Mammary cancer spread to the lungs. Am I horrible for choosing palliative?

UnderneathTheStars

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I'm sure some of you have heard about my Mousse before. I adopted her in 2018 at the age of 10. She had previously been used as a breeding cat (she is purebred persian). But, when I got her she was emaciated, her spay incision was infected, she had calicivirus, and she had infected ulcers in her mouth and nose. We decided to try and save her. She was cared for by our family vet but we also took her to multiple consultations four hours away with an internal medicine specialist, board certified dental specialist, and a cardiologist when a heart murmur was found. She was diagnosed with IBD, and severe HCM (heart disease. Her three heart medications worked wonderfully. Not only did her last scan show that her heart disease has stabilized, but it also shows improvement in her heart function. The cardiologist was surprised! Her IBD has been in remission for over a year and she went from 5lbs to 8.5lbs.

She runs around and plays more than my younger cats. Her appetite is voracious and she is super alert. That's why I was surprised when I found a small, pea-sized lump under her nipple. I brought her to the vet and they said it looks like mammary cancer. They ran a chest x-ray and found that it has already spread to her lung. There is one tumor in her left lung (same side as the mammary tumor).

The vet does not recommend surgery because she likely wouldn't survive the anesthesia due to her heart, and removing the breast tissue would be pointless as it has already spread. The vet also did not recommend chemo as, in this case, it would be palliative and would at best give us a little more time with her. She already takes three medications for her heart (fortekor, clopidogrel, and atenolol) and two medications for the chronic inflammation that her repeated and untreated respiratory infections gave her (dexamethasone and low dose doxycycline). She also gets a weekly B12 injection. All of these medications, her slew of chronic illness, and the fact that she just hates going to the vet led us to make the decision that we would do palliative care.

At this point, she doesn't have pain but we did get a script for buprenorphine for if it does happen. I know what to watch for in terms of symptoms. The vet said her dexamethasone will further help in terms of keeping her comfortable. As I'm writing this, I'm in tears. This cat is like my child. I stayed up nights with her and hand fed her when she was sick.

It isn't fair. She only got such a short time to know what it's like to be loved and cared for as a pet. I've been giving her extra streets, taking her for rides in the cat stroller I bought,and watching her nap in the sun and look at the birds from the comfort of the screened-in porch. I just love her so much. My questions are;

1. Am I selfish for choosing palliative? Numerous people on FB groups have said that cats tolerate it well, it gave them extra time with their pet, I should try it, etc. It doesn't feel right to me. I feel like I can't justify putting her through yet another round of veterinary visits, tests, and added medication even if her side effects MIGHT be minimal, especially since she is doing SO well right now.

2. How long might she have left now that it has spread to her lungs? My vet said it is hard to say and might be between 1-2 months.

3. Why is she asymptomatic, super energetic, and has a wonderful appetite with such advanced cancer?

Thank you and I'm sorry for all the questions. :(

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BlackCatOp

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Sorry to hear about Mousse. It takes a special person to adopt a senior kitty.

Regarding prognosis: Has the mammary mass been biopsied? Histopathology will provide grading and survival information.
1-year postsurgery survival in grade I (0% death),
(42.4%deaths),andgradeIIItumors(100%death). Similarly,
grade was predictive of survival for 48 feline invasive mam-
mary carcinomas in 2 studies, with 33.3% of the study animals
having grade I tumors, 47.9% with grade II, and 18.7% being
grade III. In addition, lymphovascu invasion and lymph node involvement are also extremely important prognostic indicators that must be further evaluated when biopsy samples are examined, as they are integral to a useful grading system.


As far as why she feels good still - my guess is the steroid she is receiving is masking her signs. I have heard that steroids all the animal to walk into the necropsy room. Meaning that steroids can make very sick animals feel great.

Finally, I don’t think you are wrong at all for thinking of choosing palliative treatment. I have always questioned veterinary oncology as for most cancers the extra time chemo provides is very little compared to the amount of vet visits and costs. Plus for cats, the additional stress of each vet visit would definitely affect their quality of life.

I would definitely talk to your vet regarding your concerns. Hopefully, they can guide you in your decision.
https://www.aaha.org/globalassets/0...aha_oncology_guidelines_for_dogs_and_cats.pdf
 

mrsgreenjeens

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It ISN'T fair :fuming: Why this sweet baby would have to endure all she's been through and now this! But unfortunately, sometimes (often) life just isn't fair :alright:.

I totally agree with you not treating it. There have been several cats here who've had the surgery for mammary cancer, and chemo afterwards, and the recovery from the surgery itself seems worse than most surgeries, plus as you said, the chemo for this particular cancer normally doesn't prolong their lives that much. Of course there are always exceptions, but since your Vet already advises against it due to other health issues, I would go with that and let her enjoy whatever time she has left. And you never know, she may be having so much fun just being a "cat" that she may stick around longer than anyone thinks. Let's hope so, as long as she stays asymptomatic.

My thoughts are with you and Mousse :hugs:
 
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UnderneathTheStars

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Sorry to hear about Mousse. It takes a special person to adopt a senior kitty.

Regarding prognosis: Has the mammary mass been biopsied? Histopathology will provide grading and survival information.
1-year postsurgery survival in grade I (0% death),
(42.4%deaths),andgradeIIItumors(100%death). Similarly,
grade was predictive of survival for 48 feline invasive mam-
mary carcinomas in 2 studies, with 33.3% of the study animals
having grade I tumors, 47.9% with grade II, and 18.7% being
grade III. In addition, lymphovascu invasion and lymph node involvement are also extremely important prognostic indicators that must be further evaluated when biopsy samples are examined, as they are integral to a useful grading system.


As far as why she feels good still - my guess is the steroid she is receiving is masking her signs. I have heard that steroids all the animal to walk into the necropsy room. Meaning that steroids can make very sick animals feel great.

Finally, I don’t think you are wrong at all for thinking of choosing palliative treatment. I have always questioned veterinary oncology as for most cancers the extra time chemo provides is very little compared to the amount of vet visits and costs. Plus for cats, the additional stress of each vet visit would definitely affect their quality of life.

I would definitely talk to your vet regarding your concerns. Hopefully, they can guide you in your decision.
https://www.aaha.org/globalassets/0...aha_oncology_guidelines_for_dogs_and_cats.pdf

We did not have the masses graded as there are too many of them in her nipples and the one in her lung. The vet said the fact that she is asymptomatic, eats well, and hasn't lost weight is a good sign. She told me not to bother making an appointment for euthanasia because her quality of life right now is pretty close to 10/10.

Should I continue giving the steroids? My vet said yes. she said it can help with pain and can slow the progression a little.

I've spent so much money on Mousse's care with all the steroids and tests. I believe, last time I counted, I've spent over $6,000. If I thought that chemo would work or provide substantial benefit and quality of life, I would happily do it. But, there is *something* that tells me it isn't the right choice for her and that she just wants to be home and comfortable.
 
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UnderneathTheStars

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It ISN'T fair :fuming: Why this sweet baby would have to endure all she's been through and now this! But unfortunately, sometimes (often) life just isn't fair :alright:.

I totally agree with you not treating it. There have been several cats here who've had the surgery for mammary cancer, and chemo afterwards, and the recovery from the surgery itself seems worse than most surgeries, plus as you said, the chemo for this particular cancer normally doesn't prolong their lives that much. Of course there are always exceptions, but since your Vet already advises against it due to other health issues, I would go with that and let her enjoy whatever time she has left. And you never know, she may be having so much fun just being a "cat" that she may stick around longer than anyone thinks. Let's hope so, as long as she stays asymptomatic.

My thoughts are with you and Mousse :hugs:
I'm glad you mentioned that. Chemo without surgery doesn't do much for mammary cancer as far as I know and apparently the mets to the lungs are hard to treat as well. She has been galloping from room to room, playing with the other cats, and eating voraciously since her diagnosis a couple of days ago. She has NO idea anything is wrong. I'd like to keep it that way for as long as possible. <3 Thank you so much.
 

Mamanyt1953

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By all means, give the steroids as long as they help her! And no, you are not wrong for deciding to choose palliative care. Under the circumstances, I'd certainly have done the same thing. Let her have all the good time possible, she (and you) have earned it. Do whatever it takes to let her have her time of joy. And have joy with her! Don't let your sorrow for tomorrow rob you of any of your todays!

No, it is not fair. It never is. But it would have been so much more unfair if she had never had you at all. Bless you, and bless her. I'm lighting a candle for you both right now.

00LitCandle.jpeg
 

Talien

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If the steroids are making her comfortable then yes, continue with them. It really sounds like you made the right decision in opting for not going ahead with surgery. Yeah, it might work, but if she doesn't survive then she (and you) would lose what time is left with her feeling good and being active. You know there are still good memories left to be made, so not risking that on the seemingly small chance she would recover isn't wrong.
 

fionasmom

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I am so sorry that you have found yourself and Mousse in this terrible place. I do not think that animals count time as humans do as they live in the moment so much better than we do; Mousse lives in the present with you and has since you rescued her and restored her to health and every day with you has been heaven for her, as the old poem says.

I agree with all the previous advice. I would not grade the tumors as there are too many with mets, and would not do chemo. Chemo without surgery won't work and you run the risk of upsetting the happy life that she has now. I have done veterinary oncology twice at great expense, but there were very good reasons to think that the animals in question would survive for at least a few more years given all the circumstances at the time.
 

cataholic07

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My first cat had a small mammary tumor removed but had no other masses. Over a year and half later she was diagnosed with GI small cell lymphoma, she went into remission within weeks. We continued to have a monthly check up to make sure she was ok and to get her b12 shot. 7 months later it returned. She stopped eating her wet food but was super picky and we had to give her tons of different types/flavors and would eat canned tuna if nothing else. Then she had major issues breathing, she couldnt be picked up without coughing badly. A trip to the specialist (an internal specialist as their is no cancer specialists where I live.. she was on a very strange protocol to). One of her lungs was all cancer, the other was half cancer and we elected to let her go. We didnt want to put her through a surgery and higher chemo. She hated her chemo meds and by the end was very afraid of me, broke my heart. Needless to say I hate cancer.. so much. I am so sorry your going through this. If your baby is comfortable just continue with the medication until she tells you it's time. It sounds like the surgery alone would be too hard on her.
 

Purr-fect

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But, there is *something* that tells me it isn't the right choice for her and that she just wants to be home and comfortable.
I think you are right.

Its most important to do what is best for Mousse. If her last memories will be that of suffering and pain, which further treatment will surely bring, I agree, palliative is the better option.

You are an amazing parent to her, be proud of all you have done.
 

Tik cat's mum

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I'm sorry you are going through this. I think you've made the right choice you know your girl and know what she needs right now. This way she can be comfortable and with those who love her. :alright:
 

jarn

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I'm so sorry about Mousse. She's very lucky to have you.

Our cat Esme died of oral squamous cell carcinoma. Everything I'd read said chemo just prolonged death, that a year post-dx the death rate was close to 100%...that sometimes chemo extended life, sometimes it didn't. We choose to treat her palliatively and she lived another 3 months, mostly happy, though I think for the last month she didn't drink on her own (we were giving her daily sub-q fluids). She got abx shots and painkillers. When her appetite started failing consistently we made the decision to let her be free.
 
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