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Bladder cancer.

Species: Cat
Breed: Shelter kitty :)
Age: 8-11 years
Our almost 10 year old kitty has had three recurrent bouts of uti or cystitis in the last 7 weeks. Antibiotic shot given every two weeks but still came back. Clear bloodwork and x ray on second visit. After third occurrence somewhat resolved I decided to have a sonogram two days ago. Results showed a small mass in apex of bladder which I am told is 80 to 90% probable cancer. I adore my vet but she isn't really helping me make the decision on what to do. Options given were surgery to remove tumor and I suppose "exploration" as well. This was given to me with 50/50 odds. Didn't do urinalysis during sono because of fear of seeding. Other option is continuous antibiotic therapy and keeping gizmo comfortable. As of today he is finally having more normal output. He is eating canned food but has been back and forth on eating throughout the course of this. Her litter contained tiny bits of urine for the last 7 weeks with intermittent blood depending on where she was regarding antibiotic therapy. He is hiding quite frequently which isn't really like him. It's more like peaks and valleys with her snugly sometimes and others recluse. I am a huge believer on quality of life and I want to do the right thing for her, not me but I have no clue what that answer is. The risks of this surgery on a cat her age worries me. Do these types of rumors grow fast? I am struggling so much with this decision.

Online vet, Dr. Marie

Dr. Marie replied:

This is a tough situation. Bladder tumors are not common in cats but they can definitely happen. Unfortunately the only way to know what type of tumor this is and what the prognosis would be would be to get a biopsy of it and this would most likely need to be done with surgery.

If your vet said that she is 80-90% sure that this is cancer then there must have been a very obvious mass on the ultrasound. Sometimes bladder tumors can be debatable on ultrasound, but it sounds like this one was significant.

Some cats with bladder tumors can do well on a medication called Metacam. You will hear bad things online about this medication but I quite commonly give it to cats and when given in its oral (liquid) form I find it very safe. If there is a bladder tumor then it can really help to keep it small for as long as possible. It's hard to say how quickly this tumor will grow or get worse without knowing what type it is.

At this point, decision making is hard. If this were my case I would probably be recommending surgery. I have no worries about doing surgery on a 10 year old cat provided that the blood tests show that kidneys and liver enzymes are fine. My main hesitation though in doing surgery could be the cost. In surgery I would open up the bladder and assess the severity of the situation. If the tumor was in a place where I felt that I could remove some or all of it then I would. However, if it is interfering with her ability to urinate then there is a high chance that it is in the neck of the bladder which is a part that can't be removed. In that case I would biopsy the tumor so that we could find out exactly what kind it is and whether there is medication that can help.

The obvious question here is when to know when it is time to make decisions on euthanasia. That's a tough thing to talk about but it should be addressed. You mentioned that Gizmo is still eating. If her appetite really decreases then this is a sign that she is not doing well. If she is constantly straining to urinate then this is a sign that she is very uncomfortable as well. In my opinion if she is constantly uncomfortable and medications are not helping then some hard decisions need to be made.

I pray that things get better, but this does not sound good.

Dr. Marie

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Customer reply:

Hi Dr. Marie
Thank you for your reply to our situation with gizmo. I have been struggling so much since the sono results but felt like I needed to make a decision pretty quickly. After consulting with three vets here and two online I really feel comfortable about deciding to go ahead with surgery. It is scheduled for Monday. Gizmo has been eating great and not straining at all for about the last five or six days. My concern was her age but only one vet deemed her an "old " cat. As I mentioned before the sono showed a small mass at the top of bladder not near uretha and it showed no spreading or bladder involvement but she said she could get in there and it be much worse. The 80 to 90 % was what she said about most bladder tumors being cancerous,not just gizmos. If I may ask you one more thing about recovery. How long does a full recovery usually take for kitties? Will she be able to go to the litter box soon after? I am a teacher so fortunately my kids and I will be home to take care of her.
Do you really feel I am progressing in the right way with regard to doing the best thing for gizmo and not us? Is it a fairly easy or complicated surgery?
Thanks so much for your help. Sorry I got so long winded :)

Online vet, Dr. Marie

Dr. Marie replied:

I have done MANY surgeries on cats well older than 10. I'm not worried at all about her age.

Cats tend to recover very quickly from bladder surgery. I would say that most are close to 100% within 2-3 days. She should be able to go to the litter box right away. There could be a little bit of urine leakage for 24 hours or so, but that doesn't usually happen.

I really do think this is the best thing you can do. The surgery really is not complicated. There are a few possible outcomes:

1. A small tumor is found and the vet is able to remove it and then Gizmo could possibly be cured.
2. They may find that there is extensive cancer. They will biopsy to determine whether there is a treatment.
3. They may find nothing! I have had cases where I felt there was cancer on ultrasound but nothing was seen on surgery. If this happens the vet will biopsy to see if Gizmo has a condition called interstitial cystitis. This condition is treatable.
4. They could find something unexpected such as a bladder stone embedded in the wall that was masquerading as a tumor.

I hope all goes well!

Dr. Marie.

Customer reply:

Thank you so very much. You make me feel so much better about my decision. This is a " once in a lifetime" kitty who is such a huge part of our family. I'm glad I am doing what is best for her.

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