Hi there,
I am posting on this forum as I'm torn between what option I should take in regards to my 12 year old, FIV positive kitty.
2 months ago, he was losing weight so we took him to the vet. He was still eating, etc, so it was determined he had a thyroid problem. The vet prescribed Tapazole. Since then, he's gained weight, and eating normally.
This past week, we took him back to the vet as we noticed a lump under his jaw. The vet examined him, and also found a slight lump around the shoulder and another on the back of his hind leg. We opted for a antibiotic shot and we are taking him back to the vet next week when it's time to re-examine. The thought was that it could be a bacterial infection and because he is FIV positive, he needs the meds to fight it.
It's been 6 days now since the shot, and there has been no change in the masses. Therefore, we are suspecting, he may have lymphoma. We did discuss this with the vet, and they gave us two options. Option 1 would be to take an FNA from the areas and test the results under a microscope. I understand that this is not 100% accurate. If the vet were to take samples from all 3 areas, I'm wondering what the odds were that they would find something? Does anyone have any experience with FNA tests with cats? Option 2 would be to do a full biopsy and remove the lesser two masses. Because the biggest one is right under the jaw, the vet did not want to perform surgery there. There are too many nerves, etc. Of course, the two options differ in $$ great. $450 vs $1200. Then of course, depending on what stage it could be, would determine chemotherapy costs....which I have no idea what they would be. Anyone have any idea?
I'm really torn at these two options. If anyone has gone through this, or have any suggestions as to what they would do, please guide me here. I really want to do what is best for him but I don't want him to suffer in the long run. He's my pal after all.
At this point, he shows no signs of sickness. He is eating well, and just being the typical cat that he is. The vet did do a full physical on him and found no masses around his stomach, etc. As well, they tested his blood and everything came back normal.
As well, I'm now thinking I really should jump into getting an x-ray done. The vet didn't offer it at this time, but is it something I should ask about?
Thanks for reading.
Help/advice on possible lymphoma
Re: Help/advice on possible lymphoma
An FNA for any type of lump should never really be used as a sole diagnostic, because there are too many forms of neoplasia to rule out. A biopsy is the most confirmative method for diagnosis, and also aids in what treatment approach to pursue, as well as an educated guess on prognosis.
What I would be concerned about right now is anesthesia. If you actually had full bloodwork done (a comprehensive) and kitty's liver/kidney enzymes are good, he might be a good candidate for anesthesia (for the biopsy). Combining an xray would also be a good choice as a starting point to look for any signs of a problem such as internal mass, metastisis, etc.
If this were my cat, I'd determine anesthesia candidacy, providing kitty is overall in excellent health, and get the biopsy done. Sometimes lumps are benign, and removing them early on (depending on what type), if benign, can actually help prevent them from reforming again. (as long as the vet is qualified and gets wide, clean margins). You won't know what treatment plan to approach until the biopsy results are in.
Depending on the type of lump, will depend on treatment. If benign, sometimes removal is all that is necessary.
If malignant, depending on the stage, chemotherapy might be an option. Radiation is another option, sometimes both combined. Sometimes palliative care is the only choice for late-stage or very agressive tumors.
Costs are indicative of the type of tumor, and if malignant, the likelihood a tumor will respond to treatment. Chemotherapy is dose-dependant, so it really depends on the protocol the vet chooses for the type of tumor. These doses can be once every week or two weeks, sometimes stretched out, and sometimes for a month or so. Radiation is usually only a one-time thing.
Please make sure your vet has the experience with lumps and biopsies. If he doesn't, see a feline-only vet or better yet, a board-certified veterinary oncologist. An oncologist can also be helpful to help your primary vet with results, treatment plan, and experience with the treatment.
What I would be concerned about right now is anesthesia. If you actually had full bloodwork done (a comprehensive) and kitty's liver/kidney enzymes are good, he might be a good candidate for anesthesia (for the biopsy). Combining an xray would also be a good choice as a starting point to look for any signs of a problem such as internal mass, metastisis, etc.
If this were my cat, I'd determine anesthesia candidacy, providing kitty is overall in excellent health, and get the biopsy done. Sometimes lumps are benign, and removing them early on (depending on what type), if benign, can actually help prevent them from reforming again. (as long as the vet is qualified and gets wide, clean margins). You won't know what treatment plan to approach until the biopsy results are in.
Depending on the type of lump, will depend on treatment. If benign, sometimes removal is all that is necessary.
If malignant, depending on the stage, chemotherapy might be an option. Radiation is another option, sometimes both combined. Sometimes palliative care is the only choice for late-stage or very agressive tumors.
Costs are indicative of the type of tumor, and if malignant, the likelihood a tumor will respond to treatment. Chemotherapy is dose-dependant, so it really depends on the protocol the vet chooses for the type of tumor. These doses can be once every week or two weeks, sometimes stretched out, and sometimes for a month or so. Radiation is usually only a one-time thing.
Please make sure your vet has the experience with lumps and biopsies. If he doesn't, see a feline-only vet or better yet, a board-certified veterinary oncologist. An oncologist can also be helpful to help your primary vet with results, treatment plan, and experience with the treatment.
..........Traci
Re: Help/advice on possible lymphoma
Thank you Traci.
I was originally leaning toward the full biopsy, however the vet mentioned they would not remove the lump under his chin. (pretty much the area where cats love to be scratched). This was because of the nerves associated with this area, or so I am lead to believe. She said if the FNA did turn out positive, she would suggest a vet oncologist in our area. From there she mentioned x-rays, ultrasound, chemo options if I was to go that route. Your idea of an xray during anesthesia is a good one. Perhaps going to the oncologist would be the better route to begin with now? Would the oncologist be more experienced to remove the one tumour under his chin (as well as the other two)? I've been searching for similar experiences on the net, however, I've come up empty handed in terms of trying to case studies of this nature. They've been more renal or other types of lymphoma with no first signs of lumps from what I've read.
I'm uncertain if she did a full blood work this past week. She said his WBC was normal as that is what they checked for. This past October he did however have a full testing as they checked his liver function and other things when he was prescribed with the tapazole. 3 weeks after he was taking it, (mid Nov), they again tested and everything was fine. This was to ensure the meds weren't interfering.
The two quotes I have would have him under anesthesia. The FNA for a limited amount of time, and the full biopsy, of course he'd be under for longer.
Having gone through something similar I am well aware that a biopsy is the only true analysis. I suppose my hesitation on the full biopsy is due to he FIV status. If I do have it done, will I possibly weaken his immune system further or less prepare him for chemo. (if that is in fact the next step?)
Your reply to my last post was most helpful. Thank you so much.
I was originally leaning toward the full biopsy, however the vet mentioned they would not remove the lump under his chin. (pretty much the area where cats love to be scratched). This was because of the nerves associated with this area, or so I am lead to believe. She said if the FNA did turn out positive, she would suggest a vet oncologist in our area. From there she mentioned x-rays, ultrasound, chemo options if I was to go that route. Your idea of an xray during anesthesia is a good one. Perhaps going to the oncologist would be the better route to begin with now? Would the oncologist be more experienced to remove the one tumour under his chin (as well as the other two)? I've been searching for similar experiences on the net, however, I've come up empty handed in terms of trying to case studies of this nature. They've been more renal or other types of lymphoma with no first signs of lumps from what I've read.
I'm uncertain if she did a full blood work this past week. She said his WBC was normal as that is what they checked for. This past October he did however have a full testing as they checked his liver function and other things when he was prescribed with the tapazole. 3 weeks after he was taking it, (mid Nov), they again tested and everything was fine. This was to ensure the meds weren't interfering.
The two quotes I have would have him under anesthesia. The FNA for a limited amount of time, and the full biopsy, of course he'd be under for longer.
Having gone through something similar I am well aware that a biopsy is the only true analysis. I suppose my hesitation on the full biopsy is due to he FIV status. If I do have it done, will I possibly weaken his immune system further or less prepare him for chemo. (if that is in fact the next step?)
Your reply to my last post was most helpful. Thank you so much.
Re: Help/advice on possible lymphoma
Since your vet is willing to refer to the oncologist, it might be better to get a consult with the oncologist altogether, and discuss surgery. If the primary vet removed only two lumps, and if the one under the chin happened to enlarge, eventually it may require removal, not something you truly want kitty under anesthesia twice for. A board-certified veterinary oncologist would have more experience with excisions and ensuring wide margins, as they are used to the procedures and knowing the tissue in which to get those margins. If the oncologist can do all three lumps, that would only require one anesthetic procedure, a plus. Plus they are more familiar with the chemo protocols if it is required.
That said, the oncologist might also agree that the one under the chin is in a tricky area. His or her experience will determine if it should be removed if necessary. I think overall, if it's a board-certified oncologist, you will be in a better position to get all your questions met, and probably ease of use for treatment/chemo or other protocol. Your primary vet can still be involved for followup or post-op care etc, medications if necessary, etc. Discuss it with your primary vet and if you can get a consult with the oncologist right away, this would be good. The sooner the better.
The only drawback with the oncologist might be price. Since it is a rather specialized field, it may cost slightly more, but you can discuss those costs with the oncologist during the consult for a breakdown of charges.
As long as your kitty is in otherwise excellent health, and is a good anesthesia candidate, I don't think you should worry about immunocompromised state other than the status of the tumors. If you can, try to opt for another full CBC w/differential, and a presurgical blood screen prior to anesthesia. This can be done a day or two in advance, or, the morning of the surgery.
If the lumps are relatively still small, I believe the oncologist's expertise will allow a fairly quick surgery (biopsy), so recovery should be good. He/she will probably want to do a short course of antibiotics, and/or pain meds, and as long as you take steps at home during recovery to observe the incision sites, keep him comfortable, eating, drinking etc, then he should still be able to withstand chemo. Chemo consists of at least a half-day at the clinic for observation and to keep kitty comfortable during the stay/treatment, you'll be able to bring him home each day or night. If chemo is started, try to see if you can get early appointments so you can bring him home earlier. Remember, most chemo protocols are only once a week or so, and on a specific schedule of weeks. The oncologist may want to do a CBC prior to each chemo session.
Chemo doesn't affect pets as it does humans. They don't lose their fur, and although vomiting can occur, it is generally mild or no vomiting at all. Sometimes they will have a blah feeling for the rest of the day after a chemo session, but usually just need to rest and otherwise enjoy their normal daily routine. Sometimes the blah feeling is simply due to stress at the clinic. However, you do want to be observant for any unusual signs of discomfort or vomiting, or lethargy after a chemo session and report it to the vet at once. Should that occur, the vet would either change the protocol or adjust the dose.
I had a kitty with t-cell lymphoma, she had one lump which eventually metasticized to more lumps, and even had an exploratory surgery done after her second dose of chemo. She pulled through beautifully after that, but unfortunately she had complications from other things. She had handled her chemo very well and never ceased to amaze me at how resilient she was. Also unfortunate, her lymphoma was agressive, but I wouldn't have done anything different, we did everything we could for as long as she continued showing us she was not ready to leave us.
I'm sending good thoughts for your kitty's lumps tp be benign. Please remember, depending on the type, even if they happened to be malignant, some of the protocols can still help survival rates and give kitties quality time.
Update us when you can?
That said, the oncologist might also agree that the one under the chin is in a tricky area. His or her experience will determine if it should be removed if necessary. I think overall, if it's a board-certified oncologist, you will be in a better position to get all your questions met, and probably ease of use for treatment/chemo or other protocol. Your primary vet can still be involved for followup or post-op care etc, medications if necessary, etc. Discuss it with your primary vet and if you can get a consult with the oncologist right away, this would be good. The sooner the better.
The only drawback with the oncologist might be price. Since it is a rather specialized field, it may cost slightly more, but you can discuss those costs with the oncologist during the consult for a breakdown of charges.
As long as your kitty is in otherwise excellent health, and is a good anesthesia candidate, I don't think you should worry about immunocompromised state other than the status of the tumors. If you can, try to opt for another full CBC w/differential, and a presurgical blood screen prior to anesthesia. This can be done a day or two in advance, or, the morning of the surgery.
If the lumps are relatively still small, I believe the oncologist's expertise will allow a fairly quick surgery (biopsy), so recovery should be good. He/she will probably want to do a short course of antibiotics, and/or pain meds, and as long as you take steps at home during recovery to observe the incision sites, keep him comfortable, eating, drinking etc, then he should still be able to withstand chemo. Chemo consists of at least a half-day at the clinic for observation and to keep kitty comfortable during the stay/treatment, you'll be able to bring him home each day or night. If chemo is started, try to see if you can get early appointments so you can bring him home earlier. Remember, most chemo protocols are only once a week or so, and on a specific schedule of weeks. The oncologist may want to do a CBC prior to each chemo session.
Chemo doesn't affect pets as it does humans. They don't lose their fur, and although vomiting can occur, it is generally mild or no vomiting at all. Sometimes they will have a blah feeling for the rest of the day after a chemo session, but usually just need to rest and otherwise enjoy their normal daily routine. Sometimes the blah feeling is simply due to stress at the clinic. However, you do want to be observant for any unusual signs of discomfort or vomiting, or lethargy after a chemo session and report it to the vet at once. Should that occur, the vet would either change the protocol or adjust the dose.
I had a kitty with t-cell lymphoma, she had one lump which eventually metasticized to more lumps, and even had an exploratory surgery done after her second dose of chemo. She pulled through beautifully after that, but unfortunately she had complications from other things. She had handled her chemo very well and never ceased to amaze me at how resilient she was. Also unfortunate, her lymphoma was agressive, but I wouldn't have done anything different, we did everything we could for as long as she continued showing us she was not ready to leave us.
I'm sending good thoughts for your kitty's lumps tp be benign. Please remember, depending on the type, even if they happened to be malignant, some of the protocols can still help survival rates and give kitties quality time.
Update us when you can?
..........Traci
Re: Help/advice on possible lymphoma
Thanks again Traci.
Yes, I will update this forum, of course. I plan on calling my vet tomorrow and discuss these options.
You know, I think you helped me some years ago when my cat (same one) was diagnosed with FIV. This past week I was trying to find an informative forum to gain some insight and remembered your guidance, however I couldn't find this site, or remember it's name. I came across it tonight of all things. I'm sure you were the one that set me straight that FIV was in fact not a death sentence. Because of your help, Oz has flourished as a wonderful member to our gang (3 in total). Thank you for helping me in the past, and tonight. You've eased my mind on many options and information to better serve Oz.
Yes, I will update this forum, of course. I plan on calling my vet tomorrow and discuss these options.
You know, I think you helped me some years ago when my cat (same one) was diagnosed with FIV. This past week I was trying to find an informative forum to gain some insight and remembered your guidance, however I couldn't find this site, or remember it's name. I came across it tonight of all things. I'm sure you were the one that set me straight that FIV was in fact not a death sentence. Because of your help, Oz has flourished as a wonderful member to our gang (3 in total). Thank you for helping me in the past, and tonight. You've eased my mind on many options and information to better serve Oz.
Re: Help/advice on possible lymphoma
I'm happy to help, and as for FIV, I think as long as he's in otherwise great health, with good nursing care, surgery shouldn't be problematic.
Glad you found us again! Please do post updates when you can. I know you are scared and worried, but take one step at a time, one day at a time.
Glad you found us again! Please do post updates when you can. I know you are scared and worried, but take one step at a time, one day at a time.
..........Traci
Re: Help/advice on possible lymphoma
I spoke with his vet today. I'm afraid it's not what I thought would occur, nor what you recomended for the most part. I was unaware my vet won't refer me to an oncologist unless they are sure its cancer. Regardless of that, the oncologist's office isn't booking apts until Feb 2nd. They could refer me to what's called 'internal medicine', but that would be much more $$. In anycase, we discussed Oz's alternatives again, and we opted for the FNA. However with that said, if she can get a CORE biopsy, she will do so. She will examine him the morning I bring him in for the FNA and consult with me as to whether she'd be able to get an adequate sample. I really hope she can do this. I'll be taking him home that evening. This will be occuring on Tuesday of next week.
Re: Help/advice on possible lymphoma
Did the vet state her reasoning for not referring to an oncologist beyond "unless it is cancer"?
If not, and if you have another, more experienced vet near you, I'd seriously consider changing vets.
It should be the client's choice, and the vet is obligated to refer at the client's request. Also, when the vet isn't experienced and/or "doesn't know" if it might or might not be cancer based soley on an FNA, it's incumbent upon such vet to refer, regardless. She knows an FNA is not definitive!
I'd also worry about her stating she could try to get a core biopsy, but doesn't sound as if she has confidence, and you could therefore end up paying for a surgical procedure that doesn't yield any conclusive results because the sample was not enough for pathology to determine.
I'm sorry, but an FNA is not the best method to rule out cancer, nor is it definitive, and paying additionally for a potential second surgery should be out of the question.
Is there a way you can personally talk to the oncologist's office and explain the situation? February 2 is only two weeks away, I think I'd rather wait for a consult as opposed to blindly going into surgery without knowing what can be achieved.
Maybe the vet has explained it differently to you, but if you're saying exactly what she said, I would definitely explore the option of talking directly to the oncologist's office before proceeding with surgery with the first vet. If there are other vets nearby or emergency vets, perhaps try to find out if they share this same "policy" (not referring until the first vet makes a so-called guess).
If not, and if you have another, more experienced vet near you, I'd seriously consider changing vets.
It should be the client's choice, and the vet is obligated to refer at the client's request. Also, when the vet isn't experienced and/or "doesn't know" if it might or might not be cancer based soley on an FNA, it's incumbent upon such vet to refer, regardless. She knows an FNA is not definitive!
I'd also worry about her stating she could try to get a core biopsy, but doesn't sound as if she has confidence, and you could therefore end up paying for a surgical procedure that doesn't yield any conclusive results because the sample was not enough for pathology to determine.
I'm sorry, but an FNA is not the best method to rule out cancer, nor is it definitive, and paying additionally for a potential second surgery should be out of the question.
Is there a way you can personally talk to the oncologist's office and explain the situation? February 2 is only two weeks away, I think I'd rather wait for a consult as opposed to blindly going into surgery without knowing what can be achieved.
Maybe the vet has explained it differently to you, but if you're saying exactly what she said, I would definitely explore the option of talking directly to the oncologist's office before proceeding with surgery with the first vet. If there are other vets nearby or emergency vets, perhaps try to find out if they share this same "policy" (not referring until the first vet makes a so-called guess).
..........Traci
Re: Help/advice on possible lymphoma
From what I understand, her remark was basically, the oncologist only takes diagnosed pets. She did say she could refer me to internal medicine, which would be more costly, etc. I did leave it at that as I'd rather use the money I do have towards any necessary chemo plan than to blindly give it to someone I don't know or have a relationship with.
I am confident with the vets. I've been going to them for 8 years. They've never done me wrong. My vet did consult with the lead vet at the clinic and from what I understand, the mass must be a certain size so they can access it easily enough. As of last week, based on what she examined, she did not think it was large enough to excise a proper sample. This is what I understand from our conversation. The bigger mass under the chin is the one she would take the sample from. The other two are very tiny. One of which I have difficulty locating as I really have to feel around to find it. We did discuss the FNA and how it's not difinitive. I understand the risks. As you know, I've been torn on the proper decision. To do a full biopsy - I flounder as to if I want to put him through all that at this stage without really knowing what is going on. As well, from what I understand it isn't always necessary to excise the node since lymphoma is a systemic disease. He still is strong, eating well, and being social. I see no signs of sickness. Of course, I understand too well how some cats mask illness.
I'm not giving in, nor giving up. I just have to do something now to find out if there are any results.
As always, I will keep you posted. Again, your info is appreciated greatly.
I am confident with the vets. I've been going to them for 8 years. They've never done me wrong. My vet did consult with the lead vet at the clinic and from what I understand, the mass must be a certain size so they can access it easily enough. As of last week, based on what she examined, she did not think it was large enough to excise a proper sample. This is what I understand from our conversation. The bigger mass under the chin is the one she would take the sample from. The other two are very tiny. One of which I have difficulty locating as I really have to feel around to find it. We did discuss the FNA and how it's not difinitive. I understand the risks. As you know, I've been torn on the proper decision. To do a full biopsy - I flounder as to if I want to put him through all that at this stage without really knowing what is going on. As well, from what I understand it isn't always necessary to excise the node since lymphoma is a systemic disease. He still is strong, eating well, and being social. I see no signs of sickness. Of course, I understand too well how some cats mask illness.
I'm not giving in, nor giving up. I just have to do something now to find out if there are any results.
As always, I will keep you posted. Again, your info is appreciated greatly.
Re: Help/advice on possible lymphoma
I understand what you're saying, just wanted to offer there might be options to actually avoid more than one anesthetic procedure. Anytime anesthesia can be limited, is a good thing, no matter the age or health status of a cat.
If you read the most recent post about possible lymphoma on the forum, I will also suggest to you to ask your vet about the lymph nodes. I.e., palpate them, check all of them, check the ones nearest the head, and consider aspirating one if enlarged or unusual in any way. This could be done the same time as the FNA for the lump. I'm not saying this HAS to be done, just saying you want to ask your vet about it.
If you're confident in, and trust your vet, then follow her direction. I was hoping she would facilitate your kitty and you by minimizing procedures if possible. You have to keep stress in mind, the least amount of stress/clinic visits/procedures/anesthesia/recovery periods, the better for kitty!
I do understand the decision-making process and how difficult it can be, but it is obvious you want to do best for him and you are determined to do so, Oz remains in my thoughts and prayers, please keep us updated.
If you read the most recent post about possible lymphoma on the forum, I will also suggest to you to ask your vet about the lymph nodes. I.e., palpate them, check all of them, check the ones nearest the head, and consider aspirating one if enlarged or unusual in any way. This could be done the same time as the FNA for the lump. I'm not saying this HAS to be done, just saying you want to ask your vet about it.
If you're confident in, and trust your vet, then follow her direction. I was hoping she would facilitate your kitty and you by minimizing procedures if possible. You have to keep stress in mind, the least amount of stress/clinic visits/procedures/anesthesia/recovery periods, the better for kitty!
I do understand the decision-making process and how difficult it can be, but it is obvious you want to do best for him and you are determined to do so, Oz remains in my thoughts and prayers, please keep us updated.
..........Traci