feline osteosarcoma and mestasis

[Madonna F.]

Hello everybody,

Just discovered this Board on Google, and with the encouragement of my vet, I'd like to ask for some advice and information.

My 14 year old, 18 pound female Tortoiseshell shorthair, Angelica (aka "Jelly", yes, she is tubby) was diagnosed with osteosarcoma of the distal tibia last year. She was on my bed and broke her leg when she tried to jump down. I rushed her to the vet, who discovered the cancer on an xray. Her right rear leg was amputated to the hip.

I was told that in spite of her age and weight, she had an excellent prognosis because cats (unlike dogs and people) have a very low incidence of the cancer spreading from bone cancer, if the bone cancer is in one of their legs. An amputation usually results in a cure.

Jelly adjusted and so did I, after the amputation. She's doing O.K., I guess. Only the occasional soiled backside when she can't hold herself up in the box. Thank goodness for baby wipes.

All has been well until recently, when Jelly developed a very bad bladder infection. She was passing blood and clots through her urethra, and was in distress. I rushed her to the vet, who put her on antibiotics and a shot of steriod for the inflamation. He also xrayed her to check for stones.

Although there were no stones, there was a "spot" or "shadow" on her right lung, a little smaller than a penney. The other vet at the clinic was consulted, and he also is concerned that Jelly could have metastatic disease.

For right now, we are concentrating on clearing up the bladder infection and the serious constipation problem she's also had for about two weeks. Jelly only passes a couple of hard rocks every couple of days. She hasn't passed anything in 2 1/2 days. I am now adding pumpkin to her food and a little grated carrot. She is getting triple doses of petrolax each day. It seems to have little effect. If Jelly doesn't poop by tomorrow at noon, she is going to the vet for an enema.

In the meantime, Jelly continues to eat and have an appetite. But nothing comes out!

We are going to re-do the xrays in 3-4 weeks.

In addition to any comment anybody would like to make about my kittie's case, I'd like to ask these questions:

1. Does anybody know of a cat who had bone cancer in the lower leg, get an amputation, and have it spread (or not)?
2. Does anybody know what the actual rate of metastatis is on feline osteosarcoma of distal axia? Web research indicates that it is "low", whatever that means. Does that mean 1%, 20%, etc.?
3. What other possibilities exist that could cause a spot or shadow on the lung in an xray?
4. Does anybody know of a kittie (or person for that matter) who had a "spot" show up on an xray that disappeared on its own?


Thank you so much for any help or input. I've enjoyed reading your posts. You can tell, I love my baby.

Madonna F/Angelica Mew

[davet]

the foreleg and scapula of a 13 year old cat and it lived to be about 17 before it died of kidney failure...therte is no way to predict how your old buddie is going to do or how long it will live....and stats don't mand diddly with these types of conditions...i think you will have a better idea when you get a 3 to 6 month repeat x-ray///o fprget how old you said your cat was but wait for another chest p[ic to see what is happening.....good luck

[Traci]

1. Does anybody know of a cat who had bone cancer in the lower leg, get an amputation, and have it spread (or not)?
2. Does anybody know what the actual rate of metastatis is on feline osteosarcoma of distal axia? Web research indicates that it is "low", whatever that means. Does that mean 1%, 20%, etc.?
3. What other possibilities exist that could cause a spot or shadow on the lung in an xray?
4. Does anybody know of a kittie (or person for that matter) who had a "spot" show up on an xray that disappeared on its own?

The incidence of reoccurance is rare in cats, but there are not enough statistics for cats as opposed to dogs.

The incident rate is well below that of dogs (dogs=80% all primary bone tumors, 2-7% of all malignancies), and with amputation, median survival rate of over 4 years may be common for cats.

Other possibilities: what I would recommend is checking for secondary tumors, I'm sure your vet has already, given the history and circumstances, but osteosarcoma can develop in the other bones, ribs, and soft tissues even after a tumor has been removed or, after amputation. While metastisis could indeed occur in the lungs, I think it would be fairly rare in this type, unless there were a hidden tumor on the rib or other chest area. Any tumor can potentially metasticize to the lungs, you will need to re-evaluate with thoracic x-rays (and laterals of all long bones, etc) at least once a month for about three months to be able to make an educated guess.

The only other spot I would venture a guess on, might be a fungal or respiratory infection (bacterial), but it is unlikely, given there are no direct symptoms that would indicate respiratory. As for disappearing, if bacterial in nature or fungal, medications can be approached, but you might have to consider additional diagnostics (such as a tracheal/bronchial wash) which could prove risky at this point, your vet must advise accordingly based on his suspicions.

As for her diet, not knowing what you are currently feeding, I would suggest a prescription diet that is specifically formulated with fiber, and I'm not sure the grated carrot is appropriate for her. Laxatone, pumpkin added, is fine, but your vet may want to add other agents as well. Fiber capsules are also available, your vet can advise you further. Try to stick with a canned version of the diet, ensure plenty of natural water intake, you can also add water to her food for more fluid content. If you or your vet feel she is suffering hydration, consider discussing sub-q fluids at home to help combat that.

Due to her weight, I would suggest making her as comfortable as you can, and maybe consider making adjustments for her litterbox, making it more accessible, easier to step into, little things like that can add a big difference to her comfort. Keep a warm, fleecy and padded bed available to her....with the excess weight, she is putting additional stress on her joints and adding stress to the bones, this leads to discomfort and pain eventually, so any padding you can place in her sleeping areas will help tremendously. Heat helps too, you can use a heating pad on low setting under a towel in her bed, she will find it soothing and comfortable. With the loss of the leg, it is making it harder for her to get around when she's adding so much stress to her other legs. Once she begins to feel more comfortable, try to implement a slight exercise program for her, just a few minutes a day to start, don't force her. Arthritic conditions can affect any pet who has undergone an amputation, the hips, joints and bones are so susceptible.

Keep a close eye on her respiratory function. If it happens to be a tumor in her lungs, she may develop pleural effusion (fluid), breathing may become labored, shallow, difficult, in which case, don't delay in getting her to your vet immediately for emergency care.

It sounds like you have a devoted vet team behind Jelly and you, I'm sure they are doing everything they possibly can toward monitoring her and providing her excellent care. You always have the option of consulting a feline cardiologist for further input and medical support, you might want to bring this up with your vet.

Hang in there and dont be afraid to ask questions of your vet. I'm sending good thoughts your way for Jelly and you, it's so obvious you adore her!

[Madonna F.]

Thank you both for your replies.

Davet -
Great to hear about the cat amputee who lived to be 17 and didn't die from cancer. Did this cat have osteosarcoma? You are right, the stats don't mean "diddly", but I like to hear about other case studies, to learn what experiences others have had. And the case you described gives me hope. Jelly gets another xray in about 3 weeks.

Traci -
Yes, my vet did re-xray her last year after the initial diagnosis to check for secondary tumors, and found nothing. The xray taken a few days ago was a full body xray (I'm not sure what a "thoracic" xray is) and it just showed the spot on the lungs (which wasn't there last year during the osteosarcoma).

You wrote:

"While metastisis could indeed occur in the lungs, I think it would be fairly rare in this type, unless there were a hidden tumor on the rib or other chest area. "

Why would it be rare? Because she is a cat who had osteosarcoma that is supposed to have a low rate of metastatis? How often are there "hidden tumors" that don't show up on xrays? Could her bloody bladder problem be suspect? Antibiotics seem to have that in check, though.

About 4 years ago, Jelly used to gag on her food, sticking her tongue out of her mouth and had a hard time swallowing. Vets at the time couldn't figure it out, but it cleared up. Her throat was very red, and they suspected stomatitis. She stayed on antibiotics, and it cleared up.

Also, every once in a while, Jelly will wheeze and gasp for breath. This has been going on for years, even before the osteosarcoma. The wheezing sounds wet, like I can hear fluid in there. It only happens once a week or so, and seems to be brought on by eating, particularly kibble (which she no longer gets). Can this be food allergy? She is now on CD. Before she was on Pet Guard, or other by-product free canned food.

All this is just to give you more history. I don't know if the above is connected at all. But maybe it has something to do with the spot on the lungs, and maybe it is a fungal thing. But it wasn't there last year.

Like you said, there really isn't much research out there for metastatis of feline osteosarcoma. But I really want to hear about more cases. My vet said that miracles do happen. He personally treated a cat that had a spot on an xray "disappear". Learning all I can helps me cope. So does praying.

Can you provide links to other boards, like a cat cancer board, where I might hear about other feline osteosarcoma cases?

Thank you so much for your help.

Madonna F and Jelly Belly

[Madonna F.]

Hi Traci,

I forgot to respond to you regarding your suggestions for food and comfort.

Jelly is now on CD with extra pumpkin. She loves it, but still won't poop.

She uses a low litterbox and gets in and out O.K. She doesnt have a lot of energy, but can walk across the room and backyard when she wants to. I encourage her to exercise, by carrying her to another room. Then I show her food and she will walk. This cat loves FOOD!

She also gets Cosequin for cats in her food every day to help with the arthritis. Works great.

Thanks again for your response.

Madonna F. and Jellyca-Mew

[Traci]

Yes, my vet did re-xray her last year after the initial diagnosis to check for secondary tumors, and found nothing. The xray taken a few days ago was a full body xray (I'm not sure what a "thoracic" xray is) and it just showed the spot on the lungs (which wasn't there last year during the osteosarcoma).

we call a full-body x-ray a kitty-gram (clinic humor), because we can get from chest to lower abdomen on an 8x10 or 11x14 film. A thoracic view is a chest view only, where we can view lungs, heart, spaces in the chest cavity. In your case, you'll probably want to get both as you monitor this.

You wrote:
"While metastisis could indeed occur in the lungs, I think it would be fairly rare in this type, unless there were a hidden tumor on the rib or other chest area. "

Why would it be rare? Because she is a cat who had osteosarcoma that is supposed to have a low rate of metastatis? How often are there "hidden tumors" that don't show up on xrays? Could her bloody bladder problem be suspect? Antibiotics seem to have that in check, though.

Exactly, in this type of cancer, you are usually talking about bone, rather than organs or tissues. But, again, there is always the potential of soft-tissue metasticization. I simply stated I think in cats, osteosarcoma would be rare in the lungs. As for hidden tumors, unfortunately, they are usually not detected until in late stage, that is the nature of most types of cancer. Symptoms also usually do not present until in late stage. In this case, I would pay particular attention to examining her often, checking for external lumps on the limbs, abdomen, chest, watch her lymph nodes for any signs of enlargement.

I doubt that the bladder infection is related in any way. Although this could be a secondary problem that is stress-induced, or simply a secondary bacterial infection that can be common in any primary disease process. During the inital x-rays, your vet could have seen any potential problems that would have prompted him to investigate further. If he in any way suspected it were related to a tumor, he would have probably performed a contrast x-ray (which is more involved). A more conservative approach would be to re-check a urinalysis for any signs of elevated white blood cells (indicating infection or inflammation), increased hematuria (blood or blood loss), signs of scarring that could indicate crystals or bladder wall thickening.

About 4 years ago, Jelly used to gag on her food, sticking her tongue out of her mouth and had a hard time swallowing. Vets at the time couldn't figure it out, but it cleared up. Her throat was very red, and they suspected stomatitis. She stayed on antibiotics, and it cleared up.

Stomatitis is often a progressive disease, requiring life-long care and treatment, it sounds like this has been ruled out. It could have been a staph infection, or bacterial in nature, or even a viral like feline bordetella, no way to know for sure without a swab cytology or culture of exudate taken from the mouth, throat, etc.

Also, every once in a while, Jelly will wheeze and gasp for breath. This has been going on for years, even before the osteosarcoma. The wheezing sounds wet, like I can hear fluid in there. It only happens once a week or so, and seems to be brought on by eating, particularly kibble (which she no longer gets). Can this be food allergy? She is now on CD. Before she was on Pet Guard, or other by-product free canned food.

Absolutely, could be an allergy. But other rule outs would be respiratory infection (like feline herpesvirus, calicivirus), asthma or fungal in nature. I'd also opt for a full oral exam to rule out oral ulcerations, diseased teeth, abcesses.

Can you provide links to other boards, like a cat cancer board, where I might hear about other feline osteosarcoma cases?

Here is a link to Debbie's Feline Health Links....go to her feline 'C' section and check out her cancer links. I don't have the particular link handy, but she has a link to a site called Thensome, which may include specific cancer message boards. Ideally, the relationship between you and your vet is more important than message boards, he is the only one who knows Jelly's history and present condition, not withstanding, I understand your need to find similar stories.

I goofed in above post, I meant to refer to a feline oncologist, not cardiologist, your vet can consult with one on your behalf for more support.

Hang in there....

[Madonna F.]

Hi again Traci,

Thanks so much for the great info. If you don't mind, one more question.

You wrote:
"As for hidden tumors, unfortunately, they are usually not detected until in late stage, that is the nature of most types of cancer. Symptoms also usually do not present until in late stage. In this case, I would pay particular attention to examining her often, checking for external lumps on the limbs, abdomen, chest, watch her lymph nodes for any signs of enlargement. "

Jelly has had a lump on her shoulder for years now. Last year, it was biopsied and was shown to be just a "water cyst". But I wonder if it could turn cancerous. It's been aspirated a number of times, and it also drains on its own, but comes right back.

By examining for external lumps, do you mean lumps that I can see and feel just under the skin? Like a boil? Would it be an open wound that oozes, or just a lump under the skin? Also, are her lymph nodes under her front legs? Where else should I look?

Should I also look for wheezing and gasping in relation to the spot on the lung, even though it might be related to food allergies? Oy, so many questions.

Thanks for taking the time to help Jelly and me.
Happy Saturday.

Madonna F. and Jelly

[Traci]

I don't think the lump on the shoulder should be too concerning, if it's been there all this time and not shown unusual changes, I'd leave it alone, chances are, it is a sebacious cyst, benign, nothing to warrant removal.

As for checking for lumps, yes, anything you can feel directly, especially around bones (limbs). Protrusions in front of her legs, abdominal protrusions (like by a rib).

Lymph nodes are at various parts of the body. The most common to enlarge during times of immunosuppression are the ones on each side of her neck, just under her jaw line. You can also check behind her fore legs where her chest wall meets the 'armpit'. Also, lymph nodes can be found at the lower abdomen, between the thighs, (pretend you're looking for bumps, like mammary glands that have enlarged, they would be firm). I don't think in this case they would appear as lesions, but rather, under the skin, firm, very close to bone.

As for the weezing and gasping, I'd rather you discuss this in full with your vet. If he hasn't ruled out a food allergy, this can be relatively simple to do simply by introducing a new diet. However, if she's been prescribed the C/D in the past for a condition, I wouldn't want to change that diet, unless you simply switched to a similar veterinary diet for the purpose intended. You should discuss the possibility of respiratory infection, fungal infection or asthma before considering a food allergy.

What I meant really, was that IF this spot turns out to be cancer in the lungs, then it could cause breathing distress at some point, depending on the size and location of the tumor, if it is really invasive, or is pressing against a lung, etc. Fluid accumulation also can occur with any tumor development, it is fluid that makes for difficult breathing, gasping or reduced lung function. If she isn't showing any signs of labored breathing, then let's hope that it won't progress to the situation I've described above. I would just want you to be prepared to monitor her for those signs.

[Madonna F.]

Thanks so much for your help. I've downloaded this thread, and printed it too, to show my vet. You are appreciated.

Madonna and Jelly Belly