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Cancer in a cat's chest.

Species: Cat
Breed: Shorthair Domestic
Age: 11-15 years
Hi there,

I hope this wont be too long, but I want to provide the history of the situation, as I am really confused and scared right now about my kitty Scratch (13 YO male neutered cat). He has lost some weight over the past 8 months or so. I brought him to the vet in January and we did an Ultrasound, which showed a mildly enlarged spleen and mildly enlarged liver but for the most part, nothing remarkable in the results, so we did not do much other than try a prescription food (which he didnt like). He is a very picky eater (will love a certain brand of wet or especially dry food for a couple weeks and then no longer cares for it, and then I switch it up and the cycle starts again). I tried to not switch much anymore as I know this isnt good for his tummy. He stopped eating his dry food and I noticed he's been looking a bit thinner since then (though he's eating wet food fine). About 3 weeks ago, he started having coughing attacks, which I thought was a hairball. I tried giving all sorts of hairball remedies but nothing ever came up and he continued the coughing which became more frequent. His breathing rate was also ~40-47 breaths/min so I brought him to the vet on Wednesday. Found out he lost ~2 lbs (from 10.5 lbs in Jan). We did Xrays, which showed a possible Mass above his heart which the vet said could either be inflamation of lymph nodes or a tumor, but hard to know. She prescribed Terbutaline and Clavamox. She called the next day with Blood results, and said the abnormalities were high liver values and calcium levels, which is often seen with cancer. As for options, she said the only reason to do further diagnostics would be if I would want to do Chemo if it is indeed a cancer. She said to call next Tuesday (they were closing Fri-Mon) if he wasnt better and then we'll try another med. I asked for copies of the xrays & bloodwork but they never sent them. The meds did not seem to help and he actually started seeming worse (hiding more in the closet, coughing, and fast breathing) so today I brought him to Emergency hospital, where they gave him oxygen and ran another Xray (since I dont have my vet's workups). The vet at the hospital said that it looks like a large Mass on the lungs (pointing to a different area than my vet did). He gave us Prendisolone, and Scratch seemed to feel better and eat more since we've been home.

I know that the situation isn't good, but I am just feeling very confused about what is actually going on with him, and what are my options, especially since I feel like the two docs told me different things.
I will send the hospital xrays to your email now. I will also send the Ultrasound results from back in January, though not sure if these might be too old to be relevant now.

I would love to know what your thoughts are from looking at these. Also, would you recommend that I keep him on the Antibiotic and Brochodiallator along with the Prendsolone?
Thank you so much for your time.

Online vet, Dr. Marie

Dr. Marie replied:

I'm sorry to hear that you and your cat are going through this tough time. Often it can be very difficult to come to the right diagnosis when it comes to pets. However, from what you have told me it does seem like both vets are on the same track.

I could not open the images that you sent me, other than the ultrasound report. The most significant thing for me in the ultrasound report was the part about the spleen. The ultrasonographer said that the spleen was mottled in appearance and that there was a chance that this was from cancer infiltrating the spleen or it could be something else.

Chest xrays in cats can often be very hard to interpret. So, when you tell me that the two vets each said there was a mass but the mass was in a different place there are a couple of possible explanations for this. One could be the positioning of the xray. If you are looking at an xray of a cat lying on his back a mass is going to appear different than a cat on its side. It's also possible that there is more than one mass and one of them was more readily visible on each xray. Regardless, seeing a mass in the chest of a cat is never a good thing.

Prednisolone is a steroid. The point of the steroid is to reduce swelling. If there is a tumor then this medication can temporarily reduce the swelling of the tumor and make the cat feel better, but it would be a temporary fix. We also see prednisolone work in cases of asthma. Asthma is a common cause of coughing in cats. However, unlike cancer it shouldn't cause weight loss and it would not cause visible masses to be seen on the xray. If your cat continues to do well then your vets may talk about using a long term steroid. Many cats with asthma can get by on just a very small dose given either once daily or every other day.

Regarding the antibiotic and the bronchodilator, if they have been prescribed then it is important to finish out the prescription as per your vet's instructions. Decisions on whether or not to continue the meds will need to be made by your vet. This is not something that I can legally advise you on.

If this is cancer, then you may find that things improve for a few days or weeks because of the prednisolone but then eventually start to get worse again. At that point then some hard decisions may have to be made. If, however, things are continuing to improve after a couple of weeks you can talk to your vet about long term asthma care. However, I would caution you again, that asthma is a less likely diagnosis than cancer.

I do hope that things improve.

Dr. Marie

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Customer reply:

Thank you so much for your reply. The vet did say from the start that she does not believe it is Asthma due to his age, plus that he did not have the other symptoms of Asthma. The hospital vet said he didn't know why my vet gave him the bronchodialator, but I guess it was because she wanted to try incase it helped with the coughing (though it didn't).

I have continued the antibiotic but stopped the bronchodialator (hospital vet said that should be ok).
After starting the steroid yesterday, Scratch's breathing has actually slowed down to about 30 breaths/minute. Is this significant? and he seems to be doing much better and looks more comfortable.

I know the steroids are a temporary fix, but does that mean that there is nothing else I can do at this point? Are there any further tests that I could/should do?

I just emailed you the Xrays in a different format, if you don't mind talking a look?
Also, is there anything on there that might explain what is causing the coughing?

Thanks again for your time.

Online vet, Dr. Marie

Dr. Marie replied:

That's good that the steroid seems to be helping.
Thanks for sending the xrays. I can see why you are hearing different things from different vets because it is really hard to say for sure whether there is a mass there or not. I think I can see one above the heart but I can't say for certain.

One thing you could ask for is perhaps to see if your vet can send the xrays to a radiologist to get their opinion. It is really hard to accurately interpret chest xrays of a cat.

At this point it's hard to say what else should be done. If this were a human, an MRI would probably be the next step to look for cancer. But really, even if MRI is available for pets in your area, it's unlikely that the cost would be warranted because if cancer was found, we would likely not change our treatment.

I would keep up with your vet's advice. They will likely monitor the response to steroids and decide whether long term steroids are a good idea.

Dr. Marie.

Customer reply:

Thank you again for your advice on Scratch's situation.
I finally got the bloodwork and original Xrays from the first vet.. this will be my last ask - but would you mind taking a look at the results when you have a chance?

I would just love to get the second opinion based on the whole picture.. My goal at this point is to try to get to the bottom of what is going on, so I can make the best decision for next steps..

Your time and expertise is really truly appreciated :)

Online vet, Dr. Marie

Dr. Marie replied:

Ah, ok. Now, these chest xrays are much clearer. Unfortunately I can see something that definitely looks like a mass, especially on the lateral (side) view. Here is the chest xray:

cat tumor in chest xray

Below, I have outlined the heart in red and the tumor in blue:

cat tumor in chest xray 2

One of of the sets of bloodwork there is an elevated calcium level and this makes us more worried about cancer as well.

I think that it is a good idea to stick with the steroids as per your vet's directions but unfortunately there is a high chance that this is cancer and things will likely get worse soon.

So sorry for the bad news.

Dr. Marie.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.