Suspected Lymphoma. Surgical Biopsy Thoughts

brocklanders

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Hello! New here. 1st post.I have 13 y.o. female DSH. We took her to new vet recently (a feline specialist only) here in north Atlanta for Senior Wellness. She had lost 1.5lbs. since July 2019 (now 13.8lbs). She has occasional vomiting which had increased recently. Labs looked good except elevated liver markers. Plan was to check them again 6 weeks. Meantime, my cat started having acute vomiting. Took her in. They gave her fluids, meds for pain and nausea, etc. Sent out for specialized blood work, including Feline GI Lymphoma Panel which came back at 7.7 out of 10 as consistent with small cell lymphoma. They did ultrasound which showed diffuse jejunal and ileal thickening. R/o IBD vs lymphoma. Vet now suggests surgical biopsy -- doesn't feel comfortable giving chlorambucil without it. Our cat is eating, going to bathroom and has only vomited twice in 6 weeks. Overall, pretty healthy. Torn as to what to do. Surgery (even with a very experienced specialist vet) is risky. Choices: 1) Surgical biopsy to confirm, then treat; 2) Treat as IBD, i.e. prednisolone.
 
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daftcat75

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Hello! New here. 1st post. I am in the same boat now. I have 13 y.o. female DSH. We took her to new vet recently (a feline specialist only) here in north Atlanta for Senior Wellness. She had lost 1.5lbs. since July 2019 (now 13.8lbs). She has occasional vomiting which had increased recently. Labs looked good except elevated liver markers. Plan was to check them again 6 weeks. Meantime, my cat started having acute vomiting. Took her in. They gave her fluids, meds for pain and nausea, etc. Sent out for specialized blood work, including Feline GI Lymphoma Panel which came back at 7.7 out of 10 as consistent with small cell lymphoma. They did ultrasound which showed diffuse jejunal and ileal thickening. R/o IBD vs lymphoma. Vet now suggests surgical biopsy -- doesn't feel comfortable giving chlorambucil without it. Our cat is eating, going to bathroom and has only vomited twice in 6 weeks. Overall, pretty healthy. Torn as to what to do. Surgery (even with a very experienced specialist vet) is risky. Choices: 1) Surgical biopsy to confirm, then treat; 2) Treat as IBD, i.e. prednisolone.
10% weight loss in two years. That could simply be a slowing senior metabolism. The weight loss from lymphoma is dramatic and relentless. Krista lost over half her weight in about 8 months. If you haven’t tried pred yet, that’s not a terrible place to start. Still lower risk than the biopsy. Whether it’s IBD or lymphoma, there is often a dietary component that needs to be addressed: trigger foods that are fueling the inflammatory response. Sometimes these are the proteins. Switching proteins may help. But often it’s the inappropriate filler and binder ingredients (grains and gums) that irritate the gut and the proteins are thrown under the bus. My best recommendations would be to:
1. Cut out dry food. Too many inappropriate ingredients to conduct food trials. Too many starches and grains that could be irritants or allergens. And not enough moisture.
2. Try Rawz single protein patè canned food. It is the gold standard for IBD food trials. I recommend a protein your girl hasn’t had before (or since this started.) Turkey can be novel enough for many cats. But they also have duck and rabbit if you need something truly novel. They will send you samples if you write them. Some of their online resellers sell by the can (and the case) making it easier to try the different recipes without a case commitment.
Where to Buy | RAWZ
3. Feed smaller meals more often. Instead of two meals a day, split those up to two breakfasts and two dinners.
4. You may need timed feeders to cover a daytime and overnight meals since you won’t be leaving kibble out anymore. (I hope!) I like the clamshell feeders over the wheel feeder. The wheel essentially times a portion. Uneaten portions are rotated back inside.
5. If you haven’t tried pred yet, start there. But whether it’s pred or chemo, it will only do so much if there are unaddressed dietary triggers. It won’t put out the fire if food (or treats) is lighting the match at every meal.

After you have given IBD treatment a chance (food trials and steroids), if she’s still losing weight and having gut or butt episodes, that makes a more convincing case to try the chemo without the biopsy. In the meantime, pick up a baby scale and monitor her weight. For everyone’s sanity, weigh her no more than once a week, preferably the same time and place. Make it a little ritual. Make sure you use an IBD safe treat like freeze dried meat in the same protein as her food. Even small amounts of trigger foods can keep the inflammatory fire burning. As long as she is maintaining or even able to regain weight, it’s probably not lymphoma.

It would not be a bad idea to locate a specialist to work with. There’s no cure for IBD or lymphoma. But it can be managed. Having a specialist on the case usually translates to more focused and better care. And more experience and expertise.
 
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brocklanders

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Thank you for the prompt, detailed response. Great info! Which clamshell feeder to you suggest? I see some local vendors for Rawz. She eats little dry food now (mostly overnight), so it won't be a big transition. Our vet, a feline only practitioner with a great reputation, is experienced with senior cats and oncology. She is about as specialized as I am aware of around. She mentioned the pred / B12 route for a month and then reevaluate.
 

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Welcome to The Cat Site brocklanders brocklanders ! I am sorry that suspected lymphoma is what brought you here. I have nothing to add to daftcat75 daftcat75 's very complete advise about the management of a kitty with lymphoma or IBD. My Chelsea is being treated with chlorambucil without having had a surgical biopsy. She is/was a feral who retained a marginally spikey personality even though she was brought inside (only) as a kitten and I did not feel that she was a candidate for much handling, let alone any type of surgical procedure after which I might not have been able to care for her properly. My vet did agree to this plan, although the response of your vet is not unusual by any means. As was stated, if the pred does not help and symptoms persist, you might have more luck bringing this up later. Chelsea was originally on pred alone without any major problems. Chelsea was quite a bit younger than your cat when I refused the surgical biopsy, having had this issue since she was about 8 or 9.
 
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brocklanders

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Are you familiar with that VDI Feline GI Lymphoma Panel? Wondering how accurate it is. Also, know anything about AnimalBiome? That was a suggestion.
 

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I am not familiar with AnimalBiome but it does contain S. boulardii which many on TCS use with great success. I am also not familiar with the VDI Feline Panel but went to their site. You have the blood drawn and mail it in to them? I have only done that with Dr. Jean Dodds Hemopet Thyroid panel for a dog. I did not see cost, but did see about $120 for a canine cancer test, so I assume that it might be the same figure? Two markers, B12 and folate. As you are asking, one has to wonder about reliability.

My 12 year old chubby cat has suddenly lost her appetite and is sleeping constantly

Advice needed please: Boots - 11 years old Male - Weightloss and vomiting; test results pending. Cerenia and Elura, food assistance.

It is discussed in the two threads above if you do a bit of reading. The second OP appears to have done the test and posted result pages. First one discusses sensitivity and specificity of the tests from VDI.
 
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brocklanders

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My cat first had ultrasound which indicated possibility of IBD or small cell lymphoma. My vet requested this test and it came back with 7.7 indicating "Patient has high positive Neoplasia Index indicative of lymphoma. This profile of TK1/ HPT/ B12 is consistent with small cell lymphoma".
 

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Then I would say that if your vet is behind the test it definitely has a use in the diagnosis of your cat. What did you do regarding the first cat?
 

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Are you familiar with that VDI Feline GI Lymphoma Panel? Wondering how accurate it is. Also, know anything about AnimalBiome? That was a suggestion.
I’m not familiar with the VDI GI Lymphoma panel. But it seems to me that if it was predictive with a high degree of accuracy, your vet wouldn’t be asking for a surgical biopsy. Keep an eye on her weight. That will be your best non-surgical, non-invasive way to predict lymphoma that you can do at home. Use a baby scale. They are far more accurate than the bathroom scale (eg weighing the two of you together and subtracting your weight.) And even if it is lymphoma, diet changes and pred will still be helpful. Incomplete but not without benefit. Either way, there is a very good chance that there is a dietary component and that needs to be addressed through food trials like Rawz. The remission won’t be complete regardless of her prescriptions until those triggers are found and eliminated. I had Krista’s poop tested for AnimalBiome. It was informative. She had an ear infection and then the bladder infection that finally proved too much for her and we never tried the “poop pills.” 😿
 

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Also whether pred or chlorambucil or most any other prescription where compliance is very important, consider compounding to make it more appealing (flavored liquid or treat) or easier to give (transdermal gel) to your cat. Wedgewood is the best online compounding pharmacy. Your vet calls or faxes in the prescription and they’ll call you to work out the formulation that you feel would be best. If that formulation doesn’t work out, they’ll work with you to find an alternative. You can often speak directly to one of their pharmacists if you have a question their support rep can’t answer. And their prices are very reasonable.
Veterinary Pharmacy
 
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brocklanders

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I am not familiar with AnimalBiome but it does contain S. boulardii which many on TCS use with great success. I am also not familiar with the VDI Feline Panel but went to their site. You have the blood drawn and mail it in to them? I have only done that with Dr. Jean Dodds Hemopet Thyroid panel for a dog. I did not see cost, but did see about $120 for a canine cancer test, so I assume that it might be the same figure? Two markers, B12 and folate. As you are asking, one has to wonder about reliability.

My 12 year old chubby cat has suddenly lost her appetite and is sleeping constantly

Advice needed please: Boots - 11 years old Male - Weightloss and vomiting; test results pending. Cerenia and Elura, food assistance.

It is discussed in the two threads above if you do a bit of reading. The second OP appears to have done the test and posted result pages. First one discusses sensitivity and specificity of the tests from VDI.
The vet drew the the blood for the test and submitted. $295. The VDI Feline GI Lymphoma Panel is a new test. In addition to measuring folate and B12, it measures TK1 & HPT to create a Neoplasia Index.
 
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brocklanders

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Also whether pred or chlorambucil or most any other prescription where compliance is very important, consider compounding to make it more appealing (flavored liquid or treat) or easier to give (transdermal gel) to your cat. Wedgewood is the best online compounding pharmacy. Your vet calls or faxes in the prescription and they’ll call you to work out the formulation that you feel would be best. If that formulation doesn’t work out, they’ll work with you to find an alternative. You can often speak directly to one of their pharmacists if you have a question their support rep can’t answer. And their prices are very reasonable.
Veterinary Pharmacy
I recently learned about them. Her Cerenia came from them -- a transderm.
 

Heart For Cats

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I wanted to respond since you've all been very kind in the help you've given. The vet was sure we were dealing with lymphoma, but the fine needle aspirate showed a bunch of infection and no cancer. They did wonder if there was still cancer below it, so that diagnosis was not ruled out. We immediately put him on 2 antibiotics and he stayed in the hospital 4 nights. His fever came down right away, so we were hoping things were looking up. Long story short, that was a false sense of security. A week of treatment later it turns out he actually has FIP. No one suspected it since he's only 10. I brought him to the emergency vet for heavy breathing today and they found fluid everywhere inside him and were able to make the diagnosis. When you start piecing everything together, all the signs were there, but no one could have suspected it. My poor little boy.
What were the antibiotics for? FIP is a viral disease. Something that drives me crazy is vets often prescribe antibiotics even if there is no evidence of a bacterial infection.

I am glad your vet could rule out both IBD and lymphoma without doing a biopsy.
 
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daftcat75

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I recently learned about them. Her Cerenia came from them -- a transderm.
oops! Meant to cancel. Now I guess I’m going to reply.

Krista had the chemo as a concentrated anchovy flavored oil. I mixed it with a little salmon oil and she ate that twice a week without complaint. About a nickel’s worth of oil.

The pred we originally did as pills. And that was the beginning of our devil’s bargain. I wrapped half pred pills in fish flakes and that’s how I got her to pill herself each night. But those fish flakes were trigger foods. I was keeping the fire smoldering with inflammatory triggers each night. 🤦🏼‍♂️Her remission was incomplete until that ear infection forced us to change our nightly pred routine to transdermal. Her remission was finally complete and instantaneous. But the damage of being on steroids and chemo for so long had taken a toll on her immune system and a bladder infection would prove too much for only a month after achieving remission. This is why I keep driving home the diet angle.
 
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brocklanders

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The vet drew the the blood for the test and submitted. $295. The VDI Feline GI Lymphoma Panel is a new test. In addition to measuring folate and B12, it measures TK1 & HPT to create a Neoplasia Index.
The folate was normal and the B12 low normal. Serum thymidine kinase type 1 (TK1) was high and the HPT Haptoglobin marker should mild inflammation. High TK1 with a heightened inflammatory response is commonly found in small cell lymphoma.
 
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brocklanders

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10% weight loss in two years. That could simply be a slowing senior metabolism. The weight loss from lymphoma is dramatic and relentless. Krista lost over half her weight in about 8 months. If you haven’t tried pred yet, that’s not a terrible place to start. Still lower risk than the biopsy. Whether it’s IBD or lymphoma, there is often a dietary component that needs to be addressed: trigger foods that are fueling the inflammatory response. Sometimes these are the proteins. Switching proteins may help. But often it’s the inappropriate filler and binder ingredients (grains and gums) that irritate the gut and the proteins are thrown under the bus. My best recommendations would be to:
1. Cut out dry food. Too many inappropriate ingredients to conduct food trials. Too many starches and grains that could be irritants or allergens. And not enough moisture.
2. Try Rawz single protein patè canned food. It is the gold standard for IBD food trials. I recommend a protein your girl hasn’t had before (or since this started.) Turkey can be novel enough for many cats. But they also have duck and rabbit if you need something truly novel. They will send you samples if you write them. Some of their online resellers sell by the can (and the case) making it easier to try the different recipes without a case commitment.
Where to Buy | RAWZ
3. Feed smaller meals more often. Instead of two meals a day, split those up to two breakfasts and two dinners.
4. You may need timed feeders to cover a daytime and overnight meals since you won’t be leaving kibble out anymore. (I hope!) I like the clamshell feeders over the wheel feeder. The wheel essentially times a portion. Uneaten portions are rotated back inside.
5. If you haven’t tried pred yet, start there. But whether it’s pred or chemo, it will only do so much if there are unaddressed dietary triggers. It won’t put out the fire if food (or treats) is lighting the match at every meal.

After you have given IBD treatment a chance (food trials and steroids), if she’s still losing weight and having gut or butt episodes, that makes a more convincing case to try the chemo without the biopsy. In the meantime, pick up a baby scale and monitor her weight. For everyone’s sanity, weigh her no more than once a week, preferably the same time and place. Make it a little ritual. Make sure you use an IBD safe treat like freeze dried meat in the same protein as her food. Even small amounts of trigger foods can keep the inflammatory fire burning. As long as she is maintaining or even able to regain weight, it’s probably not lymphoma.

It would not be a bad idea to locate a specialist to work with. There’s no cure for IBD or lymphoma. But it can be managed. Having a specialist on the case usually translates to more focused and better care. And more experience and expertise.
Can you point me to an online reseller for Rawz? Local vendors are like kennels, groomers, etc. I need a reliable source for any food. If not Rawz, is there another 2nd choice brand?
 

daftcat75

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Of those, it looks like Incredible Pets is the only one that sells by the can. That’s only important to find flavors to try. Once you’ve found the flavor that works, then you’ll be going from site to site to see who has a case (or two.) I would start with turkey or duck. Rabbit supply still looks too inconsistent. Beef is another option. Some cats like red meat and some don’t. You might even try the chicken pate. Usually you’re told to avoid chicken and fish when doing IBD food trials as these are the most common food proteins. But maybe you’ll get lucky and it’s only the fillers and binders that cause a reaction. It’s not a bad idea to use a simple recipe like Rawz that doesn’t have fillers and binders to confirm whether chicken itself is an issue. I would avoid fish though. Save it for emergencies when she doesn’t feel like eating anything else. If you feed fish on the regular, you lose that nuclear option.
 
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brocklanders

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Further complicating the issue is the fact that my cat also has very early kidney disease. Vet suggested Hill's 7+ rather than K/D but the IBD/lymphoma is bigger priority.
 
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