Splenic MCT

Hi, I'm trying to find clearer advice on the best course of action. Current dx: spleen cancer. My cat is roughly 5-6 years old and has had no major health issues until now. Roughly a month ago, my cat started vomiting, almost daily. After a few vet trips and dietary changes with no real change in symptoms, he referred me to a bigger vet medical center. X-ray, ultrasound, and blood tests ordered. Initial findings were elevated globulin levels, enlarged spleen, pleural effusion, enlarged lymph nodes, and obviously GI issues. A splenic FNA revealed mast cell infiltration. A lymphatic FNA wasnt possible because she, my cat moved too much. The vet then suggested, somewhat strongly, to do a CT and a splenectomy. Metastatic state was said to be unknown. Also, she prescribed anti-histamines to control the itching and vomiting. Later, when I went to my usual vet for advice and more medicine, I learned they also added an anti-vomiting agent. (Which is fine, but the fact thay they didnt mention that doesn't sit well with me) I also located one or two nodules on her head since then. Advice needed: I do not know whether or not to do the surgery. While not the deciding factor, cost is an issue. I don't see the point of the CT scan and other people that went to that medical center also reported feeling...well, it's a business first was how one friend put it. I'm concerned that it's already metastasized and removing the spleen will only put her through unnecessary stress (surgery, post op, recovery, possible chemo) for it to come back again. From what I've been reading online and from what the vet said, median survival rate is a 1 year (and the vet saying some cats she's known living up to 2-3 years). While I realize cases differ, simply stating the median seems somewhat disingenuous given the extremely wide range. Her behavior with medication is relatively normal. She hides slightly more than before (or maybe I notice it more now) but her appetite and behavior don't seem strongly affected. Thanks Blood test, x-ray, ultrasound, splenic FNA results below https://drive.google.com/drive/folders/1QkSDulHHZTHV7Vtdo7pQgRdCFyetPq7E?usp=sharing

Hello!   Your vet may be willing to ask an oncology specialist about this on your behalf, perhaps from a vet-school or referral centre, or to appeal to the company behind the drug license for Tyrosine Kinase, who may well have an education / marketing team only too pleased to share their most recent knowledge on the subject.  Daniela Murgia in the Veterinary Times, November 2016, explains that the mean survival time of cats undergoing splenectomy for haemangio-sarcoma specifically has been reported to be 140 days, but as you say, with a big range - from 42 to 245 days (Gordon et al 2010). The article goes on to explain that a significant prognostic indicator for survival after splenectomy in cats may be whether the cats are noted to have pre-operative weight loss or not;  the mean in one study (Gordon et al, 2010  -again from the article by Murgia) is three days for cats with weight loss and 293 days for cats where no weight loss was noted.  This relates to surgery rather than to chemo.  Unfortunately, as I am quoting this from Murgia's article, I do not know the numbers of cats involved in this study.  Therefore please do not assume any significance from it - rather, it may prove a  lead for  yourself or your vet to follow up. It concerns me that your cat had a pleural effusion.  I'm afraid that anecdotally, long-term survival times for cats presenting with a cancer-related pleural effusions can be poor.  Again, the local referral centre or vet-school may be a good way to trace the numeric evidence of the most up to date thinking, as relevant to your particular patient.  I am sorry for not presenting cheerful news or accessing the data that you were looking for here but hope that it gives you somewhere to go.

Thinking about this some more, a good place for vets to find leads to pathological data is by talking to their usual pathology lab; perhaps they sent the mast cells there to be identified in the first place, or perhaps they identified them for themselves.   Pathologists are rarely seen by vets' clients and rarely heard about;  rather they can be seen as a 'black box' to whom a sample gets sent, and an answer - or question mark - returns.  However, pathologists have a strong insight into identifying disease and the statistical information behind it;  if your vet cannot provide the data that you are looking for, then their pathologist may able to help.

Thank you, Liz :)   I have not done so far partially because of a language difference (I am not fluent in the local language) and partially due to the vet's attitude. When I met her, she did not seem especially forward with details about cytology, blood work, metastatis, etc. Blood work, cytology, etc were all done in house. Specifically, I was quoted the median survival time with anecdotal evidence of 2-3 years, her clinic's pristine track with splenectomies, and the alternative grim, detailed outcome should I opt against surgery (which felt like I was being guilted toward the CT/splenectomy). A lot was also lost in translation. I am mentioning this to explain my...reticence. Perhaps this is the best thing for my cat, but I am here gathering more information.   According to  Evans et al and Kraus et al, the median survival time seems sunnier, although not by much- median of 1 year with a sample size of roughly 60 and a range of 2-1730 days.   Other literature I have been reading seem to cite location and cytology as the strongest predictive factors regarding survival. Specifically, according to the 2-tier grading system proposed by Sabattini et al- the degree of differentiation, mitotic count, presence of nucleoli/chromatin clusters, and regular/irregular nuclear shape. If you could or point me to an online resource where I can get an interpretation of these images, I'd be much appreciative.   https://drive.google.com/drive/folders/1-9Y62QZeaaYDV_jW8wlAoepLnnLOn9BY?usp=sharing   I have my own interpretation of the cytology, but I am no expert. And, again, the clinic where these tests were performed have not ...been especially communicative with details aside from recommending a CT and splenectomy. I do not have clear answers and appreciate any input.

And while I am not proud to say this, cost is a factor. Performing a CT, splenectomy, etc can be crippling, financially. I have opted against the CT so far and am still waiting to pull the trigger on the splenectomy. If it, as well as chemotherapy (which also seems to have no significant effect based on the aforementioned studies mentioned) gives her a fighting chance of survival and quality of life, considering post-op recovery time, chemo, etc, then I am all for it. If it doesn't- if the cancer is aggressive, etc. and it's likely to return regardless of the surgery, then I'd prefer to focus more on palliative care. I'd prefer her remaining time to be spent in comfort rather than my desperate attempts to keep her alive and in pain. Thank you again :)

Hi - I'm afraid it is outside my remit to interpret labs and results for you:  I would have hated another vet interfering with my case when I was first opinion vetting and indeed it is professional courtesy not to - in my experience clients just end up confused. However, this may be a communication barrier more than anything (in my own language I would soften my language if I sensed an owner wasn't warming towards my recommendation in a discussion like this.  Communicating where I didn't feel the owner understood my language very well, or in a second language, is harder and I might speak in oversimplified terms?)

Also, just an aside on the state of communication with this particular vet and why I am asking here instead of the clinic where I went- when I asked for a copy of the reports for a second opinion, I was sent limited information (no cytology or interpretation). The primary vet received copies, which he sent me after I asked for it specifically.

So it was the issue of feeling pushed into something by the vet that has left you uncomfortable.   Perhaps they had wrongly assumed that it would be a no-brainer for you (for instance, because it would have been a no brainer for them) and they were taken aback to find otherwise.  Hopefully this issue between yourself and your vet won't ultimately affect the decision you make for your pet. It is ok to decide not to do the op - although this decision may take some time off your pets' potential length of life.  I can empathise with you - it is extremely hard to weigh up the financial value or ethical appropriateness of surgery to buy an uncertain number of days of possible extra life!  - and perfectly ok for you, the owner, to decline if that is what you would prefer to do. I think that it is ok to decline surgery as long as, (true of all in cancer cases), pain is still controlled and managed and euthanasia performed if, as and when it becomes appropriate. I'm afraid that I can't discuss the statistics in any better detail - your vet or a pathologist (your vet must be in touch with one - they are usually excellent when it comes to objective facts) are the go-to people for this. Whichever option you choose, then the most important thing is that you are satisfied with your decision, understand the pros and cons, and that your cat enjoys the remaining days, however many or few there are, and does not suffer.