To Surgical Biopsy, Or Not.. Ibd Or Small Cell Lymphoma

[chicy724]

We just got the call for our kitty's PARR results. It was negative for cancer DNA. But the vet said it's correct in 60% of cases. (Though when we were there she told us it was 90% accurate)

Now she's recommending surgical biopsy, and we're torn on whether we want to put her through that.

I'm already frustrated it took so long to get these results only to be told it's a tad more than half accurate. And my vet sent us to a specialist to get faster results, which has now cost is 2 weeks.

She suspects IBD or Small Cell Lymphoma.
She said the treatment is very similar, but the prognosis is the difference. And that if the treatment we do doesn't work, it's much more difficult to go in after treatment is started to get the biopsy because treatment has to be stopped and then the results could be affected from the steroids.

She has lack of appetite, vomiting and generally rests a lot and seems a bit uncomfortable. She has since developed mild diarrhea/soft poops.

Initially, U.S. presented with a mass behind her kidney which turned out to be an enlarged lymph node, intestinal thickening, and second U.S. revealed additional slightly enlarged lymph nodes and thickening, as well as mottled spleen which cytology noted as normal.

Original U.S. also noted inflammation of her pancreas, gall bladder. I don't see this noted on her second U.S.

We have done 2 ultrasounds, aspiration of lymph node and spleen. They also did an upper x-ray and those came out ok. The cells from the lymph node and spleen were analyzed, spleen was within normal realm. They sent the lymph node cells to have the PARR test done because they couldn't differentiate between IBD or Lymphoma in their lab. The PARR was negative, which they now said is 60% accurate when originally they told us it was 90%.

I feel like most results lend themselves to IBD, except for the enlarged lymph nodes... unless that is a possible condition due to systemic inflammation?

I know many of you have been in this situation, so I'm curious to learn how you made your decisions to, or not to, do surgical biopsy.

Some go straight into treatment, and some do surgery. How do you decide?

 

[LTS3]

I had a biopsy done for my IBD cat. I wanted confirmation that my cat really had IBD. The vet pretty much diagnosed my cat with IBD when I took him in for an unrelated health issue. I trust my vet but I still wanted the biopsy done. It was over $2000 for the biopsy and everything that goes along with it (anesthesia, pain medicine, anti nausesa medicine, etc) plus hospital fees. Many people opt not to do a biopsy and just treat the cat for IBD.

Here are web sites with info on treating IBD and small cell lymphoma:

IBDKitties – Helping Save Lives…One Paw at a Time
Raw Feeding for IBD Cats

Most cats do well on both diet and medicine. A novel protein diet is often helpful and prescription food is not needed. I continue to feed my IBD cat a raw diet. Steroids are typical to help with inflammation. Some IBD cats need B12 injections. Your vet may prescribe other medicines such as Cerenia for nausea, mirtazipine for lack of appetitie, fluids if needed. My cat was on omeprazole, amoxicillin, and clarithryomycin for awhile in addition to prednisolone.

 

[babiesmom5]

Having been down this IBD/SCL path with 5 cats, I can truly empathize.

It is good you started with the ultrasounds. In this case, the enlarged lymph nodes are problematic.

While the surgical biopsy is the most definitive, I chose in each case, ( after the ultrasound), to go the less invasive endoscopic route. In each case it provided a definite answer and treatment was begun promptly.

If the ultrasound shows the problem is centered more in the upper GI tract, under anesthesia, the Vet goes down the esophagus, stomach, small intestine with a lighted scope looking and taking samples. If problem is more in the large intestine, Vet does same thing as human colonoscopy going up rectum. With one cat, vet did both upper and lower GI in same procedure.

Cat recovers quickly, goes home next day and usually cat is initially started on a steroid pending biopsy results. If it proves to be SCL, then chemo is added.

I would recommend you get definitive diagnosis prior to any treatment. This way you know what you are dealing with and can treat properly. Peace of mind.

Ask your vet about Endoscopic biopsy. If faced with this situation again, I would go this route.

I wish you and your cat all the best.

 

[AbbysMom]

I just made this decision Thursday on our 14 year-old cat after an ultrasound. In our case blood work showed nothing out of the ordinary, ultrasound showed some enlarged lymph nodes near her colon with the intestinal wall being preserved, which the vet felt lended itself more to IBD.

Since treatments are similar and if it is lymphoma we would not put our 14 year-old cat through chemotherapy, we opted not to do the biopsy. She started on prednisilone on Thursday. We stopped the cerenia and mirtazapine that day. She has been eating on her own since, other than yesterday morning not being very interested in food. Her stool is slowly firming up.

Good luck to you and your kitty no matter what you decide!

 

[chicy724]

B babiesmom5
Endoscopic isn't an option, they told me. They do not think they can get a good enough sample that way, or it's too far for them to go. I can't recall which.

Also, they can't aspirate the intestine. They considered that when they were aspirating the lymph node and her spleen. They didn't think it was safe to, so they didn't.

I am trying to reach my regular vet to see if we can do a consult now that the results are in.

I feel like we've already lost 2 weeks time. He sent us to Auburn so we could get a quicker diagnosis than he could get because he'd have to send out the aspirates. Well, it turned out that Auburn did, too, and we lost another week because of it.

 

[chicy724]

I just spoke with our regular vet and he said if we don't do biopsy, we'd only treat with steroids and if she does have cancer, of course that means she won't get the proper treatment. The big question is IF we'd treat with chemo IF it's cancer. And he won't treat for cancer until he knows what type it is.
I've seen so many treat for cancer without biopsy or confirmed results of same. I'm surprised I guess. Ours won't treat without confirmation.

If we want to biopsy we have to let him know by the end of the day if we want them to do it tomorrow. Otherwise they can on Monday or next Friday.

My hubby feels like we need to know. I am worried about recovery. He gave me the risks of incision infection and tearing the intestine.

 

[1 bruce 1]

Man, I don't envy you on this one =(

We opted out of a biopsy for our cat for a few reasons...
-He's 11. Not ancient, but not a baby, either.
-He's had this problem (IBD symptoms) on and off for 6 years.
-The nearest vet that can perform the diagnostics is 2 hours away.
-He has asthma and stresses in the car. Once he went into a full blown crisis situation from the ride/regular vet visit and most times he'd much worse once we get there (vet is 15 minutes away.)

The tone of your post tells me you are both agonizing over this, and I would be too. I wish I had a magic answer but I don't =( I just know what it feels like to be stuck between a scary option and a scarier option with each option having pros and cons.
Whatever you all decide to do, you have a lucky, loved little cat indeed.

 

[chicy724]

Someone in a FB group I am just got her biopsy results back and her kitty has both small and large cell lymphoma.
She waited to do the biopsy, and her kitty wasn't responding well to the treatments. Biopsy was the next step in determining why, what she had so they could treat properly. She waited 6 months to do the biopsy.

This is reason enough for us to do it, I think. That is the most significant caution that both the specialist and our regular vet stated. If we don't do biopsy now and she doesn't respond to steroids, or it is cancer then we run the risk of being in that same situation.

 

[denice]

I think this is a decision that many of us that have dealt with IBD have had to make. I chose not to get the biopsy and treat as IBD. What your vet is probably wanting to confirm is not only if it is lymphoma but also if it is large cell or small cell. Small cell is less aggressive and is treated with Leukeran along with a steroid. Leukeran is sometimes also used to treat IBD. Large cell has a different chemo protocol. Lymph nodes can be inflamed as a result of IBD as well.

One thing to keep in mind, if you go ahead and start a steroid and then decide to have a biopsy she will need to be taken off the steroid and be off of it for two weeks before the biopsy. It reduces the inflammation so it would skew the biopsy results.

 

[babiesmom5]

If I were in your shoes, I would definitely get a biopsy NOW rather than later. As @denise stated above, once you start the steroid, and if the cat does not respond, then your cat will have to be taken off the steroid for a period of time, thus delaying/compromising diagnosis.

A biopsy is also needed to distinguish between large cell and small cell lymphoma as chemo treatment protocols differ.

You did not say how old your cat is. Large Cell Lymphoma tends to strike younger cats. Small Cell Lymphoma tends to strike older cats. IBD can be any age and it can (sadly as I well know) "morph" into SCL.

I think you have to rely on the one who would do the biopsy if your cat is presently in good enough condition to undergo such an invasive procedure. In my case, the cat was 14 1/2 and my very good Internal Medicine Vet wisely advised the Endoscopic biopsy. His very words were "with a surgical biopsy, he likely wouldn't make it off the table". I am glad I heeded his advice.

Since you are not all together clear why an endoscopic biopsy could not be done, is there another Internal Medicine Vet you could take your cat to for a second opinion? A second qualified opinion couldn't hurt to explore your options and provide greater peace of mind.

 

[chicy724]

My regular vet and the oncology vet we saw said endoscopy could likely yield inconclusive results if a sample wasn't deep enough.

The oncology vet said endoscopy wasn't an option, and for the reason above.

Our regular vet offered it (would have to be done by a different vet) but said the same thing about possibly inconclusive results.

Daisy is almost 13. (Aug 16th)

 

[kristenann]

I feel for you. My kid Tiberius has been battling IBD for several years now and I wouldn't wish it on anyone. His current treatment protocol is 5mg prednisolone daily, 5mg famotidine daily, 25mg atopica every other day, b12 injections once a month and a prescription novel protein diet.

I choose not to biopsy him and I never regretted my decision. I know for a fact I cannot afford to do chemo nor would I put him through it even if I could. When he became symptomatic I opted to treat as IBD. With each flare we added in more meds.

I suspect he has small cell lymphoma at this point he has lymphoma but again for me the actual diagnosis is irrelevant. I have reached the maximum of what I'm willing to put him through.

I think it's important to keep in mind that both IBD and lymphoma are chronic and degenerative. You have to decide when and what is enough.

 

[Lydiabean]

I'm very sorry you're going through this. I actually just made a post about IBD/lymphoma myself.

We were in this position 1.5 yrs ago and decided not to do the biopsy for a handful of reasons: 1) she was 14 at the time; 2) she was very sick and underweight at the time and I was worried about putting her under for the biopsy; 3) repeated vet visits would just stress her out and not improve her quality of life; and, 3) we wouldn't have done chemo anyhow at her age so the treatment was the same either way (prednisone/prednisolone).

Honestly, if you're considering chemo, I'd do the biopsy. Otherwise I wouldn't bother, because, as your vet said, the treatment is the same.

 

[chicy724]

I would like to think we'd treat with chemo if it's cancer.
Small cell seems to be chlorombucil/leukeran.
Large cell is more aggressive and harder.

We are thinking we will see what we're up against and do next steps from there.
She's our baby and I don't think we would forgive ourselves for not trying everything we can to get her better.