Cancer in cats

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Cancer in cats is the leading cause of death in older cats. While there are a number of similar neoplasia and indeed treatments, much less is understood about feline than human cancer.

Not all human treatments can be applied, not due to a lack of understanding, but to the thorough understanding of what a cat will find an acceptable quality of life. While, for example, human bladder cancer may be curable with radical surgery, a cat will not tolerate the ostomy that will be required to manage the urine flow.

Specific cats, however, will accept treatments others will not. Therapy for cats always must be individualized, although there may be non-obvious things common to cats. A cat's loose skin, for example, lets it accept a subcutaneous injection with little or no discomfort, while the same cat will desperately resist a pill, and perhaps also liquid squirted into its mouth.

Veterinarians, to treat it effectively, must:

  1. Dispel myths
  2. Establish a team
  3. Deliver care: "TLC" approach to staging, supportive care, disease-modifying care

Ogilvie and Brown use the TLC abbreviation both for "tender loving care," and for assessment:[1]

  1. Tissue diagnosis by biopsy and histopathology
  2. Location of the primary tumor, nonmetastatic effects on other organs, and distant metastases if present
  3. Condition of the patient, both cancer-related such as paraneoplastic syndrome and cachexia, but also, remembering the typical cat with cancer is old, overall geriatric health care,

Quality of life

Hospice and palliative care increasingly is a viable option, sometimes to avoid or defer euthanasia. Not all owners and veterinarians are aware of alternatives in veterinary hospice and palliative care, where there is no intent to cure the disease, but to extend a comfortable quality of life. This will require a team effort for training those who will give home care, the availability of needed treatments, and the commitment of the caregivers. Some palliative care regimens will require injections or other drug administration every 8, or even ever 4 hours.[2]

Nevertheless, it can be quite effective, giving months or even years of additional life with good quality. Owners also must recognize the disease may rapidly progress and it will not help. Palliative care includes both pure comfort measures, but also radiotherapy and chemotherapy intended to slow, but not eliminate, tumore growth.

Euthanasia

Euthanasia is an immensely difficult decision for owners closely bonded to their cats. Many factors go into deciding if, and then when, it is appropriate. Clearly, if the cat is in severe distress that cannot be relieved, it is the humane thing to do. The cost of treatment, or even its availability, may be prohibitive.

The cat does have input into the decision, even though it will need interpretation. One cat, who is extremely athletic and active, may be emotionally upset by any disability. Another cat, highly socialized and fairly sedentary, may be much more tolerant of his disease and its treatment. Will the cat communicate well if he is not feeling well, and thus get treatment, or will he hide?

Treatments must be individualized: if a cat resists oral medication, injection, or even transdermal gels, may be options -- these may need to be compounded by a specialized pharmacy.

A rule of thumb used by the Tufts University Veterinary School pet loss counseling line is to decide what three things a cat loves most. When he can no longer do them, euthanasia is probably appropriate. If the cat does what he wants and appears happy, weight loss and visible damage are not, in themselves, grounds for euthanasia.

References

  1. Gregory K. Ogilvie and Antony S. Moore (2001), Feline Oncology: A Comprehensive Guide to Compassionate Care, Veterinary Learning Systems, ISBN 1888254535, pp 1-4
  2. Guidelines for Veterinary Hospice Care, American Veterinary Medical Association, April 2001; reaffirmed April 2007