Palliative Care For Cats With Lymphoma
Lymphoma is one of the most common types of cancer in cats. It is a cancer of the white blood cells that can occur anywhere in the body. It doesn’t always show up in the blood work – usually we need to take biopsies or samples of tissues to diagnose it. The clinical signs of lymphoma depend on what organ is affected – if the lymphoma is in the stomach or intestines, you will see vomiting and diarrhea; if it’s in the brain, seizures; the nose, discharge; etc. The treatment of choice for cats with lymphoma is usually chemotherapy. The chemotherapy options range from medications that you can give orally at home to once weekly injections of rotating chemotherapy drugs. Chemotherapy is not usually a cure; however, it is a way to achieve remission. It almost always comes back eventually.
If your cat is diagnosed with lymphoma, you have some options. The biggest choice is whether to pursue chemotherapy. Most cats tolerate chemotherapy quite well with no side effects, but if your cat is one of the 1-2% who has serious problems with chemotherapy, or the 10% who has mild problems, chemotherapy can be difficult. If you choose not to pursue chemotherapy, there are other options. These options would be classified as palliative care, because we are not aiming to cure the disease – we are aiming to control symptoms and maintain a good quality of life for as long as possible. There are no treatments that are going to cure lymphoma without aggressive care, such as surgery or chemotherapy. Palliative care is used to manage symptoms, and can be used alongside definitive therapy or by itself.
The most commonly used palliative care option for lymphoma is steroids (usually prednisolone. Steroids help decrease inflammation and can also shrink the lymphoma cells. They increase appetite and energy level as well. Usually, this improvement only lasts about 2 months, but sometimes we do see a longer improvement. The side effects of steroids of increased drinking, urinating, and panting are more commonly seen in dogs than in cats. Steroids can lead to diabetes in cats, but usually at high doses for a prolonged period of time. If your cat is drinking more and urinating more on steroids, it is best to get their blood sugar checked. Steroids can also unmask heart disease – if your cat had heart disease that was not apparent (called subclinical), the addition of steroids can sometimes cause them to develop heart failure. If this occurs, we need to discontinue the steroids and treat the secondary heart failure. Steroids should not be stopped abruptly – if you start steroids, make sure to check with your veterinarian before stopping them.
Other things that can help a cat with lymphoma feel better include:
Appetite stimulants like mirtazapine
Vitamin B12 injections – many cats with lymphoma of the GI tract are deficient in B12. If we don’t supplement them, they don’t feel good.
Pain medication – in general, lymphoma is not a painful disease; however, cif you have an older cat they often have arthritis as well and can feel quite worn down. Pain medication like gabapentin or buprenorphine (amongst others) can help.
Acupuncture can sometimes help with a cat’s mobility and appetite
Anti-nausea medications
Anti-diarrhea medications such as probiotics, metronidazole
A good well balanced diet
If your cat with lymphoma is not eating, that is usually a sign that they are getting sicker and death may be coming soon. If your cat is comfortable other than not eating, and appetite stimulants do not work, you can consider having a feeding tube placed directly into your cat’s esophagus so that they can maintain proper nutrition.
Having a cat with lymphoma is difficult and there will be good days and bad days. It is important to monitor your cat closely and make sure that they feel as good as possible for as long as possible. You should work closely with a veterinarian that you trust to help manage all of the symptoms of lymphoma.