Kitty Lymphoma Advice
March 5, 2021 6:57 AM   Subscribe

I have an 8 year old kitty (the handsome black fella on the left) who started having digestive issues in December. We got a preliminary diagnosis of IBS, but after bloodwork, they are suspecting small cell lymphoma. Since this seems to be a fairly common cat issue, I thought I'd ask for some advice.

We did an ultrasound in late February that led to the IBS diagnosis. Bloodwork came back about a week later with elevated calcium levels, which led the vet to think it might actually be lymphoma. He's 2 weeks into his first round of prednisone and has transitioned to a limited-ingredient (venison and pea) food. There has been no more vomiting and he seems to be feeling pretty good, but maybe a tad quieter than usual.

The surgical biopsy will run about $2k, and if it is lymphoma, he would likely start a round of chemo. Financially I can make this happen, but I want to make sure I'm doing the best for my little guy. I don't know if I should put him through surgery, and if so, how to decide when (now? if symptoms come back?). If we do the surgery and it is lymphoma, what's his life look like after that? He's so young!

I have an appointment to talk to the vet in a few weeks once he's done with this round of meds, but I'd love any experience/advice from anyone that has been through this.
posted by tryniti to Pets & Animals (6 answers total) 3 users marked this as a favorite
I went though this with my beloved Kilo. Me-mail me if you'd like - happy to talk though my experiences, but I dont quite have the time right now to type it all up. She looked exactly like your kitty - love black cats!!

The short-ish version however - As your vet probably mentioned, the ultasounds cant differentiate between IBD (used interchangably sometimes with IBS) and lymphoma, the only way to get a diagnosis is the biposy. My vet and I decided against the surgery in my case. For one, my cat was a little older and we didn't feel the surgery was worth the risk. Why? Becauase according to my vet, severe IBD and lymphoma are treated the same way - pred and the chemo, plus anti-nausua meds. The biopsy result wouldn't change the treatment plan. Also - cats tolerate chemo much better than humans. My vet was more worried about me handling the meds than she was with the cat taking it.

There's also a pretty good facebook group but I cant find it right now, I'll see if I can dig it up. I also found some good advice here:

The most important thing I can recommend though - get used to weighing your kitty at home. Weight loss will be the first sign of anything amiss other than the vomitting in IBD/lymphoma cats.

Although she's gone now, Kilo lived for several more awesome years even with the IDB/lymphoma, so dont fret - it's not all doom and gloom, and the symptoms are treatable!
posted by cgg at 7:25 AM on March 5, 2021 [6 favorites]

My cat had the same situation - I opted for the biopsy, (contrary to cgg’s experience, my vet said the treatment for IBD wouldn’t include chemo but lymphoma treatment would, so I wanted a firm diagnosis to best treat him) The biopsy confirmed Lymphoma, and he’s been on meds and handling it well for almost 4 years now! He’s going to be 18 this year. His meds do run about $100/mo but it’s worth it and his quality of life is still excellent. We’ve gotten into a decent routine with the pills, but that’s probably the biggest challenge - I only have one friend I really trust to cat sit because she doesn’t shy away from giving him pills.
posted by girlalex at 8:54 AM on March 5, 2021 [4 favorites]

Small cell lymphoma is quite treatable, and cats can definitely have a good quality of life on the sort of pill chemo used for it. My 15-year-old cat was diagnosed over two years ago, and now she vomits less and has gained back two pounds. We pill her by hiding the pills in treats. There are new protocols where you might only have to do the chemo pill every two weeks; the older regimen would be every other day, but the Feline Small Cell Lymphoma mailing list has opinions about that. My cat's on an every-four-day regimen which doesn't match either protocol, but since she's doing well, we're listening to her specialist. Some vets support giving chlorambucil to cats that seem to have severe IBD without a biopsy; some will only do it with confirmed small cell lymphoma diagnosis. It's a well tolerated medication, but it's still chemo and has some toxicity.

A possible problem with biopsy at this point is that prednisolone (this is likely what your cat is getting, rather than prednisone -- cats are generally given the prednisolone form due to how they process the medication) can make the biopsy inaccurate, since it suppresses small cell lymphoma very well, at least for a while. Ideally you'd get the biopsy before starting pred if you want to get it. The lymphoma mailing list I mentioned above has quite a bit of information on this, if you search their archive. It can be a little overwhelming; I'm a little wary of extremely opinionated laypeople when it comes to medical issues, but it's a science-based group with veterinary support. This does not mean you're wrong if you listen to a professional who's advising you otherwise -- I couldn't talk my vet into trying the every-other-week protocol, and I'm not doing every test and supplement they recommend -- but they're definitely a good source of information.
posted by kite at 9:23 AM on March 5, 2021 [1 favorite]

We went through this with our cat in the summer of 2018, and the details were very similar to your case. Weight loss and loose stool were our signs that something was wrong. She was about 13 years old at the time, and we're lucky enough that she's still with us.

We opted for the biopsy, which did confirm intestinal lymphoma. The surgery went well, though it was definitely the most sedated she's ever been. She didn't seem to be in any distress or pain once she woke up, so I don't think the surgery was too hard on her.

The treatment was the same as your vet described: prednisone [EDIT: prednisolone, as the comment above me corrected] and chemo. I can't recall exactly how long we kept her on the chemo, but we took her in for a followup ultrasound after about a year, and they found no trace of the cancer. She's not on chemo anymore, but she's still on the steroids. Her quality of life honestly seems kind of great, especially given that she was already pretty old at the time of diagnosis.

I'll say this: we feel incredibly lucky. During the diagnosis and treatment stage, our kitty oncologist (hell of a career path) never once mentioned "the cancer goes away and never comes back" as one of the possible outcomes. She had basically told us to expect, best case scenario, about 6 months to a year of extended life with treatment. I'm sure our vet was just managing expectations, but the fact that she's still with us 3 years later feels like a gift.

I do have one piece of practical advice: if you end up needing chemo drugs and you're based in the U.S. (or anywhere else with a similarly dystopian health care infrastructure, if such a place exists), you should absolutely order the meds from this Canadian pharmacy. I know the website looks a little late-90s janky, but I promise you they were WONDERFULLY professional, and most of all, affordable. Our chemo pills were about $120 a bottle. The same medicine bought from a U.S. pharmacy would have been over $1000 a pop—literally 10 times more expensive. If not for those beautiful Canadians and their affordable medicine, I shudder to think about the decisions we'd have been forced to make. Seriously, they had maybe the best customer service I've ever received, and I'll forever be grateful to them for the extra time we've had with our cat.

I truly hope that your kitty bounces back stronger than ever. Feel free to me-mail me if you have any questions, and I'll do my best to answer them. Hang in there!
posted by gettingpaidforthis at 9:40 AM on March 5, 2021 [6 favorites]

Yorvit was diagnosed last year with small cell intestinal lymphoma. I did go for the expensive biopsy, in part because I was in a "I can't lose my cat on top of everything else I've lost" head space so I threw money at it. The surgery and recovery were kind of tough on him, mostly because his health was pretty fragile at that point. Yorvit is on prednisolone and chlorambucil and has responded spectacularly. Regained the weight and energy. No more vomiting. Back to being pretty much his normal self. I have no regrets about the money spent on the surgery. The treatment costs haven't been bad -- gettings meds through the local SPCA where he's getting treated.
posted by gingerbeer at 12:09 PM on March 5, 2021

We went through this with our cat a few years ago. We ultimately decided against doing the surgical biopsy because the little old guy was nearly 17, and there were risks in just putting him under. Also, they had started him on prednisolone and he was doing great on it, so we decided to just manage his symptoms as palliative care.
posted by bedhead at 2:39 PM on March 5, 2021

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