Possible Gastrointestinal lymphoma diagnosis

PinkBeanGrey

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Hello All, I'm looking for experience with people who had a similar diagnosis. I thought we'd have 5 more years with her so this has been a huge shock to both myself and my husband.

2 months ago I took my little lady in for vomiting and she was very constipated. A week later we had to rush her to the ER because she was vomiting again and wasn't defecting. She was mostly blocked with a lot of gas. They did not sedate her for either of the enemas.
Finally got her on some miralax and tried to make her more active. Bloodwork showed some slight elevations in kidney values so decided to watch for signs of renal disease. I planned to take her in for another exam after the holidays to check all was well.
Since that week we'd fluctuated with her eating ok and not eating ok and I had the trial period of figuring out how much miralax to give her. About 3 weeks ago I stopped the miralax and she was having some normal looking BM.
Finally had some ok stool but we were struggling to get her to eat consistently. She was always eating dry food but would be picky with her wet food so assumed it was just preference.
On 12/24 I noticed a decrease in eating beyond just not interested in the food. On 12/27 she hadn't eaten at all so I called the vet and got her seen on 12/28. They did xray and bloodwork and xray didn't show constipation and bloodwork came back with very low platelets and high WBC count. Decided to do an ultrasound and they found her lymph nodes and large color were very inflamed (no specific lumps found). From all that information they're suspecting she has lymphoma. She'd normally fluctuate between 8 - 8.5 lbs but this visit she was 6.9 lbs.
My option were to do exploratory surgery (see what's inflamed and get a biopsy) or start her on steroids and see if she responded. Started the steroids last night (12/29)
She hasn't wanted to eat on her own so I've been syringe feeding her, she has weakness in her back legs but is walking around and still jumping up and down on furniture (have made her some make shift stairs to help her). Right now my plan is to give her the week on steroids and if we see improvement, continue taking it day by day. However, I haven't been able to get her to pur for the last 24 hours and I'm worried that she's in a lot of pain.



Introduce my little lady:
In August of 2005 We found a little kitten about 2.5 weeks old in a box behind a bakery. The staff said someone dropped the box off and they weren't sure what to do. Adopted her immediately (obviously) and she almost died of coccidia in her first few weeks of life but made it through. Fast forward a few years later when my family had a hybrid vehicle she decided to sleep in the driveway in a blind spot and got ran over because she couldn't hear the vehicle and no one saw her (one of the reasons we always honk now to move vehicles). Ran away and it took hours to find her but I was the person who did.
Given that we found her at such a young age I believe I definitely imprinted on her but I've always been her person. It wasn't until I left for college that she really started talking to the rest of my family. Growing up my parents let her sleep inside with me at night (she was indoor / outdoor because we had a FIV+ cat inside and didn't want him mingling with our other cats. plus he was a jerk to them lol). She's always been an indoor cat at heart and has been very comfortable living in an apartment with us for the last year and a half.
 

fionasmom

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Lymphoma

Gastro lymphoma in cats

Feline Lymphoma - NC State Veterinary Medicine

Welcome to The Cat Site! I am sorry that you are facing this with your little girl. I have had two cats with gastrointestinal lymphoma. One, years ago, was only ever given pred, but survived for quite a while. The more recent one did take chloramubucil (Leukeran) and also did well for about a year and a half.

The articles above discuss lymphoma, but remember to focus on gastrointestinal lymphoma as you glance over them, as there are two other kinds in cats.

I am concerned that your cat is not eating, although you are syringe feeding her, and that there is rear end weakness. In your case, I would start the pred but if the weakness and inappetence continues for much longer, or if you are simply not able to get her enough nourishment, stay in touch with the vet. You don't need another issue creeping in here. If you suspect pain, that is serious now. Neither of my cats with GI lymphoma exhibited serious symptoms in the beginning.

If you do exploratory surgery, will she come through it successfully?. Sometimes the diagnostics for lymphoma progress from step to step and remain inconclusive.

I am going to add that neither of my cats had any exploratory procedures. The first was probably too many years ago and there was less motivation to pursue what appeared to be lymphoma. With the second, she was semi feral and often unmanageable, although indoor only and I was concerned about follow up to any procedure. The vet agreed to let us use chlorambucil without any preceding work and, in our case, it seemed to help for over a year.
 
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PinkBeanGrey

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Thank you for the welcome and for commenting!

We started last night so not a full 24 hours on pred yet. She got up to drink water last night and urinated, so is moving around some. We started her on an appetite stimulate on the 28th (transdermal) which doesn't really seem to increase her appetite, yet. Vet said to give it 48 hours and some time since we'll need the pred and that to work together. Our plan is if we have a few more days with no improvement, especially in getting her to eat on her own, we'll make the choice.

Exploratory surgery doesn't seem like the way to go because of the weight loss and acute downturn in energy. I cannot imagine putting her through the recovery and I feel that it would just lead to us putting her down instead of waking her up from the surgery. She's the easiest patient in the world but it took her a week to recover from a full dental with tooth extractions, so having that big of a scar to manage just doesn't seem right. And both of the Doctors who have seen her feel confident that she has lymphoma, at least given the bloodwork plus ultrasound and constipation issues.
I'm calling the vet tomorrow to give an update and to talk about what else we could do.

From all the info I'm finding, I'm surprised the vet didn't bring up any possible chemo. Although I think right now we're just trying to get her to eat and get some of that weight back on her.
 

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Hi. So sorry for what is going on. I don't have much to offer, but from what I have experienced so far, the general 'trend' is to start with steroids, and depending on the outcome, add chemo later.

Feeby's last ultrasound showed enlarged lymph nodes in the intestinal area, but they still wouldn't go directly to lymphoma and said it still wouldn't rule out IBD. However, Feeby has no symptoms besides inappetence and weight loss, both of which can be related to her other conditions of hyperthyroidism and early CKD. She is being well managed on H-T meds and Mirataz (appetite stimulant) at this point. I bring up the Mirataz because that might also help your cat, along with possibly some anti-nausea meds as well. I do not think there is any issue in adding these meds alongside of the steroids, so you might want to ask your vet about this.

I guess I am only posting here to offer support and hope that the steroids help, even if the vets want to add chemo down the road. The most common form of feline lymphoma is small cell - which is slower growing than others, and usually responds well with both steroids and chemo. It is not a cure, of course, but offers a more comfortable life to the kitty involved and allows their parents to spend more time with them. There have been noted cases of remission too!
 
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PinkBeanGrey

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You are probably right that the vet wants her to begin to gain some strength; please keep us posted.
Yeah the more I think about the more I think that's it. Regardless I am finally seeing a little more of her normal self popping up so that gives me some hope <3

[QUOTE="FeebysOwner [/QUOTE]

Thank you, it does give me more peace of mind. Right now I'm very impatient to have her back like she was a week ago and I have to remember that things take time and unfortunately it requires waiting to see if things work for her. I am so scared to not do enough and do too much

She is better this evening so hopefully with a full 24 hr + of pred we'll see more of a change. And the appetite stimulate we have is Mirataz
 
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PinkBeanGrey

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UPDATE:

Yesterday evening we got a small glimpse of our kid back and she seemed to be feeling a little better. enough to be alert when we went in the room and talking to us (very weakly but still good to hear her)

I made the mistake of being worried about feeding her too much so I ended up only giving her 1/4 of her requirement on 12/29 and thankfully I realized my mistake midday yesterday and upped her syringe feeding (constant googling for recommendations). That's when we noticed the improvement. When my husband and I thought about it, she hasn't eaten enough to sustain herself in the last week+ so right now our goal is to get her nutrients.
We're aiming for 1 can of A/D a day and since I work from home it's doable.

We left 5 pieces of her dry food out over night and she ate them!!

Updated vet and didn't mention chemo, will probably next week if we can get her strength up over the weekend.
 
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PinkBeanGrey

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Hello all!

Wanted to give another update:

She's slowly coming back to herself but still more reserved than her normal (understandable).
Because of her constipation issues I've been assuming her odd bathroom habits this week have been related to her struggling to poop so have been giving her miralax. She's been having some normally formed stool (lighter shade of brown then I'd like to see) but I still thought maybe she was having some discomfort with passing. Yesterday we took off the top of the litter box to see exactly what she was doing and watched her go in 4 times trying to pee and finally relieved herself on the 5th go. I honestly should have just scheduled for her to go earlier in the week but we had her scheduled for an appointment today.

We kept having a winter storm warning and last night my husband and I decided to just go ahead to the ER in case we'd be stuck and unable to travel and get her care. Sure enough, she had a UTI and was given pain meds and antibiotics. She's looking so relieved that I feel terrible for not following my hunch sooner.

I just assume she gets a urinalysis when we do full bloodwork (what our previous vet did) but looking at her records from the new vet, I do not think they've been including that at all. I feel terrible for not advocating more for her but am relieved that it is a UTI and that we are able to provide her treatment and relief! At least now for the future I'll be asking for a urinalysis directly, especially because she is an older lady and I am still worried about her developing kidney disease.

I do have a question for you all:
She was very anemic when we brought her in on 12/28, the vet didn't recommend anything to give her but I've noticed that she is eating litter (which I can guess she's still trying to get the appropriate nutrients). Do you all have an article you recommend for ways to help make sure we're providing all the nutrients she needs?
She's getting both wet and dry food and I've been cooking plain chicken breast for her as well. But I'm afraid I'm still missing nutrients from her diet and am struggling to understand what I can offer her.
 

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What did the vet have to say about the anemia? Does he think it is related to the possible lymphoma? Did he suggest other tests that could be run, or what steps you could take to try to correct it? If she is getting commercial cat food, the nutrient aspect should be taken care of, unless her diet consists of more than 50% chicken breast. You might need to add a supplement like EZ Complete if it does.

Here is an article about anemia, in case you haven't yet read up on it. Perhaps, it would help you to formulate some questions for the vet.
Anemia in Cats | VCA Animal Hospital (vcahospitals.com)
 
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PinkBeanGrey

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What did the vet have to say about the anemia? Does he think it is related to the possible lymphoma? Did he suggest other tests that could be run, or what steps you could take to try to correct it? If she is getting commercial cat food, the nutrient aspect should be taken care of, unless her diet consists of more than 50% chicken breast. You might need to add a supplement like EZ Complete if it does.

Here is an article about anemia, in case you haven't yet read up on it. Perhaps, it would help you to formulate some questions for the vet.
Anemia in Cats | VCA Animal Hospital (vcahospitals.com)
Thank you! She only gets the chicken breast as a treat right now so primary diet is commercial foods.

They didn't recommend anything and it was assumed to be related to the lymphoma because she was doing so poorly that day.
Recommended treatment if we didn't do exploratory surgery was to give comfort care (pred and appetite stimulant). She was light pink and slightly yellow as well. Dr thought prognosis for exploratory surgery would be poor at that time and if we elected for surgery we'd need a blood transfusion.

When I called to update three days later I mentioned she was still slightly yellow and pale but eating and doing better and the Dr said it would take a few days for the pred to kick in.

When we bring her in for a CBC I'll request a fecal test to rule out any parasites.
She hasn't received any flea/tick or dewormer for months, she is indoor only.
 
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PinkBeanGrey

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Update:

So Platelets looked good and overall she had been eating well but RBC went from normal to 15 (low end is 30) so our vet thought that maybe if she did have a mass it had ruptured and we needed to consider surgery ASAP. She recommended an ER consult with the specialist so we decided we wanted to go ahead for it.

However we're now left with even more questions, when went the route of internal medicine and the doctor could not find a tumor at all with a more advanced ultrasound. She doesn't know if that's because the prednisolone worked and reduced any tumor or if our vet just suspected but didn't confirm. Lymph nodes were still enlarged but she warned that because we are on prednisolone that we may never get a diagnosis of what is wrong.

She said we could do a blood transfusion and see how she does from there but if we loose RBC again then there's something that is probably too intense to cure.

We decided to try more testing to make sure that we weren't all focused so much on a mass that there's something else being missed. Because my husband and I were originally worried that kidney disease was a high probability we just want to make sure that it isn't something treatable that we've missed.

Honestly it feels like we've done more with less answers but the specialist doesn't think she'd survive not being on prednisolone for the 2 weeks that would be needed to get a diagnosis. So I've been looking for mobile vets so that we could consider euthanasia at home.

We had to fast her for her ultrasound and I'll admit I'm struggling because she literally kept us up all night complaining that she was hungry and was active and playing a little the day before so I know that she is anemic but given that we had that UTI for a couple of days I'm scared that there's something obvious that might have been missed. And of course worried that this is it.

The specialist does not want to do any chemo without a diagnosis, understandably, and i guess it's so in the air of what it could be that we might be back at square one. Today we just wait to hear about all the other results and hope for good news and prepare for the worst.
 
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PinkBeanGrey

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UPDATE:

Ok so this is a weird rollercoaster

Noticed her making frequent trips to the litterbox and were worried about constipation and while waiting for appointment, we noticed some bloody urine.

Got her into the vet suspecting to put her down/ maybe the UTI hadn't resolved and vet comes back with a picture of a tumor in her bladder. Vet was very reluctant to put her down since we are waiting for test results and she is urinating eating/active. While we were talking in the exam room, Tigger was walking around and being genuinely curious and talkative (not showing signs ready to go).

So we got some more pain meds on board and will recheck monday/tuesday about anemia. Because of the blood there's the concern that this is the tumor that's bleeding but not much we can do right now except wait to see if our meds work.

I'm emotionally drained and suspecting we'll be saying goodbye monday but glad to have some pain meds on board and to finally have a picture of a tumor. I hope I don't regret bringing her home this trip but she was very excited to be back and went straight for the heat pad and pets.

I am concerned because I imagine the specialist should have seen this when they did the ultrasound so either this tumor is FAST growing or they never looked at the bladder?!?

Either way, prognosis is probably poor and we will be saying good by this coming week if not in a few days.
 

fionasmom

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Your question about what was seen on the ultrasound is valid. I can't say for certain what was done or how it was handled and am not implying that anything was done incorrectly. I would ask the vet however.

I am very sorry about this, but I don't think that you did the wrong thing in bringing her home, especially since she is seemingly okay for now.

Please keep us posted.
 
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PinkBeanGrey

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Side Note: When I thought she was very anemic early her RBC were still within normal range and she just had a very low platelet count and high WBC. It wasn't until the recheck CBC that her RBC was below normal (15 vs the low of 30). She is still very pale and the vet yesterday did say that with the transfusion and doxycycline it would probably take about a week to know for sure about anemia. Now with the final diagnosis of a tumor I really don't know how to feel about everything.

I also hadn't realized that the records weren't sent over so unfortunately the vet had no info from the specialist. My husband and I could only relay what we had remembered. It's scary if the tumor wasn't visible when the specialist looked (super fast growing) and it's disappointing if it was and they just didn't look.

With the heavy pain meds on board she still made frequent trips to the litter box this morning (for 2 hours). We may not be able to wait for the results we were hoping for. We found some piles of urine so it seems that the frequent trips are little eliminations (and sometimes nothing) so I don't know if she feels like there's more left and she cannot get the rest out or if the tumor makes her feel like she needs to urinate still. At this point I'm worried I'm keeping her alive for me and not for her. Thankfully she's resting now but if each urinating trip takes 2 hours I'm not sure it's fair for her. She wasn't yowling/talking during all that so at least the pain meds seem to be helping.

Because we've probably gone undiagnosed for weeks now I'm not sure if chemo is still an option or if it would be wise to try to wait and get a diagnosis. We have been on prednisolone and from what I see in the notes on 12/28 her bladder looked normal. That would mean that this tumor grew even with steroids and because the specialist increased her pred dose we might not even get a clear answer on what type of cancer (or this is a result of the cancer spreading despite our best efforts).

I appreciate you both for being here during all this. We have had a beautiful 16 years together and it wouldn't be so bad to say goodbye while she's still capable. I'm now stuck deciding if I make that choice today or wait until tomorrow and see how she does tonight. The ER has wonderful staff as well so I feel ok going there if we have to.
 

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So sorry you are going through this. I went through a similar journey with my Brillo in October. She was 15, and I too was sure she’d see 20 and maybe more.

Trust your gut as far as letting her go or not. Better a week too soon than a minute too late, and when decisions are made with love, they are always the right ones.
 

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I agree that she may feel pressure from a tumor and that is creating the 2 hour bathroom window. Do you feel as if there is any point in getting all the paperwork to the specialist? It should have been done and even now it should be done immediately if you request it. If you want to know if chemo is an option, I would follow that up so that you have peace of mind, if nothing else, that you got all the answers you needed.
 
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PinkBeanGrey

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Thank you so much for the kind words, and I am so sorry you went through this with Brillo, 15/16 just doesn't seem so old so I do have trouble seeing her as a 'senior'.
But with her behavior and now this confirmed growth, I think we have our answer.

At this point I'm afraid I'd just put her through more stress. Her bathroom habits have been better today but it seems to correlate with how much she drinks, so the less she drinks she goes in once and is fine. If she gets into the excessive drinking that's when it causes her to have several trips. She's been resting most of the day but we're offering her small bits of water through out the day so she doesn't just get up and try to take in all of her water requirement in the evening.
I'm going to call the specialist tomorrow and ask them to email the results both to me and to my vet. I am hoping to set up an at home euthanasia appointment but we just had a blizzard roll through so they may not have the availability this week.

Our plan is to still do a CBC and have them ultrasound the bladder again, if she's still anemic then we know our answer. If the tumor has grown, then for sure it'll be time. She hasn't been her full self for a few weeks now so I think unless we have a miracle we have hit the point of only a few weeks left and risking feeling like we've gone to far.

I really do appreciate you all and will keep you posted how the next few days go <3
 
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PinkBeanGrey

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Hello All,

Unfortunately we did not have much longer with our little lady. Turned out the specialist had sent the files over the day we took her home, it was our vet office that hadn't put it in the system. But it didn't really matter in the end.
Over the weekend we had a blizzard and I honestly panicked because she struggled to urinate for an hour each time she got up to go and I was worried about not having access to medical care. We think she developed a blood clot from getting poked for a urinalysis (explaining the sudden 'mass').
On Monday I called to schedule her euthanasia and shortly after the specialist called and said that she was FIV+ which confirmed to me that even if we kept her restful for a few days, she was in her final days. In hindsight, I wish I'd waited another day or even two but I know that she no longer had weeks like we'd hoped. It's still incredibly hard to believe that she's gone. Looking back at the video I took of her at home, she looked exhausted.
She is the first of our pets that I feel we put down before things got to the point of regretting not doing it sooner which is honestly the hardest decision I've had to make.

A week after we said goodbye the specialist called again to say they got the rests back from her smear and she did have lymphoma. So with Lymphoma, being 16, and FIV+ her chances were very slim on any chemo helping and that's if we'd started in on time. With how she was those last few days I'm not sure she would have survived the week but I'll admit I am still delusional about her prognosis.

In November I really thought we'd have her for a few more years because she seemed so healthy at the time. I learned a lot about lymphoma and I hate that it was at her expense but I know more about what we'd do if we ever have someone diagnosed with it again.

Unfortunately living in an apartment we won't be taking on any new members anytime soon but we definitely want to foster a few who need a place to get back on their feet.

I appreciate you all and it means so much to me that there's so many cat lovers out there :)
 
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