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Lymphoma in Cats- Signs, Treatments, & Prognosis - Ethos Veterinary Health |
Living With Lymphoma - Catwatch Newsletter.
Lymphoma in cats prednisone.Pet Owners -
Lymphoma in Cats - The Pet Oncologist.
Nasal lymphoma: Cats with lymphoma in their nose often have swelling in their muzzle and face, discharge from the nose, and frequent sneezing. Nasal lymphoma is unique in that it sometimes is completely localized to the one area.
Multicentric lymphoma: In this cancer, lymph nodes throughout the body are affected. Common lymph nodes that owners notice are on the neck under the chin, in front of the shoulder blade, in the armpits, in the groin, and behind the stifles knees.
Once your veterinarian has identified either a tumor or suspicious lymph nodes, she will likely recommend a biopsy or fine needle aspirate FNA to get a definitive diagnosis. An FNA is the cheapest and least invasive method, however.
To do an FNA, the veterinarian will insert a needle into either a tumor or a suspicious lymph node and extract cells for evaluation under a microscope. In addition, not all areas of the body are accessible to FNA. That said, FNA can be a good place to start, especially when a full biopsy is not an option.
If a decision is made to seek a biopsy to rule out intestinal lymphoma, an endoscopic biopsy may be an option. Endoscopy requires anesthesia so your cat will sit still while a tiny flexible fiberoptic camera is passed into her gastrointestinal tract to inspect it and to obtain tissue samples, but it is less invasive than obtaining biopsies via laparotomy surgical incision into the abdominal wall. Biopsies obtained via endoscopy and laparotomy appear to be equally effective at providing useful diagnostic information.
When a sample is sent to a lab for histopathology analysis under a microscope and determined to be lymphoma, the pathologist will give it a grade based upon a number of factors, including cell size, appearance, and architecture. The grade indicates how aggressive the cancer appears to be and is useful for determining the best treatment option for your cat and her prognosis.
Low-grade or small-cell lymphomas have cancer cells that divide more slowly. This grade is less malignant and usually more responsive to chemotherapy. High-grade or large-cell lymphomas have rapidly dividing cancer cells and are more aggressive. These cases are more difficult to treat. The downside is that it can be expensive. The cancer cells are still around, however, and may take off again in the future.
Many cats with lymphoma achieve full or partial remission with treatment. 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.
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. In my opinion, there are three basic options for chemotherapy of feline lymphoma:. Like with dogs, the answer is: it depends. Cats treated for small cell intestinal lymphoma often live years and some can even discontinue chemotherapy. More aggressive forms of lymphoma like large cell lymphoma may only survive months despite multi-agent chemotherapy. A board certified veterinary oncologist can give you the most accurate prognosis for your cat.
Ann Hohenhaus is a third-generation veterinarian, double board certified in Oncology and Small Animal Internal Medicine. November 23, Cats Oncology Share. 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.
Last spring I wrote about canine lymphomaso in honor of Cancer Awareness Month, I thought I would do the same for feline lymphoma. Lymphoma is cancer of the immune system. The immune system is distributed throughout the body to protect against infections. Lymphoma in cats most commonly affects the gastrointestinal tract, although since the immune system is distributed throughout the body, lymphoma can be seen in any organ in the body including the eyes, in front of the heart, and in the kidneys, liver or spleen.
Unlike canine lymphoma, feline lymphoma rarely occurs in the lymph nodes. In cats and also humans it is not a single disease, but is probably more than 20 different diseases; each of the 20 or so forms of lymphoma behaves somewhat differently and the prognosis varies between types. The most common form of lymphoma we see in cat intestines is called small cell lymphoma.
We also see an intestinal variant called large cell lymphoma. The photomicrograph on the right shows a rare form of feline lymphoma called large granular lymphoma. The name comes from the granules seen in some of the cancerous lymphocytes. 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. In my opinion, there are three basic options for chemotherapy of feline lymphoma:. Like with dogs, the answer is: it depends. Cats treated for small cell intestinal lymphoma often live years and some can even discontinue chemotherapy. More aggressive forms of lymphoma like large cell lymphoma may only survive months despite multi-agent chemotherapy.
A board certified veterinary oncologist can give you the most accurate prognosis for your cat. Ann Hohenhaus is a third-generation veterinarian, double board certified in Oncology and Small Animal Internal Medicine. November 23, Cats Oncology Share. Tags: amcny, animal medical center, animals, ann hohenhaus, cancer, cats, feline, lymphoma, NYC, Oncology, pets.
About the Author. Related Posts Oncology. Back to blog.
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. Twenty-eight (%) of 37 patients with available steroid dosing information received prednisone or prednisolone at a dose of 5 mg PO every Treatment with a single chemotherapy drug. This is most commonly used in intestinal small cell lymphoma. Steroids and chlorambucil can keep a. One study has reported excellent results in cats with chronic lymphocytic lymphoma using a protocol of prednisone (10 mg PO per cat per day) and chlorambucil . 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. Forgot your password? In some cats the response is somewhat shorter three to six months. At this low dose side effects are extremely uncommon.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 ravenousness , weight 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 lymphocytic , poorly differentiated high grade, lymphoblastic, or immunoblastic , and 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.
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