Intestinal Mass in 15 yo FIV positive cat, whether to operate or not.

AnthonyM

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My cat Jack, around 15 years and FIV positive has been diagnosed with an intestinal mass following an ultrasound. I don't know what type of mass it is but the vets notes are as follows,
'large mid intestinal mass present intestinal wall thickness up to 1 cm in areas and enlarged mesenteric lymph nodes present. Liver, spleen, GB, kidneys, bladder and rest of GIT wnls. ddx lymphoma vs adenocarcinoma, MCT or other. Surgical removal may be possible and in some cases may give good QOL for up to a year depending on diagnosis, plus or minus subjunctive chemotherapy. FIV pos status increases risk of morbidity. Other option palliative care'.
I'm worried about putting Jack through traumatic surgery and how he and I would cope with post operative care. The vet says the mass is probably an adenoma or mass cell tumour but is well contained and about 3 cm in size. As he is FIV+ I'm not sure if the palliative care of steroids will cause complications.
He is bright and eating but has consistently loose stool.
If anyone has had a similar experience or can offer advice, this would be much appreciated. Thanks for reading!
 
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Furballsmom

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I can't offer advice but you're right, and the vets' notes bear this out, that you and he are in a rather nasty catch-22 😔🙏
 

stephanietx

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If it were me, I would not have the surgery, especially since your kitty has FIV and there could be complications. Also, the surgery is only going to increase his life by a year or a little bit more, but there will be ongoing treatment (chemo). As difficult as it is, I would opt to love on him and not subject him to the stress of the surgery, recovery, and subsequent treatments.
 
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AnthonyM

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If it were me, I would not have the surgery, especially since your kitty has FIV and there could be complications. Also, the surgery is only going to increase his life by a year or a little bit more, but there will be ongoing treatment (chemo). As difficult as it is, I would opt to love on him and not subject him to the stress of the surgery, recovery, and subsequent treatments.
Thank you, I appreciate your opinion, it's a difficult decision.
 

carrie640

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Oh boy....I am so very, very sorry you are going through this. I don't have an exact experience but a few year ago, our cat, Sally, just stopped eating. She was always a HUGE foodie (true story..but she was not a fat cat). She LOVED food. She would sit by her dish and wait until you gave her a can. LOL Then, when we gave her a can, she would just sit there and wouldn't eat it. We thought she was just being picky, but when this continued for a number of days, we grew concerned. I mean, we gave her cans and she wouldn't eat it but wanted MORE. Took her to the vet. She had a blockage in her upper intestine. She couldn't eat. She was hungry, but she couldn't eat. She completely WANTED to eat, but she couldn't. We were told the tumor was inoperable. We took her back home for a few days to spend time with her, but we had to, eventually, do what was right because it came to a point where she just was going downhill. Your case seems a bit different because Jack is eating. I am not well versed in FIV, however. Age can be a factor, for sure. My cat, Lucy, is 19. Her bloodwork is normal except for her thyroid (and even that isn't terribly high) but she really could use a couple of teeth extractions due to periodontal issues. The vet is completely willing to do the surgery if that is what we want, HOWEVER, it does not sound like he would opt for that as a first choice of treatment. She is still 19yo and could not recover well from anesthesia. Other than her mouth issues, she is eating, well hydrated, and the vet said, "I otherwise do not feel that it is 'her time' yet". Hell, I am 50 and can't bounce back easily. They have to put dextrose in my IV to give me a jump-start. So, age can factor in. For me, I originally thought I should put her through the surgery because there could be a chance she could survive it and be free of the pain. What if we put her down when she could've survived? There isn't anything I wouldn't do for her. But, we have to also do what is right. Because Lucy was otherwise fine and can take antibiotics to stay ahead of infections, we opted for that over euthenasia. We just have to take it day by day and see how she does.

If I were you, and I am not, I would gather as much info as you can. Is it possible to monitor the tumor and see how it goes? If it grows, is it possible at that point for surgery? I completely feel this.....it always seems like a lose/lose decision. I say go with your heart and what you feel is best, as well.
 
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AnthonyM

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Oh boy....I am so very, very sorry you are going through this. I don't have an exact experience but a few year ago, our cat, Sally, just stopped eating. She was always a HUGE foodie (true story..but she was not a fat cat). She LOVED food. She would sit by her dish and wait until you gave her a can. LOL Then, when we gave her a can, she would just sit there and wouldn't eat it. We thought she was just being picky, but when this continued for a number of days, we grew concerned. I mean, we gave her cans and she wouldn't eat it but wanted MORE. Took her to the vet. She had a blockage in her upper intestine. She couldn't eat. She was hungry, but she couldn't eat. She completely WANTED to eat, but she couldn't. We were told the tumor was inoperable. We took her back home for a few days to spend time with her, but we had to, eventually, do what was right because it came to a point where she just was going downhill. Your case seems a bit different because Jack is eating. I am not well versed in FIV, however. Age can be a factor, for sure. My cat, Lucy, is 19. Her bloodwork is normal except for her thyroid (and even that isn't terribly high) but she really could use a couple of teeth extractions due to periodontal issues. The vet is completely willing to do the surgery if that is what we want, HOWEVER, it does not sound like he would opt for that as a first choice of treatment. She is still 19yo and could not recover well from anesthesia. Other than her mouth issues, she is eating, well hydrated, and the vet said, "I otherwise do not feel that it is 'her time' yet". Hell, I am 50 and can't bounce back easily. They have to put dextrose in my IV to give me a jump-start. So, age can factor in. For me, I originally thought I should put her through the surgery because there could be a chance she could survive it and be free of the pain. What if we put her down when she could've survived? There isn't anything I wouldn't do for her. But, we have to also do what is right. Because Lucy was otherwise fine and can take antibiotics to stay ahead of infections, we opted for that over euthenasia. We just have to take it day by day and see how she does.

If I were you, and I am not, I would gather as much info as you can. Is it possible to monitor the tumor and see how it goes? If it grows, is it possible at that point for surgery? I completely feel this.....it always seems like a lose/lose decision. I say go with your heart and what you feel is best, as well.
Thank you very much for sharing the circumstances with your cats and for your kind words. The vet could always do another ultrasound to see if the mass is getting bigger but Jack is losing weight quite rapidly and it is likely that his health will soon start to deteriorate. With his FIV+ status the vet is cautious about using steroids, so any palliative care may just be pain relief. I don't want him to be traumatised or suffer, perhaps he's best in the home he knows until he no longer has a quality of life.
 
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AnthonyM

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And, I think I agree with Stephanie. If it is going to involve chemo, I don't know if that would even be an option for me. :(
Thanks for your comment!
 

stephanietx

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Thank you, I appreciate your opinion, it's a difficult decision.
It's a VERY difficult decision! I haven't been in this exact situation before, but I've had to make that decision twice now in my adult life since owning kitties. It's difficult, but it's the last loving thing I can do for them.
 
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AnthonyM

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Thanks again!
 

carrie640

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Thank you very much for sharing the circumstances with your cats and for your kind words. The vet could always do another ultrasound to see if the mass is getting bigger but Jack is losing weight quite rapidly and it is likely that his health will soon start to deteriorate. With his FIV+ status the vet is cautious about using steroids, so any palliative care may just be pain relief. I don't want him to be traumatised or suffer, perhaps he's best in the home he knows until he no longer has a quality of life.
And it's one of the most selfless things you can do...whatever is best for the cat... even though we are an emotional wreck through the whole thing:( I hope you don't find offense to this, but I'm going to pray for you and Jack❤. Hang in there!
 
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AnthonyM

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And it's one of the most selfless things you can do...whatever is best for the cat... even though we are an emotional wreck through the whole thing:( I hope you don't find offense to this, but I'm going to pray for you and Jack❤. Hang in there!
Thank you, that's very kind of you!
 

silent meowlook

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Hi. Steroids shouldn’t complicate FIV. I have known cats with FIV and lymphoma that did well with chemotherapy. That said, if it is an adenocarcinoma, those are nasty tumors. Did the rest of the ultrasound show consistency with lymphoma such as thickened intestinal mucosa lining? Was the ultrasound done by a specialist? If not, you might want to see about a referral to a specialist for their opinion.
I have known FIV cats with intestinal lymphoma that received chlorambucil and Prednisolone and lived years like that. Chlorambucil is chemotherapy, but it is a pill you give. My cat is on it and also has an intestinal mass. My cat has lymphoma though. A specialist might be able to do a fine needle aspirate as opposed to surgery to get you a likely diagnosis.
How is your cat feeling?
 
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AnthonyM

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Hi,
Thank you for replying! These are the qualifications of the vet that did the ultrasound, BVM&S CertAVP(SAM) MRCVS Clinical Director. The only report I've had about the tumour is as stated above;
'large mid intestinal mass present intestinal wall thickness up to 1 cm in areas and enlarged mesenteric lymph nodes present. Liver, spleen, GB, kidneys, bladder and rest of GIT wnls. ddx lymphoma vs adenocarcinoma or MST '.
The vet said it was about 3 cm and contained.
I will certainly look into referral to a specialist, Jack is quieter than usual. He spends more time sitting on the floor, he would usually be on my bed or the window sill although he does climb up occasionally. He's bright and eating well. I know Sheba is not the best food but it seems to improve the diarrhea. He eats it well with Fortiflora on, which the vet suggested. I do wish I could help him without an operation, so I am very grateful for your suggestions.
 

silent meowlook

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I wonder why they are thinking maybe adenocarcinoma or mast cell tumor? Lymphoma would be the most common of intestinal cancers. But obviously they are the ones examining your cat.
I think a specialist is a good idea and hopefully you can do home treatments like I do. My cat has been on Chlorambucil and Prednisolone for over 2 years now.
Or you could try talking to your vet about trying that protocol, fully understanding it may not help and might not be the best treatment if the mass is one of the other less common tumors.
Just a thought.

I too, didn’t want my cat to have surgery or anesthesia, so treatment was based on a presumed diagnosis because of how it appeared on ultrasound.
 
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AnthonyM

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I wonder why they are thinking maybe adenocarcinoma or mast cell tumor? Lymphoma would be the most common of intestinal cancers. But obviously they are the ones examining your cat.
I think a specialist is a good idea and hopefully you can do home treatments like I do. My cat has been on Chlorambucil and Prednisolone for over 2 years now.
Or you could try talking to your vet about trying that protocol, fully understanding it may not help and might not be the best treatment if the mass is one of the other less common tumors.
Just a thought.

I too, didn’t want my cat to have surgery or anesthesia, so treatment was based on a presumed diagnosis because of how it appeared on ultrasound.
Thank you for your further reply. I think it's just the vets opinion but she didn't seem to want to consider treatment without having the mass analysed. I can ask again. Jack seems quiet this morning, he vomited a little clear liquid in the night and seems to sit quite slowly, so I assume something hurts? I can't seem to help his diarrhea with his food now and I wondered if he's having too much fortiflora? He's only eaten a small amount this morning. I wonder if you could suggest any food that might help?
 

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I'm so sorry you are going through this. I lost my FIV girl to cancer exactly two years ago today.

Happy

When Happy was first diagnosed we decided to go ahead with the surgery and have the tumour and her eye removed. However, by the time the stitches were ready to come out the tumour was already starting to grow under her ear. She only lived another three months after surgery. She developed tumours all over her body and there was nothing that could be done for her. In retrospect, if I had known surgery was only going to give her another 3 months I wouldn't have put her through it.

Every cat is different of course, as is every case. Please talk to your vet about the best possible outcome for Jack. Quality of life is more important than quantity and it might be better not to put Jack through a surgery that will only buy him a little bit of time if that time is spent in recovery.

Hoping that your vet thinks that treatment will be worthwhile and that you and Jack have many more happy days together.

:hugs: :hugs:
 
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AnthonyM

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I'm so sorry you are going through this. I lost my FIV girl to cancer exactly two years ago today.

Happy

When Happy was first diagnosed we decided to go ahead with the surgery and have the tumour and her eye removed. However, by the time the stitches were ready to come out the tumour was already starting to grow under her ear. She only lived another three months after surgery. She developed tumours all over her body and there was nothing that could be done for her. In retrospect, if I had known surgery was only going to give her another 3 months I wouldn't have put her through it.

Every cat is different of course, as is every case. Please talk to your vet about the best possible outcome for Jack. Quality of life is more important than quantity and it might be better not to put Jack through a surgery that will only buy him a little bit of time if that time is spent in recovery.

Hoping that your vet thinks that treatment will be worthwhile and that you and Jack have many more happy days together.

:hugs: :hugs:
Hello, Thank you very much for sharing your story and your kind words. I'm very sorry to hear about your cat, It's so awful not knowing what to do for the best when they are ill. I've asked for a phone call from the vet today to see what can be done to make Jack feel more comfortable. Your good wishes are much appreciated!
 
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