Lymphoma or Cholangiohepatitis - Any experiences?

[Nasicus]

My lovely 13yo moggie Boo (aka Beep or Beeper) started to look a wee bit skinny towards the end of last year/start of this year. Feeding her up didn't work, so following bloods and a freeT4 test we had a course of antibiotics and milk thistle supplement, followed by treatment of a very low does of thiamacare as whilst her results were odd, vet suspected hyperthyroidism. A month of that didn't make much or enough of a difference (and in fact was starting to over suppress the thyroid) so we took her off of that and last monday took surgical biopsies of her liver and gallbladder.
Results came back and the vet rang yesterday, and the results from the lab are a tossup between Lymphoma or Cholangiohepatitis (CCHS). Apparently they both look very similar so can be hard to tell apart, so whilst the vet is speaking to some other people to get their opinion on the results, we'll probably be taking more blood and sending off the haematology to see if they can identify the type of white blood cells present and hopefully get a concrete diagnosis.

I've got all my fingers and toes crossed it's CCHS, as that's fairly easy to treat/manage/and in a good number of cases cure. And I'm hopeful that it is as whilst she initially lost weight, it's since been stable and condition wise she looks fine, lovely glossy coat, not particularly ribby or hippy, just a skinny cat. She's just as active, affectionate and vocal as she's always been.

If it IS lymphoma though, then we'll need to determine if it's low grade or worse. I'm not sure I would put her through the chemotherapy, I know it wouldn't if it's high grade as it seems to only give them 4-9 months more on average.
But low grade seems to be a different kettle of fish, with oral steroids and chemo being administered daily, giving them up to another 2 years.

Has anyone here had any experiences with either low grade lymphoma or CCHS? How did your cat respond and get on with treatment? How much did it cost? I hate to bring cost into it, but we've eaten up about £2k out of a £4k max benefit policy, and we're still not quite there with the diagnosis yet, so I need to be financially prepared for the cost once the policy limit is reached.

For your viewing pleasure, here's Beep in all her post surgery, baldy tumtum, methadone high glory ?

 

[AmyMay]

At 13 years old she’s had a wonderful, long life.

I’m afraid no animal of mine would be put through chemotherapy.

 

[Nasicus]

At 13 years old she’s had a wonderful, long life.

I’m afraid no animal of mine would be put through chemotherapy.

Yes, she's 13, but by no means an 'old' cat nor is she at deaths door.

I was hoping to get experiences from people who have treated low grade lymphoma, as like I said, I wouldn't do chemo for high grade, the risk to reward ratio is far too small for it to be fair or ethical.
But for low grade, it's a different type of chemotherapy, a daily oral pill. Chemotherapy in animals isn't the same as nor as nasty as the chemotherapy used in humans, so I'm interested to know other peoples experiences with it, not so much opinions.

 

[fiestiemaestie]

All the cats who have had chemo that I have met and helped (CHOP/COP protocols) have tolerated it really well, and have a much better quality of life than they had pre treatment as they felt so much better!
The ones treated palliatively with just steroids have not had more sad ends and they tend to go downhill rapidly.

 

[Boulty]

I have known of a few cats with low grade lymphoma who have had a few nice years with good QOL on minimally invasive treatment (mainly oral steroids plus or minus chemo). If this has been going on since the start of the year & she has no obvious abdominal masses then would guess that high grade highly unlikely as would have likely progressed by now & she'd be unlikely to be as well as she is.

The one I had with suspected high grade lymphoma went downhill very quickly & was PTS within about week of finding the mass (he went from vaguely unwell to poorly enough we decided a biopsy under GA to stage / guide potential chemo would be unethical within the space of a weekend & FNA wasn't conclusive). He'd been in the vet just over a month prior after getting in a fight & with no obvious mass & it was just a bit smaller than my first when we found it & already spreading to his kidneys.

Fingers crossed you can get an answer soon & work out the best way forward

 

[Nasicus]

All the cats who have had chemo that I have met and helped (CHOP/COP protocols) have tolerated it really well, and have a much better quality of life than they had pre treatment as they felt so much better!
The ones treated palliatively with just steroids have not had more sad ends and they tend to go downhill rapidly.

Thankyou Fiestie, it's good to know that the chemo helped rather than hindered!

I have known of a few cats with low grade lymphoma who have had a few nice years with good QOL on minimally invasive treatment (mainly oral steroids plus or minus chemo). If this has been going on since the start of the year & she has no obvious abdominal masses then would guess that high grade highly unlikely as would have likely progressed by now & she'd be unlikely to be as well as she is.

The one I had with suspected high grade lymphoma went downhill very quickly & was PTS within about week of finding the mass (he went from vaguely unwell to poorly enough we decided a biopsy under GA to stage / guide potential chemo would be unethical within the space of a weekend & FNA wasn't conclusive). He'd been in the vet just over a month prior after getting in a fight & with no obvious mass & it was just a bit smaller than my first when we found it & already spreading to his kidneys.

Fingers crossed you can get an answer soon & work out the best way forward

I'm hopeful that if it IS lymphoma that it's low grade, as like you say, it's been a while since first noticed and apart from slow loss of weight/condition she's absolutely fine otherwise.
The vet has gone back to the pathologists and basically said 'can you look again but a bit harder please' to try and get a solid diagnosis, so fingers crossed we'll get somewhere soon!
Otherwise she's just as shouty and demanding as always, running across the keyboard during video calls and ramming herself under the duvet covers and into my arms for bedtime cuddles.

 

[Nasicus]

Update: Sooo turns out it's low grade lymphoma in the liver, which is a bummer, but certainly not worst case scenario, when this kicked off we scanned her to look for masses and found nothing.
I decided to give the chemo a go, a lot of reading and discussion with my vet reassured me that side effects should be minimal to non-existent. I was pleasantly surprised to find that it's 2 pills given every 2 weeks, alongside 2 steroids a day for 7 days then 1 every other day.
Boo has her first chemo pills on friday, and has been absolutely fine and normal besides being hungry from the steroids, which is fine by me as weight loss was what kicked this all off. We'll test her blood again around October the 5th to see what impact it's made and how her liver etc is handling it all. I was expecting vomiting post chemo pills as she's always been a pukey/regurgitating cat anyway, but none what so ever which is great!

 

[Nasicus]

Further update: Boo has had her second lot of chemo pills last friday, and is continuing to do really well! No side effects from the chemo what so ever, the steroid every other day has had the effect of increasing hunger/thirst, but this has worked quite nicely as she's now putting on a bit of weight/condition and is looking and feel pretty much like a normal cat again, hips and spine nicely covered. Will have bloods taken in the next week or two and will be interesting to see what the results will be!

 

[AmyMay]

I’m so pleased she’s responding well.

 

[Nasicus]

I’m so pleased she’s responding well.

Thankyou AM, I am too! I've been watching her like a hawk for any signs of negative side effects and so far none so fingers crossed that continues!

 

[Nasicus]

Figured I'd give a further update!
Beep's still beeping about, she's not put much weight on since last update and I think on last weigh in had lost about 100g. Her liver parameters weren't great on last check, not awful, but not quite where we'd expect them but Vet suspected it might be the steroid dose suppressing it, so she was dropped from one every other day to half every other day and we're due to blood test again soon. Still no issues with the chemo pills which is great!

In herself though, she's great, same as she's always been! She's eating well and her coat is lovely and shiny! She's now being fed a mixture of Natures Variety Kibble and Wainwrights Kitten Kibble, no exact science as it's all just mixed together in the storage box, but I suggested the idea of adding kitten food for the extra calories to the vet and he thought it was a good idea and worth a try.

 

[Nasicus]

Beep continues to Beep!
Still having the steroids and chemo pills. I mentioned in the last post she'd dropped down to half a steroid, a follow up blood test showed her liver parameters got worse, so she was bumped back up to one. Blood test again this month to see how it's all going.
In herself she's the same as always, although she is looking a bit skinnier currently. We've gone through various foods since the last post, as she'd eat something and then change her mind and refuse to touch it. Currently feeding Felix as Good as it Looks, that's been accepted for about 2 months now, not really what I'd like to feed but at this point it's whatever. She probably eats 3-4 pouches a day, if she asks for more she gets it.
So that's 10 months on the steroids and chemo pills, and despite being a bit scrawny she's doing just fine otherwise

 

[Nasicus]

Final Update on Boo, she was peacefully PTS yesterday. Her blood tests last week showed that she had developed Hyperthyroidism after all, alongside the Lymphoma and worsening Liver Parameters. The final nail was her having a mild focal seizure yesterday, mostly likely a symptom of the hyperthyroidism, but we could not treat it due to the medication being contraindicated with liver diseases. So the decision was made to put her to sleep peacefully whilst she was still happy and comfortable and before the inevitable decline which was likely about to start.

For anyone who may find this thread in the future whilst searching for experiences with cats and chemotherapy (Specifically chlorambucil tablets and steroids in this case), if you asked me if I would do it again, I would say that yes, I would.
Boo's side effects of the chemo were pretty much non-existent. She was the same cat as she always was. For a time we did see an improvement in her body condition and her weight was stabilized, until the hyperthyroidism took hold. The side effects of the steroids used in conjunction with the chemo did a great job in increasing her appetite, which really helped. Even when the hyperthyroidism cropped up, she was still hungry and packing food away.

Rest in Peace, Boo.

 

[Ratface]

I'm so sorry that you have lost the wonderful Beep. She had the best possible life with you, and when she became ill you gave her everything that you had and that she needed.
I hope that when the initial misery of her loss is tempered a little by the passing of time, you will look back at the lovely times that you shared together, and smile.
Much love and deep condolences.

 

[Nasicus]

I'm so sorry that you have lost the wonderful Beep. She had the best possible life with you, and when she became ill you gave her everything that you had and that she needed.
I hope that when the initial misery of her loss is tempered a little by the passing of time, you will look back at the lovely times that you shared together, and smile.
Much love and deep condolences.

Thank you for those very kind words, RF

 

[Ratface]

Sorry, my wretched old phone misnamed Boo.
Sincere apologies.

 

[Nasicus]

Sorry, my wretched old phone misnamed Boo.
Sincere apologies.

No not at all, she went by Boo and Beep

 

[Kunoichi73]

Sorry to hear about Boo. She had a lovely face, reminded me of a friend's cat who was PTS recently.

 

[View]

So sorry you have lost your wonderful friend. RIP Beep

 

[SEL]

I'm sorry you lost her xx I think it sounds like you made the right decisions at the right time for her but I know she'll be very missed xx

 

[Nasicus]

Thanks all, bit of a weepy weekend, definitely missing our bedtime spooning/cuddles. But I'm at peace with the decision at least.

 

[Ratface]

Please don't take this suggestion as condescending: have you looked up the seven stages of grief? As almost everyone who has lost beloved animals and people will know, the progression is often not linear but goes backwards and forwards, and often pounces at unexpected/ inconvenient times.
Much over.

 

[Ratface]

The predictive text strikes again. Much love. Not over!

 

[Nasicus]

Please don't take this suggestion as condescending: have you looked up the seven stages of grief? As almost everyone who has lost beloved animals and people will know, the progression is often not linear but goes backwards and forwards, and often pounces at unexpected/ inconvenient times.
Much over.

Not condescending at all RF, for someone who isn't aware of the seven stages, it can be very difficult to navigate! Thankfully (or not, depending on how you look at it), I'm quite well acquainted with the stages, and like you say it's definitely not a linear experience!

 

[Supertrooper]

My beautiful Mog has just been diagnosed with we think low grade lymphoma. We aren’t going to do biopsies but his kidneys and intestines are abnormal on scan.

Just waiting for rest of bloods in case he needs extra B12 etc but with the reassurance of the senior vet who I trust I think we will start him on steroids & chemo. It could give him an extra few years and minimally invasive for him.

We need to get his appetite better and put some weight back on him.