Splenic mastocytosis in a cat

Dr. Marie replied:

Oh, this is a really tough situation. The decisions that you have to make are not easy.

Splenic mastocytosis is not very common. What is happening is that there are tumors in the spleen that are producing extra mast cells. Mast cells contain histamine and can cause many side effects including an upset stomach.

As you know, the best treatment for splenic mastocytosis is to remove the spleen. But, this is not always an easy task. Cats that have this condition can have trouble clotting their blood and the surgery can be very risky. The other factor is that this surgery will likely be quite expensive. At 15 years of age, I would be really hesitant to do this surgery.

*If* your cat survived the surgery and the surgeon was able to fully remove the cancer, then, if the spleen is the only part of the body affected, the average survival time for cats after this surgery is 3.5 years. However, in a 15 year old cat, this might possibly be a little unrealistic.

The other complicating factor is that it is hard to know whether the cancer is contained in the spleen or whether it also is affecting the intestines. This would have to be determined by taking samples during surgery and then waiting several days for the results. If mastocytosis has spread to the intestines then the survival rate is very low. The fact that your cat has significant gastrointestinal symptoms makes me worried that this could indeed be the case.

So, if this were my patient, with the information that you have given me, I would give you these options:

1. Do surgery right away. The cost will be high. There is a significant chance that he will not survive the surgery and there is also a chance that we will find on surgery that the cancer is also affecting the intestines in which case, things may not improve much. But, there is also a chance that we could cure this problem.

2. Try to manage with medication. It is really impossible to say how long this would work for. It could be perhaps a year, but it could be much much shorter.

To me, #2 makes much more sense. I know it is hard but because there are so many variables associated with surgery as well as risk, I don't think that this would be a wise decision.

Some cats with this condition do well with steroids. Another drug that sometimes helps control the histamine release is cyproheptadine. Some vets will also try benadryl to help with the histamine issues and possibly even pepcid to help with stomach upset. These are all options you can discuss with your vet. There are chemotherapy protocols that can be used in some cases, if surgery is not an option, but this would likely require a referral to a veterinary oncologist and would be quite pricey.

What I usually do in cases like this is have my clients set some guidelines for themselves in terms of what they and the cat can tolerate before they start discussing euthanasia. If the symptoms get worse gradually then it's hard to one day say that enough is enough and it is time to stop the suffering. So, if your cat continues to get worse, or is losing weight and not eating then you may need to talk to your vet about whether this is an option that should be considered.

I wish I could give more hopeful advice. I'm not saying that a cure is impossible, but in my opinion the odds are a little stacked against you.

Dr. Marie.


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Dr. Marie replied:

I understand your frustrations, but let me share with you my perspective. If you were a patient in my clinic and I had to advise you on this situation, here is what I would be thinking:

Surgery is risky. There is no way that I would do surgery on a 15 year old cat with cancer without doing a full panel of bloodwork and also xrays to determine if there is obvious spread of cancer to the lungs or other signs that would make me decide against surgery. The bloodwork is not just to say whether or not the cat would survive surgery, but it helps me know which medications to use. For example, if I am seeing kidney issues on the bloodwork then I know I need to adjust my anesthetic protocol to use drugs that are easier on the kidneys. And I know that I need to be careful with giving enough intravenous fluids to support the kidneys but not too much as to overload them. I also know that I need to keep a close eye on the blood pressure.

Now, one could say, "Well, I don't want all that monitoring...if the cat dies, he dies." But it's not that simple. Let's say I didn't monitor the blood pressure and it ends up dipping during surgery. This can cause serious kidney problems. I wouldn't know this until several days after the surgery though (assuming that he survived surgery). So, when he presents back to me with vomiting and a lack of appetite and looking really unwell, what do I do now? We'll need to do more tests and we'll likely need intensive hospitalization. And those cost money. And I know that my actions of taking a low cost cut rate road to surgery, have made this cat very ill.

The next issue is the cost of the surgery. Many people are shocked to find out that if I do surgery on an animal and the animal dies during the surgery, the cost is not that much lower than for an animal that survives. I've still had to place a catheter, administer a preanesthetic, administer an induction drug, place the cat on an anesthetic machine, prep for surgery, open up my autoclaved surgical packs and spend a good amount of time doing surgery. And, if the cat starts to not do well, it's not like he suddenly dies under anesthetic. No...rather, we would notice things happening and we would say, "OK, let's try increasing the IV fluids", or "Let's give this drug and see if that helps...." At the same time, I've paid my staff to concentrate on this case and I haven't seen any other patients. So, if, after all that, your cat does not make it, there is still going to be a fairly substantial bill.

Now, this next part is tough, but history tells me that the vast majority of time, if an animal dies under anesthetic and I have not already collected some type of payment, I'm not likely to get paid for this. I can't tell you how many people feel justified in not paying a bill because an animal has died.

You could argue that I should be doing this out of the kindness of my heart because I want to help animals. But, the reality is that many times a day I see animals that need help and owners can't afford it. If I treated all of them and didn't charge (or gave big discounts) I would go out of business.

This topic is one that is near to me, which is why I wrote this article: Why are Vets so Expensive.

I know that every vet hates the fact that finances play such a big role in our decision making process with clients.

I hope what I have written hasn't upset you too much. It's just that it's not as simple as "let's try the surgery and see what happens."

So, if you were my client, and you fully understood that surgery was a big risk, and you were willing to go ahead with the tests and pay for surgery even if it is not successful, then I would consider doing this. But, from what you have told me I would likely still be advising against it because of the poor odds. If you did go ahead, I would also be making you sign multiple waivers explaining that you understood the risks.

I know it is really hard to see your little one not doing well. I wish there was an easier solution.

Dr. Marie

Dr. Marie replied:

I'm glad that my advice has been helpful. I had feared I had been a little too direct.

I think that age plays a big factor in this decision. In my mind, a 15 year old cat is quite an ederly cat and this makes surgery more risky than in a young healthy cat. The other potential issue is that there are other symptoms of sickness with the vomiting and diarrhea. In a young cat with no signs of sickness I would be much more excited about doing surgery.

Still, if your vet *is* recommending surgery, they wouldn't do this if they're not comfortable. It really is a tough call!

Dr. Marie replied:

You can keep coming back. I haven't implemented a cut off date yet as most people don't abuse the system. :) I would like to hear of the outcome of this story for sure.

I hope everything works out for the best,
Dr. Marie

Dr. Marie replied:

No need to worry about a bonus. I don't really run this site for the money - just for the chance to help out where I can. I need to charge something for the questions to limit the number that I get otherwise I'd be spending my entire day answering them. :)

So glad to hear that surgery went well. And also it is great news that there was nothing obvious in the intestines. It's hard to say whether the liver growth is something to worry about or not. I'm assuming they are biopsying it and should have some answers soon.

It's hard to say for sure what the next hurdles are. Sometimes with spleen surgeries, post op bleeding in the abdomen can be a concern. But, at this point the next steps involved keeping him supported while he recovers from surgery.

It sounds like he is in good hands and I would trust the advice that your vets give you.

Dr. Marie.