Living With Lymphoma - Catwatch Newsletter
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Lymphoma in Cats- Signs, Treatments, & Prognosis - Ethos Veterinary Health.Lymphoma in Cats - The Pet Oncologist |
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Feline Lymphoma: What Your Need to Know - The Animal Medical Center.
Three major types of treatments underlie all cancer therapy: surgery, radiation therapy and chemotherapy.
Since lymphoma is widespread throughout the body at the time of diagnosis, surgery is not generally used for treatment as removal of all the lymph tissue in the body is impossible, but sometimes a solitary mass of lymphoma may be removed from the intestine if the mass is causing problems for the cat.
Surgery may also be recommended to obtain a biopsy for diagnosis. Radiation therapy can be used in select cases of feline lymphoma, especially if chemotherapy stops working. However, chemotherapy remains the mainstay of feline lymphoma treatment. In my office file drawers, I have a big fat folder of articles describing various chemotherapy protocols for the treatment of lymphoma. Many of them are simply a riff on a theme.
I will provide an interpretation of results, specific details about the cancer's biologic behaviour, prognosis, and multiple treatment options to cater to the individual needs of each pet and pet owner. I will also comment on whether further testing is required and address any specific questions or concerns. I can also provide chemotherapy protocols and client handouts to pet owners about the specific cancer and chemotherapy medications, to help pet owners make an informed decision. Unfortunately, due to legal reasons, I cannot provide online pet cancer advice directly to pet owners.
However, your veterinarian will be able to discuss all these options with you before you consider treatment and can contact The Pet Oncologist with any questions or concerns. Prednisolone is a steroid anti-inflammatory that can make a sick cat with lymphoma feel much better within one to two days of administration.
Occasionally cats will go into complete remission with prednisolone alone. However, remission duration is often short-lived and lasts on average of around one to two months. Therefore, prednisolone can be used by itself or in combination with other treatment options such as chemotherapy to treat lymphoma in cats.
Back About Publications. Back Vet Education Handouts. Back Gallery For Vets. Back Contact Subscribe. All Rights Reserved. Prednisone, as discussed above, has some anti-tumor activity, but is mostly used to make your pet feel better. A median survival time of months is associated with prednisone use alone for high grade lymphoma. Prognosis for feline lymphoma is most commonly predicted by the grade high vs low , the severity of clinical signs upon presentation, location of the disease, his or her viral status, and initial response to therapy.
Small cell lymphoma low grade is associated with an excellent prognosis with most cats living two or more years on oral chemotherapy at home.
However, high grade lymphoma large cell is associated with a poorer prognosis with the majority of cats succumbing to the illness within the first year after diagnosis. Extranodal presentations such as central nervous system, renal, or bone marrow involvement often carry a less favorable prognosis even with aggressive therapy.
Conversely, nasal lymphoma carries a more favorable prognosis. Initial response to chemotherapy, usually noted within the first weeks of treatment, is highly prognostic with cats that have a complete response early on having a significantly improved prognosis over those cats that do not respond.
Lymphoma is considered to be the most chemo-responsive cancer in cats and treatment with multi-agent chemotherapy is associated with the longest survival times.
The induction part of the treatment protocol ranges from weeks. The most successful protocols use multiple drugs. This allows the veterinarian to use lower doses of each drug, minimizing side effects, while also attacking the lymphoma from multiple angles.
If a cat shows side effects to a medication, your veterinarian will adjust the treatment protocol to ensure her comfort. Approximately 70 percent of cats achieve complete remission for varying periods of time, with a median remission time of days. Cats that maintain full remission for one to two years about one third of feline lymphoma patients that are treated may survive for significantly longer periods of time i.
During complete remission, cats can live high-quality, fairly normal lives. Some chemotherapy drugs can be administered by mouth in either pill or liquid form, while others are given by injection usually into a vein. These medications can even be given at home. Injectable chemo drugs include doxorubicin, vincristine, and cyclophosphamide, and many others that may be used depending upon response, availability, and the potential side effects of each.
Treatment frequency and duration vary widely based on the protocol being used and how the cat responds to treatment. Injectable drugs require a veterinary visit and are usually given less frequently weekly or every few weeks. Treatment duration can range from six months to two years.
Some cats may need a few rounds of treatment before symptoms improve, but others can get relief as quickly as 24 hours after their first chemo treatment. If your cat comes out of remission, or her lymphoma comes back, changing to a different chemo protocol will often be successful in getting her back in remission. If a patient comes out of remission repeatedly, however, her lymphoma may become resistant to all treatment options.
Surgery will not cure lymphoma. Radiation therapy can be beneficial in conjunction with chemo in some cases, especially for nasal lymphoma. Response to treatment can be unpredictable in feline lymphoma.
Inflammatory bowel disease IBD currently is recognized as a common and important medical problem in cats. Three general types of clinical presentations have been identified in cats with idiopathic IBD: 1 a clinical course characterized primarily by vomiting, 2 a clinical course characterized primarily by diarrhea, and 3 a clinical course that includes both vomiting and diarrhea as primary signs.
Associated clinical signs can include change in appetite anorexia, inappetence, or ravenousnessweight loss, and lethargy. In some cats, the clinical signs are cyclic; they seem to flare up and then abate in a predictable pattern. Vomiting, one of the most frequent clinical signs of IBD in cats, is most often recognized as an intermittent occurrence for weeks, months, or years Affected cats are frequently misdiagnosed as having hairballs as the primary problem.
As the disorder progresses, an increased frequency of vomiting often leads the owner to seek veterinary attention. In addition to vomiting, diarrhea is a common sign observed in feline IBD and most likely is due to derangement of normal mechanisms of absorption and motility caused by mucosal inflammation. In most cases, diarrhea is intermittent early in the course of the disorder, and there may be a transient response weeks to several months to dietary manipulation or any of a variety of medications.
Later, the diarrhea becomes persistent and usually responds only to specific treatment, which is determined after a definitive diagnosis is made. Signs of small bowel diarrhea predominate, but signs of large bowel diarrhea may be evident as well if there is generalized intestinal tract involvement. Appetite changes in cats with idiopathic IBD vary from decreased appetite to complete anorexia to ravenousness. Inappetence seems to occur more commonly in cats that have vomiting as the primary clinical sign and usually occurs during exacerbation of clinical signs, and vomiting or diarrhea is not observed until later or not at all.
The three leading differential diagnoses for a cat with a ravenous appetite, diarrhea, and weight loss are IBD, hyperthyroidism, and exocrine pancreatic insufficiency uncommon. A definitive diagnosis of IBD can be made based only on intestinal biopsy. Further tests are run to evaluate the overall health status of the patient and to rule out other disorders.
Recommended baseline tests include a complete blood count, biochemical profile, urinalysis, fecal exams for parasites, serum thyroxine test, and a feline leukemia virus test. Testing for feline immunodeficiency virus should be considered in cats with chronic wasting disease.
It is important that the clinician formulate a treatment protocol based on a correlation of clinical course, laboratory and gross findings, and histologic findings rather than relying on histologic changes alone.
Corticosteroids are the cornerstone of treatment for idiopathic inflammatory bowel disorders. Mild to moderate cases often respond to prednisone or prednisolone at a starting dose of 0. Cats with inflammatory changes graded as mild usually respond quite well to the lower dose and alternate day or every third day treatment can often be achieved by two to three months. Occasionally treatment can be discontinued altogether by three to six months. I do prefer to use prednisolone over prednisone in cats with inflammatory disorders of a moderate to severe nature, as there may be improved bioavailability in some cats with prednisolone.
This dose of corticosteroid is usually well tolerated in cats. In these cases a dose of 0. Use of combination drug therapy may also be required at the outset to control clinical signs and prevent progression of the disease.
Cats with hypoproteinemia and histologic changes graded as severe often respond quite well when an aggressive therapeutic course is undertaken. When combination therapy is indicated metronidazole Flagyl is usually the first choice to be used in conjunction with prednisone.
Metronidazole's mechanism of action includes an antiprotozoal effect, inhibition of cell-mediated immune responses, and anaerobic antibacterial activity. Ideally, at least several months of metronidazole therapy is given once it is started. In some cats with severe disease long term consecutive use or one to two month cycles of treatment may be required.
Side effects to metronidazole at this low dose are uncommon in cats. Occasionally nausea or vomiting may be seen. Consistent control of clinical signs in cats with moderate to severe IBD is more difficult to maintain when methylprednisolone acetate is used alone, however. It is recommended that sole use of methylprednisolone acetate be reserved for situations in which the owner is unable to consistently administer tablet or liquid Prednidrops prednisone preparations.
Initially 20 mg is given subcutaneously or intramuscularly and is repeated at 2-week intervals for 2 to 3 doses. Injections are then given every 2 to 4 weeks or as needed for control. If remission cannot be maintained with use of corticosteroids and metronidazole then azathioprine Imuran should be used. Azathioprine is an immunosuppressive drug with a nonspecific effect.
Replication of rapidly dividing cells, including immunoblasts, is inhibited. Azathioprine is usually used in cats only when the previously discussed therapeutic measures fail to control the disease. The most important side effect of azathioprine in cats is bone marrow suppression. I use a maximum starting dose in cats of 0. At this low dose side effects are extremely uncommon. Alternatively if clinical signs of IBD do not resolve on the initial azathioprine dose the dose can be increased slightly if there is no evidence of bone marrow suppression.
Because of a lag effect, beneficial therapeutic results from azathioprine often are not apparent until 2 to 3 weeks after treatment is started. Azathioprine is generally used for 3 to 9 months in cats. A majority of cats with IBD do not require azathioprine treatment. A complete blood count should be run to monitor for anemia and leukopenia at 3 to 4 week intervals for the first 2 months and then once monthly.
Significant side effects are most often identified during the first 3 to 6 weeks of treatment with azathioprine. There is usually no physical evidence of early azathioprine toxicity in cats. Mild leukopenia e. Azathioprine is currently only available as 50 mg tablets. The low dosage used in cats requires that the tablet be broken into small fragments i. Since this is a very inaccurate and potentially dangerous way of administering azathioprine to cats, this drug must be administered in suspension form.
I have used a preparation which allows for accurate dosing of azathioprine and less chance of accidental toxicity. A 50 mg tablet is pulverized and mixed in 15 ml of V. Syrup Ft. Dodge Laboratories. This is a flavored vitamin preparation which is quite palatable to most cats.
Powdered medication mixes well with the syrup and does not seem to precipitate out appreciably. The dosage in ml is then calculated based on the cat's body weight e.
The client is instructed to shake the medication well before administering it. Alternatively, a suspension preparation can be made by a compounding pharmacy service.
A major advantage of administering azathioprine in this manner is that any required increase in dosage can be done very accurately. If azathioprine is well tolerated and there has been inadequate clinical improvement the dosage can be increased form 0. Poor responses to treatment of cats with IBD usually result from 1 inadequate initial corticosteroid dosage, 2 poor client compliance, or more commonly 3 treatment for only small intestinal inflammatory disease when colitis is present as well.
Some cats with concurrent IBD and colitis may show minimal or no clinical signs of colitis. Because dietary allergens may play a role in the cause if IBD, specific dietary therapy may be beneficial. Often, moderate to severe degrees of IBD are either temporarily responsive or only minimally responsive to careful dietary manipulations. However, long term control of IBD with as minimal a drug administration schedule as possible may be aided by specific dietary management. This should be started as soon as a diagnosis is made and continued as drug therapy is decreased later.
Chicken, duck, lamb, or venison based diets are often tried initially. A gradual change to commercial diets that are low in additives and that are formulated with chicken or lamb as their primary ingredient is then attempted.
Lymphoma is the most common feline neoplasm. It is also the most common form of gastrointestinal neoplasia in cats. Gastrointestinal lymphoma is often referred to as either well differentiated low grade or lymphocyticpoorly differentiated high grade, lymphoblastic, or immunoblasticand intermediate or mixed.
Endoscopy has been shown to be a very useful modality for diagnosis of intestinal lymphoma in cats, especially when multiple biopsies are obtained using proper technique and instruments that can procure adequate size tissue samples.
Full thickness intestinal biopsies may be required in a very limited number of cases in order to establish the correct diagnosis. Many cats respond favorably to treatment for intestinal lymphoma, especially with the low grade or chronic lymphocytic type.
Clinical signs can be very similar to cats with IBD. Therefore, it is strongly recommended that cats with chronic GI signs undergo a biopsy procedure as early as possible, so that the correct diagnosis can be established and the best course of therapy be made available for each individual cat. Multi-agent chemotherapy is recommended for all cats with GI lymphoma. Surgery is done only if there is an isolated mass that is causing some degree of luminal obstruction.
Survival times in excess of 12 to 18 months are not unusual. In some cats the response is somewhat shorter three to six months. The prognosis for longer survival time is much better if the diagnosis is made before clinical signs become chronic and debilitation results. Sixty-nine percent of the cats with lymphocytic lymphoma treated with this regimen achieved a complete remission.
The median disease free interval for cats that achieved complete remission was The median survival for all cats with lymphocytic lymphoma treated with chemotherapy was 17 months range, 0. The protocol that I have used most often was originally published by Cotter in Dosage levels have been modified slightly since that time. This protocol utilizes cyclophosphamide, oncovin, and prednisone or prednisolone COP. This protocol can be easily managed in any practice setting.
Vincristine is administered intravenously at a dose of 0. The initial doses are often decreased by approximately 25 percent for cats that are inappetent or debilitated. If well tolerated the dose can then be gradually increased. Care is taken to ensure that none of the vincristine is given extravascularly. The average volume that is administered is quite low 0.
Prednisolone is a steroid anti-inflammatory that can make a sick cat with lymphoma feel much better within one to two days of administration. Prednisolone pre-treatment decreases the susceptibility of feline lymphoma cells towards doxorubicin or vincristine treatment in vitro. If chemotherapy is not an option, due to a cat's illness or owner finances, prednisone can be used for palliative, or hospice, care. Although prednisone does. Treatment with a single chemotherapy drug. This is most commonly used in intestinal small cell lymphoma. Steroids and chlorambucil can keep a. Depending on the study, prednisone was generally given at doses ranging from 5 to 10 mg per day. For all these regimes, the results were similar. Remission. A major advantage of administering azathioprine in this manner is that any required increase in dosage can be done very accurately. The downside is that it can be expensive. Also, the haircoat may become thinner, but complete hair loss does not occur.Lymphoma is the abnormal proliferation of lymphocytes which are one of the main types of white blood cells involved in immunity. Lymphoma is one of the most common cancer in cats. It may arise in lymphoid tissues such as lymph nodes, spleen, and bone marrow. However, lymphoma more commonly arises from other tissues in the body.
Often owners will notice non-specific signs of illness, such as reduced appetite, lower energy levels, weight loss, vomiting or diarrhoea. Some cats may present with a mass and no apparent signs of illness. The signs of illness that will vary depending on the extent and location of lymphoma. Diagnosis is usually confirmed with sampling the affected organ and lymph nodes by either cytology fine needle aspirate samples or biopsy tissue sample.
Staging refers to how far cancer has grown and spread in the body. Staging is important to provide prognostic information on which to base decisions and identify unrelated problems that could affect treatment choices.
Cats are usually staged with blood and urine tests, chest x-rays and abdominal ultrasound. The results of these tests will allow veterinarians to develop individualised treatment recommendations for your cat. There are many levels of treatment options available for cats with lymphoma. If your cat has high-grade or large-cell lymphoma, the prognosis for untreated cats is guarded, with an average survival time of approximately two months or less.
Combination chemotherapy with a three to five drug combination, alongside with prednisolone is the standard of care treatment modality. It is usually administered over four months. However, occasionally cats can potentially be cured, living up to 2. However, other less costly and less effective options are available, including single-agent chemotherapy and prednisolone alone. If your cat has low-grade or small-cell lymphoma, the gold standard treatment is different.
It typically involves the use of oral administration of chlorambucil chemotherapy and prednisolone indefinitely, which owners can administer from home. That is a common initial response from pet owners when they hear the word 'chemotherapy'. However, chemotherapy in pets is much different to people.
It is essential to understand the difference between chemotherapy treatment in human and veterinary medicine. In human medicine, the main objective of chemotherapy is to eliminate all cancer cells to try to obtain a cure.
Usually, it is administered aggressively and has more chances of developing side effects. Curing cancer in veterinary medicine is desirable and feasible for some cancers.
However, due to the less aggressive approach for example, lower dosages , pets usually tolerate chemotherapy far better than humans.
The primary goals of chemotherapy are to minimise discomfort associated with cancer growth or slow the progression of cancer while striving to maintain or improve the pet's quality of life. Pets experience fewer and less severe side effects than humans. For example, when the neutrophil count drop to a critically low value and cats experience sepsis or infection.
Occasionally cats will require dose reductions or treatment breaks in order to tolerate chemotherapy. If you decide to proceed with chemotherapy in your cat, any side effect he or she experiences is unacceptable. If you have limited funds, it is still important to discuss all the available treatment options and associated costs with your veterinarian or a pet cancer specialist.
At The Pet Oncologist, I work directly with your veterinarian to provide individualised treatment recommendations for each pet. I will review all the medical information submitted via the online submission form, and provide your veterinarian with a comprehensive written report within 1 to 3 business days. I will provide an interpretation of results, specific details about the cancer's biologic behaviour, prognosis, and multiple treatment options to cater to the individual needs of each pet and pet owner.
I will also comment on whether further testing is required and address any specific questions or concerns. I can also provide chemotherapy protocols and client handouts to pet owners about the specific cancer and chemotherapy medications, to help pet owners make an informed decision.
Unfortunately, due to legal reasons, I cannot provide online pet cancer advice directly to pet owners. However, your veterinarian will be able to discuss all these options with you before you consider treatment and can contact The Pet Oncologist with any questions or concerns.
Prednisolone is a steroid anti-inflammatory that can make a sick cat with lymphoma feel much better within one to two days of administration.
Occasionally cats will go into complete remission with prednisolone alone. However, remission duration is often short-lived and lasts on average of around one to two months.
Therefore, prednisolone can be used by itself or in combination with other treatment options such as chemotherapy to treat lymphoma in cats. Back About Publications. Back Vet Education Handouts. Back Gallery For Vets. Back Contact Subscribe. All Rights Reserved. Unauthorised distribution is prohibited.
What is lymphoma? Will my cat be sick? How do I check if my cat has lymphoma? What are the treatment options available for cats with lymphoma? What now? What if I have financial limitations? Learn more about 'Lymphoma in Cats'. Subscribe to Newsletter. Like and Follow on Facebook or Instagram!
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