A Cat with Cancer - Difficult Decisions

A Cat with Cancer brings sadness and difficult decisions to its human loved ones. This case involving feline adenocarcinoma of the mammary glands illustrates this well.

Hello. I'm writing to ask your opinion on a few things that are keeping me from making a final decision about my dear 12 year old kitty.

Her name is Kiki ...she has been a light in my life and now that she needs me to decide for her, I just want to make sure I used all sources of information. Loved this concept of your website to ask for help to specialized professionals halfway across the globe.

The story goes like this...

In March 2010, Kiki had a surgery to remove a mammary tumor with about 5cm. Only the tumor was extracted, not the entire chain.

The X-Ray post-surgery showed no presence of metastisis and the biopsy said:

"It identifies broad ill-defined lesion, inserted within the breast tissue. It is constituted by tubular proliferation of atypical epithelial cells, associated with extensive necrosis. These elements have a high index ______(?) (up 7 per field at high magnification), large vesicular nuclei and little cytoplasm. The limits of the tumor are poorly defined and the periphery is observed lymphatic vessels containing clusters of cells into the lumen.

Diagnosis: Cribriform breast carcinoma grade 3 (high malignancy), with vascular permeation."

(long story short: the vet mistakenly gave us the wrong report at the time and we only got the real one today..)

In October 2010, the tumor has returned and it's huge: it seems there are several, in a total mass of about 6cm in diameter. It's already ulcerating.

The Veterinarian who did the procedure, does not advise to operate any further and only suggested to have her using a body-suit to prevent her from licking thus allowing it to heal and to take some pills (antibiotics) to help the healing process.

For now, Kiki is eating really well, she sleeps and plays around. Since this Vet's attitude seemed a bit like giving up, we decided to consult another Vet.

This time, the scenario was quite different. She advises us to operate her to remove the entire chain. She re-did the X-Ray and some blood tests.

The X-Ray continues to show no presence of metastisis but the blood tests showed a kidney deficiency of about 75%. As such, after surgery she would need serum (?) for the period of 5 days.

Kiki is using the body suit for only 3 days and since she started using it, she has become depressed... Although she continues to eat, she doesn't move all that much... I'm guessing she doesn't feel all that comfortable and I think she's becoming tired of all this coming and going to the vet and having to swallow pills, which she hates.

I'm more inclined to operate her and remove the chain, but I fear for her kidneys and for her spirit... since she appears to be so depressed, with the pain from the surgery she might let herself go... I'm also afraid that operating will strengthen the tumor even more.

So what I need is just some guiding tip, based on your experience. From what I see, she is still well, with no sign of pain.

We are leaning towards the surgery and we want to do it as soon as possible. Thanks in advance for a speedy reply, for Kiki's sake.

Best regards,
André Luís

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Dear André,

First, let me say that your devotion to your Kiki is to be commended. She is a lucky cat to have you caring for her. Also, let me say that I am sorry for the difficulty you and Kiki are experiencing. Having a cat with cancer can be very stressful.

There is no right or wrong answer. Morally, ethically, or medically. Many of my clients who have a cat with feline cancer have chosen surgery at this point; many have opted not to have surgery. Whatever you do, I would stick with your second vet.

The body suit that you are referring to is certain to dampen her spirits. My other concern is that when we "bandage" an infection, we run the risk of keeping it moist and promoting the growth of bacteria. This is ok for a very short period of time, but not long-term.

If you want to do everything you can to save your cat with cancer, surgery would definitely be the direction to follow. The entire cat mammary chain should be removed and, in the not so distant future, if all is going well, the other chain should be removed.

Such a surgery probably sounds painful and scary to you, but in the hands of a competent surgeon, it is actually not so horrible. The feline mammary glands all sit right beneath the skin and the surgery does not involve opening up the chest or abdomenal cavity so in many ways, a common "spay" procedure is more serious and risky.

Of course, there is some pain associated with the surgery, but there are pet meds that can alleviate most of this pain. If your vet administers pain relief medication, the pain Kiki experiences can be kept to a minimum.

There is no way of knowing if Kiki's kidneys will be worsened by the surgery. There is certainly a reasonable chance they will not be harmed further if certain precautions are taken. I would administer IV fluids for 3 days at a rate approximately 3 times her body weight in pounds, with the fluids being started several hours before the procedure. This can be very protective for the kidneys.

Thank you for the picture! She is beautiful and has such an expressive face.

I sense the right answer is in your heart already and that is to go ahead with surgery and I sense that it is the best answer for Kiki as long as you understand there are no guarantees when any cat with cancer undergoes treatment.

I wish you well and hope you will keep me up-to-date on her progress.

Best Wishes,
Dr. Neely

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