultaneously, during the same surgery. My cat got better amazingly fast and she is happy and healthy at the moment.
There seems to be a difference between "classic SCC" and multifocal SCC which is just a progression of the Bowen's.

Below are 2 links that I found very helpful, maybe you can share them with your vet.

Bowenoid in situ carcinoma in cats: CO2 laser treatment

Skin Squamous Cell Carcinoma In Cats | VCA Animal Hospitals

My advice knowing what I know now is to really search for a dermatologist that knows the disease and has CO2 laser.

On the cost part, adding up all that we did ONLY since the diagnosis until the surgery and what we probably had to do for the rest of the year, it’s pretty much the same.

I hope my long story helps :)
Please do let us know what you found out.
 

fionasmom

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Thank you so much for taking the time to write your experiences with your cat. It is wonderful that your cat has returned to good health.
 

AlexaB

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Hi ladies! We have been finally cleared by our vet and advised to "go back to our normal lives for now" haha! I think I was a bit emotional in my last post because for us it was a tough experience. But I stand by what I said: this disease is rare and seems to be better known by dermatologists then by oncologists. At least this was my experience. This is how a laser operation looks like 6-7 weeks after (posting because I find it useful for others)
 

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fionasmom

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There is some real healing going on there and I hope that you are both able to go back to your normal lives. Please let us know from time to time how he is.
 

SilveredFox

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Update after a lot of stress and some lost months from (me) crashing a lot - her neck is pretty much almost good! The giant gash healed up and there's just the tiniest little bump left (there's another lesion starting on the side of her neck but it's still small and it's in a spot I can use the neck covering so when I dose her I can cover it) From a 2 inch crusted gash to something you almost can't feel!

Her foot is still horrific and I have no idea how best to treat it. I can't rub the cream on it because it's still raw, but without the cream (which seems to be working at least some for her as evidenced by her neck) I can't make any progress.

She started picking at her food so right now I'm just trying to keep calories in her (Vet gave her a shot of Convenia so I'm nerves but her foot was raw looking so she probably needed something for it)

Currently trying to assist feed a little until her appetite comes back. Vet's also prescribing some Mirtazapine but I figured I'd try syringing her first just because I know she'll let me. (I hope I started it soon enough because I'm utterly terrified of assist feeding - and she got a little drop on/up her nose so I'm worried about everything. Aspiration worries are one of my biggest fears) But she's actually following me to the bathroom now since I started so I'm not sure if I should just keep assist feeding or try out the Mirtazapine (she's never had it so I don't know if she's sensitive but she also has had sensitivity reactions to Convenia and I don't want to add problems trying to fix problems)

She's also more interested in food after assist feeding so I don't know if maybe this is just the best option for now instead of drugs. We did a full blood panel + urine check last week and everything looked ok she just has been picking at her food.

We had to do this after her teeth got bad snow/holidays had my vet booked solid to get her through the teeth pain long enough to make it to her dental appointment, and I think she remembers that while she doesn't like the process, it makes her not hungry and helps so I'm just thankful she tolerates me so much. My nerves are still shot, I still haven't found a specialist and I spent months working myself into exhaustion trying to save up money for her and I'm just still worrying about time lost (again).

But she's hanging in there, being a wonderful girl and I wanted to keep this updated (I'm so glad about her neck it was raw enough I was worrying it would never heal) So the fact that it's basically smooth now is such a relief.

I don't honestly know what to do about her foot though.

She lost some weight and I hadn't realized while I was working on the financial side, so I feel super guilty about that, but I'm just hoping I caught it in time and she didn't cause damage picking at her food for too long before I got brave enough to just try assisting manually.

I'm working on getting my license so I can try and get to places that offer laser but it's very slow going and I still don't have a car yet. But I'm closer to managing it and I can always rent something if I can just get my license so I'm just praying that everything stays stable long enough that I can get options to travel where needed.

I'm worried about how much time I've wasted trying to get driving so I can have options, and worried it'll cost this precious time that she needs me to be on the ball with her, and I got complacent with her neck getting so much better.
 

fionasmom

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Thank you for the update. Members often continue to read threads and want to know how things have progressed or concluded, so we appreciate your willingness to continue. It is good news that so much has improved and you have done a wonderful job of caring for your baby.

Syringe feeding probably won't go wrong if you continue to do it slowly and carefully in small amounts using the side of the mouth and giving time to swallow. It sounds like maybe she becomes interested in food if she gets some from the syringe. Mirtazapine will increase her appetite, but it is up to you to judge what you think is best.

I had a GSD once with a seriously injured foot which I thought would never heal, but the use of a laser was like a miracle. I do see your problem with putting the cream on her foot from an earlier post.
 

babiesmom5

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Hi ladies! We have been finally cleared by our vet and advised to "go back to our normal lives for now" haha! I think I was a bit emotional in my last post because for us it was a tough experience. But I stand by what I said: this disease is rare and seems to be better known by dermatologists then by oncologists. At least this was my experience. This is how a laser operation looks like 6-7 weeks after (posting because I find it useful for others)
Thank you so very much for sharing your detailed experience with your cat's Bowen's Disease as well as the good photos! It is a tribute to your persistence and going with your gut instinct. I am only reading this now as I've been off this site for a while dealing with a new issue with my cat, (Corneal Ulcers in both eyes) in addition to the other issues. The Corneal Ulcers have healed, thanks to a good Oncologist, so had to put the Cyrotherapy treatments on hold.
Now we'll refocus again on the Bowen's issue. She is now 21 1/2 years old!
I am so glad to hear of the good outcome of your cat. Hopefully after all you and your cat have been through, you can go on with your lives with stability and a sense of normalcy! All here have learned a lot.
 

AlexaB

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Hi ladies! The notifications don't seem to work properly but today I came here to ask some questions and saw some new posts. SilveredFox SilveredFox , don't get discouraged and do not blame yourself for anything. I see you have your cat's best interest in mind and you do everything that you can. Let me/us know if I can help with any advice.
B babiesmom you can not understand how much your posts helped me! The fact that your cat is 21 and a half dealing with all of her problems is so encouraging!!
We have not heard about Kitty in a while, I truly hope she and her mom are ok.
Just as an update, my cat is doing great, she gained weight (she is now fat hahaha), her labs are good, she eats, drinks, cuddles - truly doing great. Some of the vets working in the clinic even said she looks like a different cat.
We just came back from the vet now because we have to do her kidney labs every 3 months but we had a longer discussion. She has the most amazing vet and I am extremely happy we have her. We started going to her just before her diagnosis and she is the one who finally referred her to a dermatologist. She has treated her ever since and I am extremely gratefull because I trust her and I know she will do things right. Longs story short, as it happens with Bowens, my cat had new lesions. They were very small but because the biopsies done in germany sugested a progression of some of them to SCC, our doctor decided to take the new ones out surgically and send them for biopsy. The biopsies came back negative for anything malignant. Happy us! Fun fact, they came back as something completely unrelated to her issues (benign folicular tumors). Now she has 3 new lesions, also very small (1mm in size) and we started discussing about what we can do, if they are related to Bowens or again folicular tumors. My doctor called in the pathologist of the clinic who happened to be there and we started discussing options. First thing they said is they will call the lab to look at the probes again and make sure they are indeed folicular tumors and not Bowens.
Anyway, some questions were raised.
1. Do we use cryotherapy for the new ones or go for the surgical option so that we can do biopsy (given the SCC) or do we trust the previous biopsy and go for cryotherapy? Fact is whatever they are, they are not malignant
2. Do we do cryo or do we cauterise them (apparently some oncologists are against this option, some find it good)
3. What can we do to prevent lesions from appearing or at least growing fast? Here, some interesting options where displayed - one would be medication like isoprinosine that is used to treat HPV in humans but is also used for cats - vet said she used it, but not for bowens lesions. Also, a kind of auto-vaccine. It's the second time I hear about this. This auto-vaccine is supposed to expose the cat's body to parts of the virus and stimulate an imune response to make it fight it.
My questions would be : how ofthen do you use cryotherapy (every 3 months, 6 months etc) - a question more for babiesmom who is using it for a long time.
Did you ever discuss the isoprinosine or autovaccine option with your doctors? Question to all :)
Thank you!
 
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