Lymphoma Diagnosis- Not Sure If Small Or Large Cell

[cleo3802]

Hello all,
My 15 year-old Cleo was just diagnosed with lymphoma from an ultrasound and bloodwork. The vet said she has enlarged lymph nodes and a thickened intestinal wall which indicates that it's lymphoma. We can't afford to get the biopsy done to determine which lymphoma it is (small or large cell) and we also don't want to put Cleo under the knife at such an old age. If it's large cell lymphoma, we won't be able to afford the intense chemotherapy that would be needed. We decided that we're going to treat it as if it's the small cell lymphoma with oral chemo and prednisone and just see how she does in the next few weeks. If her symptoms worsen, we might have to euthanize her.
Has anyone else had an experience like this? I'm very upset and worried about Cleo. I'm really not ready to let her go, especially right before Christmas. What should we do, and are there any ways we could possibly tell which lymphoma it is without a biopsy and just from symptoms?

 

[mrsgreenjeens]

I'm so sorry about Cleo . Did you ask your Vet if there was any other way to know without a biopsy? I think they are the ones to answer that question.

I think treating as if it's small cell seems logical, as long as it won't hurt her if it isn't. What does the Vet say about that? Could it possibly hurt if it turns out to be large cell?

I don't know of anyone who is ever ready to let their furbaby go, and hopefully you won't have to for awhile yet. At age 15, she's getting on up there, so some day it will happen, but hopefully that day isn't anytime soon.

Wishing you an Cleo the best

Keep us posted on her progress.

 

[babiesmom5]

I can tell you that there is no way to differentiate between small cell lymphoma and large cell lymphoma from just an ultrasound alone. I will tell you however that large cell lymphoma often presents as a mass. SCl is an "infiltrative" type cancer.

Only way to be certain is via biopsy. I can well understand your reasoning for not wanting to put your 15 year old cat "under the knife", but there is another way; "endoscopic biopsy". The cat is put under anesthesia and a lighted scope is put down the esophagus into the stomach and first section of small intestine taking pictures and cell samples. Cat recovers quickly and results are known in a few days. i have done this with several cats age 15 years or older, and am glad I did.

If it is small cell lymphoma, treatment is Prednisolone combined with Chlorambucil. Most cats go into remission and can live several years this way. As you are aware, Large cell lymphoma is more aggressive and treated with chemo infusions, however, it usually does go into remission fairly quickly.

If you have definitely decided to only treat if it is small cell lymphoma, then I think the Pred certainly will not hurt, but the Chlorambucil won't do much. Most vets want a positive diagnosis before prescribing chemotherapeutic agents...it's not a "hit or miss" game.

I would recommend you consult with a Vet Oncologist who can best explain your options and advise going forward.

I wish you and Cleo all the best. Do not give up hope after receiving a cancer diagnosis. Cats can live a good quality of life despite cancer. I have had cats with cancer in the past and have one now...in fact just returned from her chemo infusion...and she is doing quite well.

 

[ifwewerebirds]

I'm not 100 % certain on this- maybe someone will correct me, but if there are enlarged lymph nodes, can't they do a fine need aspiration and examine those cells?

FNA is a tiny needle that gathers a very small amount of cells.

 

[babiesmom5]

Short answer, yes, FNA can be done...but it is often inconclusive.

Lymph nodes contain lymphatic fluid. A FNA could aspirate some unaffected lymphatic fluid just normally occurring in the lymph node with abnormal lymphocytes going undetected. It could also aspirate some immature cells not giving accurate staging or prognostic information.

In LCL, the cancer cells are comprised of large lymphoblasts, so FNA can sometimes be sufficient to make diagnosis; however it is often inconclusive, so a biopsy is needed to obtain a definite diagnosis.

In SCL, the cancer cells closely resemble normal small lymphocytes, so it is very difficult to diagnose SCL just on FNA cytology alone.