HELP! Cancerous Tumor

[MissWhiskers]

This is a little update on Serenity -
I received a Dr's report in the mail yesterday from the Opthalmologist. She labeled it a "Recheck Bulletin"as it is to go over what she has done and seen during the recheck appt and the procedure she did to stitch the corner of her eye (to protect the cornea as she cannot completely close that eye) and she had planned to look in her mouth. That was last Wed and Thurs. The most important part reads:
"Serenity was dropped off on 6/17 for the procedure. Unfortunately, her jaw could not be opened even under propofol sedation through an IV catheter. Dental tarter was certainly visible externally and there was a soid swelling of the left side of her jaw. Our dentist Dr. Chamberlain consulted briefly and we agreed that the appearance was suggestive of a neoplastic lesion, temporomandibular joint involvement was likely, manually attempting to open he jaw was unwise, and that advanced imaging like an MRI, combined with biopsy would be the best way to evaluate this further. The owner and I discussed that based on today's findings a serious malignant mass was the most likely scenario. Even without considering financial constraints it would likely to be a difficult lesion to treat. I did not feel the cat was immediately suffering, but euthanasia will likely need to be considered for humane reasons in the fairly near future."

Needless to say I am really hurting. And I keep hanging on to some denial. I keep saying to myself there hasn't actually been a biopsy - and, they are just saying what they think....
Anyway today I made an appt with an Oncologist. If it is as the Drs have said I guess there is not much hope, but at least maybe the oncologist can advise me on treatment for the balance of her life, right?

I don't know what I would do without you all - your advice and support. Thank you for everything!

Karen

[CarolC]

The good part is she does not feel the cat is immediately suffering. If you can help her with her food and water and grooming, maybe she can have a few more sunny days. Hopefully the oncologist can give some idea of what you can expect. You sure never expect this years down the road when you bring home a kitten or adopt a cat. It's the last thing you expect. I'm glad she has you.

[MissWhiskers]

Based on suggestions from you all I asked the Drs to change her meds. We are changing the antibiotics from Clavamox (I was just finishing that up anyway) to Clindamycin (will that help with "anarobic" infections???) and we are changing from Meta Cam to Buproponex(spelling?) and we see an Oncologist on Monday.
Carol you are so right - Serenity is one of 3 kittens I found in a box at a church almost 15 years ago. They were only a couple of weeks old and should have been nursing with their mother! Someone had put some french fries in the box - like from Popeye's(fast food chicken) - as if to help feed them!? It looked like someone who didn't know any better, but was trying to help!! Anyway they were so weak from hunger!! I ran to a Vet that was open that Saturday morning, and got some Kmr and a bottle and instructions for what to do. I don't know if it was because they were so weak. but they wouldn't eat on their own - I had to keep trying to force the milk into them. Finally, one by one they started taking the food in on their own. I know it is probably just a coincidence but they are dying in the reverse order of how they "came around"! Back on that day I was worried that 3rd one wasn't going to make it! It was the one boy, Goober who came around first that day and he died about 3 months ago of cancer in the liver and spleen area. Serenity came around 2nd and it seems like her prognosis is poor right now. Little Girl is still here - not currently having any problems. I just think that is kind of interesting. Oh, and I have always called them "my 3 little kittens who lost their mittens." The day I found them I had originally planned to turn them over to a rescue group, but after nursing them every couple of hours, and wiping their bottoms to go to the bathroom, etc. - I bonded with them and decided to keep them. They were so small I would lay on the sofa and put all 3 of them in a little puddle on my chest for naps. Serenity had this way of laying stretched out on her back but a little propped up on her side that I thought looked like a Playboy centerfold photo, or something!
Well, how I do go on!!!

I will keep you posted and again I thank you all.

Karen

[Diana R.]

Karen:

Clindamycin is indicated for anaerobic infection and stomatitis. My cat Charlie, who I had euthanized this time last year, he was 16, had oral squamous cell carcinoma and also stomatitis. He too had the tumor in the mandible area (left lower jaw). The prognosis for this cancer was 6 months, however, after the inital diagnosis, which we thought was a mistake because he was doing so well, he lived 18 months before his mouth got so bad and smelled so bad and the tumor was growing. He had a gastric feeding tube (actually had to put in twice on two different occasions) and I feed him through the tube. He was also on feldene or piroxicam, which is a drug in capsule form for transitional cell carcinoma. This I put in a syringe mixed with water and this also went in the tube. The clindamycin, which is a liquid, also went in the tube. It is a very nasty tasting and when I gave it orally, they suggested putting it in the refrigerator to lessen the taste.

Please keep us updated on Serenity and the oncology appointment. I have had so many cats with cancer but it is typically a disease, like kidney disease, that they get in their old age. You take such good care of your cats and I know Serenity has had and is having a good life with you. Diana

[MissWhiskers]

Thank you Diana! Your experience is invaluable to me! So the Clindamycin is good, right? I did ask about the Feldene, but I think the Dr. was not "comfortable" with prescribing that not knowing exactly what the "lesion" is. That was the opthalmologist who has been so nice, but as she said to me on the phone yesterday, Serenity's eye is more or less an "innocent bystander" being affected by this thing which she believes is around the TMJ, and this is out of the realm of her area of practise. She was nice enough to call my vet to recommend the change in meds. I have not been real happy with my local vet office ovr this situation. Actually I have been going there for the last few years because it is so close to where I live and I did not have a car. I just recently got a car and plan to go elsewhere in the future! First, they claimed they "recommended" an Opthalmologist much sooner than they really did - when they had merely mentioned that as one possible option. Secondly, Serenity had a regular check up on April 30th at which time I was told she needed some dental work. Now I wonder if what the Dr saw was what is going on now. I have asked for a Dr's summary of that visit and am being put off, questioned, being told there might be a charge for that - but no report. And they have not returned calls in a prompt manner like I would think this situation calls for!
Anyway once I see the Oncologist then they can be in charge of meds - and maybe I can ask about the Feldene (Piroxicam) again?
Everyone's advice on these meds will be GREATLY APPRECIATED!
By the way, I just started the Clindamycin and Buproponex Fri morning and at the time I am writing this (appx 1:00 am Sat) - I think Serenity is feeling better and more active.
Thanks again!

Karen

[MissWhiskers]

I took Serenity to an Oncologist yesterday. They examined her, did x-rays and bloodwork and urinalysis.
Briefly, they " did not find evidence of cancer on her xrays. Bloodwork showed mild elevation in her kidney values which may be consistent with older age changes. On palpation of her abdomen, she does have slightly enlarged lymph nodes in her abdomen which may be part of her disease process, but also may be the result of underlying gastrointestinal disease(I think they said possible Inflammatory Bowell Disease) unrelated to Serenity's present problem." Of course they recommend doing an MRI, or CT Scan, but I don't have the financial ability to get those tests done - which I feel terrible about!
Their "Differential Diagnosis" included Malignancy [1. Squamous Cell Carcinoma, 2. Lymphoma, 3. other cancers(Sarcoma)] Versus Benign [Abscess/Granuloma secondary to foreign body/dental disease].
Early on - even before the diagnostics were performed - it seemed like they suspected Squamous Cell Carcinoma but by the end of our time there it seemed like they were suspecting Lymphoma - which I think they had said eariler is MORE TREATABLE - does that sound right?? I THINK they were trying to work with me considering my limited financial resources. They gave her an injection o L-asparaginase and said that if the mass responds to that - it probably is Lymphoma! and IF SO we could pursue Chemotherapy, maybe once every 3 weeks for 8 months, OR do a Radiation Protocal of twice a week for 4 weeks (appx $2000. to 2500). And I am going to give her daily steroid injections.
Here is exactly how it reads in the report they emailed me today:

...In order to better define the nature of Serenity's left retrobulbar mass as well as to determine the extent of her disease, additional diagnostics including aspirates/biopsy of the mass and advanced imaging (MRI/CT Scan) are needed. These findings will affect the recommended treatment options as well as prognosis. Our top two differentiials include:
1. Squamous cell carcinoma: Carcinomas of the mouth are one of the most common oral tumors in cats with the most common tumor histology associated with feline oral carcinomas being squamous cell carcinoma. Typicaly, with oral squamous cell carcinoma, the lesion is highly locally invasive and the risk of metastasis to regional or distant sites is low(<20%). Treatment options are limited as oral squamous cell carcinoma tends to be refractory(??) to both radiation therapy and chemotherapy. **Given the degree of involvement suspected based on Serenity's examination, surgical resection is likely to NOT be possible therefore multimodal treatment options including palliative radiation with systemic therapy (ie chemotherapy ) may result in disease control and pain improvement of 3-6 months. IF ONLY PALLIATIVE CARE is pursued (pain medications and palliative radiation), 1-3 months would be considere a good outcoeme.
2. Lymphoma: Lymphoma, a malignancy of the lymphatic system, is the most common cancer diagnosed in dogs and cats and can affect ANY portion of the body. Typically seen in the gastrointestinal tract in cats, lymphoma can also result in masses that affect the tonsils, the nasal cavity, and potentially the retrobulbar area. The treatment of choice with lymphoma is chemotherapy. The anticipatied response rate in cats with lymphoma is 60-70% with a median remission duration of 1 year. (NOTE: I am NOT sure that I understand what that means?) Radiation given in a hypofractionated (???) protocol and prednisone can also be used to address this disease with a good outcome being 6-12 months. (I am afraid to ask, but Does that mean that even WITH the treatments the cat can be expected to live 6-12months at best?)

SO IF ANYONE HAS ANY ADVICE, IDEAS, EXPERIENCE THEY CAN SHARE WITH ME PLEASE DO! I NEED ALL THE HELP I CAN GET!!!!

Thank you!!

Karen

[Diana R.]

Karen:

What did they tell you was the cost to get a biopsy of the mass without the MRI/CT scan. Serenity would have to go under anesthesia so they could do the biopsy. I have never had and have never been told that MRI/CT scan was necessary in order to diagnose cancer and I have had many cats who have had cancer. They have had surgery to get a biopsy and then send it off to the lab for analysis. I can tell you that the prognosis for SCC is poor. Charlie was the exception to that, he lived 18 months after the diagnosis and he was on feldene, clindomyicin and had a feeding tube in. Gemini, who had lymphoma in the nasal area only lived 6 months and the chemo was not working with her. Junipurr, on the other hand, who has lymphoma, was given a 6 month prognosis and has been on the chemo and in remission for 2 years. I had another cat Gideon with GI lymphoma who lived 2 years post-diagnosis until he was 19 and I don't think the lymphoma killed him.

Refractive means that SCC is resistant to chemo and radiation. Palliative has to do with reducing not curing the symptoms and essentially make them comfortable. With the SCC, though prognosis is not good and typically 6 months. With the lymphoma, they are saying that 60 -70% of the cats will respond to the chemo and if they do will go in remission and live on average a year---but again they typically need to stay on the chemo. It seems they are saying she could go on radiation and prednisone rather than chemo which would not be as good as the chemo and still live 6 - 12 months.

I guess I would ask the oncologist about doing a biopsy without the MRI so you know what cancer you are dealing with and then they can look at the protocol for that cancer. Diana

[MissWhiskers]

I hope everyone had a nice 4th of July holiday!
I wanted to let you all know that I took Serenity for her one week recheck with the Oncologist, Dr. Christine Manley. Her office might e-mail me a more detailed report like last time, but this summary was on my receipt for today:

Serenity's mass has shown a mild to moderate response to steroids and L-Asparaginase. Her weight is 5lbs today which is a slight decrease from last visit. We have given aother dose of L-Asparaginase(known as Elspar) today and will monitor closely for a response. We have also discussed placing a feeding tube in Serenity. The Radiation Oncologists I recommend are .. They may be able to work with you on a schedule that both benefits Serenity and is amenable to you. Please recheck with us in one week or call with an update in one week and we can make a decision regarding the next best step depending on how her mass responds to today's treatment. Thank you...

So it seems to me that things are as well as can be expected!? The Dr can't say for sure that it is Lymphoma VS Squamous Cell Carcinoma, but remember she does not have the big, main diagnostic results to go on - due to my financial constraints. It does seem to me that we are proceeding with the plan we made if we thought it was Lymphoma. And I think the response after this second injection of Elspar might be even more indicative of Lymphoma vs Squamous Cell Carcinoma. The Dr. says I can go ahead and start seeing the Radiologist - except that I don't any money for that! THAT is my BIGGEST CHALLENGE now!!! That and feeding her more to hopefully gain some weight back. She usually weighs about 6lbs. She weighed 5.2lbs a week ago. She has a very good appetite she just can't do it by herself. I will increase how often and how much I feed her. I already was trying to feed her as much as possible - I will just have to try harder! Right now I am feeding her liquefied A/D that Carol told me about. She likes it fine. I might also look into that Royal Canin that I think Critters told me about.
If anyone has any suggestions for me along these lines - please let me know!!

Thank you as always,
Karen

[Diana R.]

Hi Karen:

Sounds like things are going as well as can be expected for little Serenity. I know cost is a consideration but I would strongly consider having a feeding tube inserted. I would have lost Charlie a lot sooner if I had not done that. If you do have a feeding tube put in place you may want to use IAMS Maximum Calorie. If you continue to feed her by mouth, I know my cats preferred the A/D to the IAMs. Hope the mass continues to respond to the chemo. Diana

[CarolC]

Jean had great success with feeding tubes, too, I wish she was still here. I agree about the Iams, I tracked down a vet clinic in town that carried it and bought some after reading about it, thinking it might be better than the a/d. It may be better for putting in a feeding tube where they don't taste it, but when you open the can it is just gross.

Baby food like turkey or chicken is not balanced and has fewer calories than a/d, but if you cat likes baby food and you want to give it for a change, you can stir taurine into it. I used to buy Gerber Turkey (pure turkey) and break open a 500 mg capsule of taurine and stir half of it into a jar of turkey. My cat liked it.

But nowadays with baby food going for 90 cents a jar (it's ridiculous), you might as well buy the a/d.

I got a Cuisinart Mini-prep for pureeing cat food. (It was on sale for $29, I don't normally buy designer cookware.) With it I was able to take some flavors of regular canned cat food and puree it down. I don't remember which flavors worked anymore. Some still had little bits of bone in them that made it hard to syringe feed, but some sort of worked. It helps to add a little water. If you know anybody with a baby food blender, you might try it. If you can make some of the regular-priced cat foods into something you can syringe feed, it would save money.

[MissWhiskers]

Oh dear - about 2 am Wed morn I noticed that there was swelling around Serenity's other eye and redness. I would say it was rather sudden as it was not like that a couple of hours earlier. Unfortunately the Oncologists office is closed on Wed. I did leave them a phone message. I am wondering if it could be an allergic reaction versus that the tumor or neoplasia moved or spread?? I mean as fast as it happened?? There was one day that the other eye was like this - that is, swelling and redness AROUND the eye aea. That prompted me to take her for a "recheck" which is about when the Dr. started referring to her eye as "protruding". I guess the question is "Could a cancerous lesion move that fast?? or is it more likey a reation fo somethy else?"

Karen

[CarolC]

Could you possibly post a photo? Are you saying it is the "third eyelid", the swelling is coming up from the corner of the eye and around the eyeball? Is it bright red, any blood?

[MissWhiskers]

Carol, I just got home from work and saw your suggestion - we don't have internet access where I work. I will probably try to take a photo and post it. I am not very knowledgeable/proficient about those kind of things, but it does sound like a good idea. First I have to feed her and then run to the vet for a refill of Buprenex - so it will be a couple of hours.
The 3rd eyelid is showing more than usual, but it is more like a swelling aroundthe eyesocket, and there is no blood but you can see through the fur enough to see the skin looks pink.
I don't know much about cancer but I am starting to think it might be more like an allergic reaction. Maybe I should think if or what we might have done differently right before this "flared up".
And thank you - just knowing that there are people out there listening is very reassuring! As it is I am pretty much freaking out!



Karen

[Christine]

Here are her pictures. Karen, she looks so tiny and sweet.

[MissWhiskers]

Thank you Christine.

The lower photo was from about a week ago and her right eye was absolutely fine. The left eye had been the only one that had been affected by what they think is a cancerous lesion somewhere between the TMJ and eye which was pressing on the eye causing it to protrude and she was unable to close those eyelids. But she has received Elspar injections 2 weeks in a row and getting steroid injections and that has greatly reduced that situation.

The top photo shows the right eye and area around it swollen and the skin under the fur looks pink. This came on suddenly and reminds me of an allergic reaction to something. The meds she is currently taking are:
1. Buprenex, 1 ml every 12 hours (for pain)
2. Dexamethasone, 2ml injection once a day (steroid)
3. Neo-Poly-Bac ointment for the left eye 4 times a day

Other than the way it looks it doesn't seem to be affecting how she feels which has been better with the Elspar and steroids. Also she has a very good appetite but still can't open her mouth completely due to the problems on the left side, so I am still feeding her Science Diet by syringe.
I will be taking her to the Radiology Oncologist for a consultation next week.
Thank you,
Karen