Feline mammary tumors: Dante-esque options and uncertain outcomes
What would you do if your pet was just diagnosed with a deadly disease? What would you do if you knew that treatment of the disease would typically help her live comfortably for almost two more years? Most of us, given the choice (assuming we are in possession of the necessary funds), would jump at the opportunity.
But what if the treatment required forty-eight hours of certain pain and discomfort? Or grueling vet visits every 21 days thereafter?
This is the position one of my new clients has just been thrust into by virtue of his cat’s diagnosis of mixed mammary adenocarcinoma with lymphatic involvement. A mouthful of diagnosis, for sure, and one that carries an inescapably grave prognosis.
When dogs get mammary tumors the prognosis is typically guarded. Removal of the offending masses is often the only treatment required, as the lumps fall into the benign category 50% of the time. While they can be malignant (horrifically so), the odds are not so dramatically stacked against dogs with mammary cancers.
When during the course of a physical examination we discover bumps on a cat’s belly, usually adjacent to her nipples, the expression on our face will change as we consider how best to inform you of your seemingly healthy cat’s potentially impending death. The disease is that aggressive and deadly for almost 90% of cases, even when discovered early. A full 17% of all known cancers in cats will be of this variety.
And there’s nothing you can do to prevent it (that we know of) Spaying before the first heat is no sure-fire deterrent, as it is with dogs. (It does, nonetheless, help somewhat.)
But there is something we can do to increase your kitty’s survivability, as we like to say in our medical jargon. Treated cats can comfortably live about 600 days longer if the tumors are excised (along with all of her mammary glands) and later receive moderate dose chemotherapy injections every three weeks for the rest of their lives.
It’s no great position to find yourself in after giving your pet a cozy life of high quality food, a big warm home and lots of loving attention.
In this case, Kitty is 11 years old. She’s a tad chubby from all her yummy treats and the sedentary comforts she’s enjoyed. When she had two little nodules removed a couple of months ago her diagnosis was confirmed. Her owner was told by his then-vet that she would surely die. Too true. After a few weeks of soul-searching and online research he mysteriously made his way to my hospital (I still don’t know who referred him).
He wanted choices, especially now that Kitty had two new masses on another mammary gland. So after consulting with one surgeon and two internists we gave him choices—perhaps too many:
1-Do nothing and enjoy Kitty for the next couple of months until her condition worsens and she begins to feel sick. We will euthanize her then.
2-Put your faith in veterinary medicine and let a vet surgeon slice Kitty in two neat parallel lines: from one end of her left chain of mammary glands to the other, then repeated on the right for a total of sixteen full inches worth of fancy knife work (bilateral radical mastectomy)—not to mention two subsequent days of oblivion tinged with opiate-blunted pain.
3-Having rendered Kitty thus, let our medicine work its magic in the hands of a highly educated internist. She will insert an intravenous catheter and spill a blue liquid into her veins—one chosen specifically to seek and destroy any recalcitrant cancer cells. Repeat every 21 days.
4-Should the scalpel not appeal to your sensibilities, the drug alone may well suffice for a time. But we make no claims as to its effectiveness—this research is not yet available.
I’m sure I presented Kitty’s owner with a less colorful version of his options, but I believe I made the same fine points. He chose door number four. But he wants me to administer the drug. That might not be so simple.
That’s going to take one of my famous cheesecakes and perhaps a Christmassy poinsettia. Otherwise, my friendly neighborhood internist might not be easily persuaded to give up her magic formulas (not to mention her precious contacts with the chemotherapy drug distributors from whom we must negotiate small doses for big bucks).
At the moment I am still in the feasibility stage of this enterprise. Can I get the drug? How much do I need to order? How much will it cost us? If Kitty reacts poorly to the drug will we still be out thousands of dollars? And, most importantly, will it really help? Will we stop treatment if I see no measurable changes in Kitty’s tumor size by the end of the first 21-day drug interval? What costs will ensue then? Can I return the unused drug?
This is a perfect example of what happens when you go searching for choices in veterinary medicine. You’ll doubtless find them. But will you like them? With cases like Kitty’s it’s rare to find one you’ll really warm up to. They’re all fierce, trauma-inducing and poison-laced alternatives seemingly fashioned from deep within Dante’s third circle.
Any human cancer patient can likely relate to the above paragraph. But it’s different with our pets. Their limited cognition reorganizes our priorities and alters the stakes. Dare we put them through it? Will it be worth it? Will I hate myself forever for trying? Who am I really doing this for?
My new client’s answer: Let’s try. But if she suffers for even one day then we stop.
OK. Let’s go for it.