HELP! Cancer or IBD? Cat presenting with symptoms - newly diagnosed heart murmur and hyperthyroidism.

2021.10.16 22:53 thelifescape HELP! Cancer or IBD? Cat presenting with symptoms - newly diagnosed heart murmur and hyperthyroidism.

Hi There- any advice would be greatly appreciated as our cat has just been diagnosed (tentatively through ultrasound) with lymphoma (or IBD?) AND severe hyperthyroidism. The hyperthyroidism is making diagnostic tests for lymphoma very dangerous - however, without a diagnosis, we have been told we cannot start cancer treatment.
What do we do to help our beloved old friend? Feeling hopeless.
Much gratitude for any guidance.

Providing a history and Vet notes with details to hopefully help. Trying to include as many details as possible. Again - thank you.

-------

Recent diagnostics:
1. Small intestines: The region of moderate wall thickening with loss of architecture is concerning for infiltrative disease such as such as lymphoma [progression from small cell to intermediate?]. Severe inflammatory bowel disease cannot be excluded but appears less likely [granulomatous vs severe lymphoplasmacytic vs other]. This region cannot be reached via endoscopy - although ultrasound-guided aspirates of the intestinal wall could be attempted I suspect that thickness biopsies will be required for definitive diagnosis (only 20% success of diagnosis). Several other segments of jejunum and ileum had a prominent muscularis layer and consideration is given to small cell lymphoma versus advanced inflammatory bowel disease. A gastrointestinal panel to be submitted to evaluate the patient for B12 deficiency or empiric supplementation.
Recommend empiric treatment with Corticosteroids if this patient does not undergo further diagnostics.
2. Lymph node/mesentery: Mild lymphadenopathy adjacent to the thickened segment of jejunum - rule out reactive process versus infiltrative disease. This lymph node cannot be sampled with ultrasound guidance due to location. Focally hyperechoic mesentery in this region is likely secondary to enteritis. No evidence of free fluid at the time of the study.
3. Right limb of the pancreas: Normal variant versus mild pancreatitis.
4. Kidneys: Consideration is given to age-related changes versus mild nephritis. Correlate with clinical signs, blood work and urinalysis
7/15/21
Current medications:
Physical Exam:
Notes about Plan:
Vet is concerned that the thickening of his intestinal tract is secondary to infiltrative disease such as lymphoma but advanced inflammatory bowel disease cannot be excluded.
The location of most significant intestinal thickening cannot be reached/biopsied via endoscopy.
This area could be sampled via ultrasound-guided aspirates but results may be inconclusive as discussed. Alternatively abdominal explore or laparoscopic-assisted small intestinal biopsies would be required to sample this region. This procedure would require general anesthesia. We would also need to wait for his intestinal tract to heal from the biopsies before resuming treatment with Prednisolone.
His ileum is also thickened and blind biopsies could be attempted via a colonoscopy; however this approach would not allow us to biopsy the region where the small intestines is most severely thickened.
His clinical improvement [e.g. resolution of vomiting] is likely secondary to treatment with Prednisolone. Corticosteroids such as Prednisolone will temporarily treat some forms of intestinal cancer such as lymphoma and is the treatment of choice for inflammatory bowel disease. In cases of lymphoma, response to Prednisolone only is generally short [few months] and will interfere with future diagnostics such as biopsies [may yield inconclusive results].
He was also recently diagnosed with hyperthyroidism, which can cause symptoms such as vomiting , diarrhea , increased water consumption , increased urination , weight loss and anxiety. Physical exam revealed the presence of a thyroid slip consistent with hyperthyroidism, a heart murmur and a gallop sound. Hyperthyroidism can lead to heart disease, which may resolve with time once the hyperthyroid condition is controlled. Nevertheless, his current heart condition is a risk for anesthesia and this must be taken into consideration if you elect to pursue full-thickness intestinal biopsies under general anesthesia.
Recommended to start him on Methimazole [treatment for hyperthyroidism], decrease the dose of Prednisolone and attempt ultrasound-guided aspirates of the thickened intestinal tract under sedation next week. Also recommended completing the series of chest radiographs to rule out pulmonary metastatic disease and an echocardiogram.
Diet: Continue Purina EN
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