Tigger and "Is it IBD or lymphoma?" Part 3: Treatment and Outcome
Given the diagnosis of lymphoma, Tigger was started on an aggressive dose of the steroid prednisolone. There are lots of chemotherapy protocols out there but lymphoma is an interesting cancer in that, in the low grade form, it is highly responsive to immunosuppressive therapy. At high doses, steroids can suppress the immune system. In addition to prednisolone, the chemotherapy agent chlorambucil was considered but given that Tigger was very good at spitting out pills (and this is one drug we do not want anyone exposed to in the environment), we chose not to start her on this drug.
Follow-up ultrasound several weeks after starting the prednisolone showed that her intestines were no longer thickened.
Tigger came into the clinic more often for routine weight checks and to monitor her tolerance to steroids. She tolerated her steroid well as we were able to use a flavored liquid that mixed into her food. She had no more vomiting with blood and maintained a good appetite, even gaining some weight. After 2 years or so, she did develop diabetes, which is a risk that comes with high dose & long term steroid use. When the diabetes is steroid induced, weaning off the steroid often reverses the diabetes and puts the cats into a remission state. In Tigger's case, she was unable to be weaned off the prednisolone as that was what was giving her a good quality of life. Given that, we elected to treat the diabetes with under the skin insulin injections.
Tigger did well with her injections (much easier than pills!) and though it involved more trips to the clinic while we stabilized her blood sugar levels, we were able to comfortably manage her diabetes. Because she tolerated her treatments well and had a good quality of life, we had her in our lives for another 3 years before she passed. In the end, it wasn't the lymphoma specifically but rather a combination of lymphoma, chronic kidney disease, and general old age that led us to make the decision to let her rest at the wonderful age of 18 years old, 5 years after her initial lymphoma diagnosis. Of final note, although this case was academically interesting as it took several steps to finally yield a diagnosis of lymphoma, the decision to go into surgery with my own cat was no less frightening for me and it was not a decision that was undertaken lightly. Ultimately, I am glad that was the decision as I knew how aggressive to be with my treatment plan.