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SECONDARY LUNG CANCER
"What will survive of us is love."
It was cancer which finally beat Harpsie. Despite being the fighter he was, he only managed 15 days from diagnosis to euthanasia. The cancer in the abdominal area (carcinomatosis) was still not causing him too many problems, but the secondary lung cancer was making it harder for him to breathe, so we had to make the agonising decision to help him cross. This secondary lung cancer, incidentally, had not been visible at all on x-rays only ten weeks earlier, so obviously Harpsie had a pretty aggressive form of cancer.
Because we did not really have the chance to treat Harpsie's cancer, and because the treatment for cancer depends so much on the particular type of cancer, this page does not contain a lot of detail about feline cancer treatments and prognosis, but there are links to more detailed information which may be of help to you.
Cancer happens when the cells in the body stop reproducing normally. The cells multiply and form a tumour. There are many, many different types of cancer, but about 85% are carcinomas, which is the type of cancer which Harpsie had.
Feline Advisory Bureau has a very helpful overview of the main types of cancer seen in cats and the causes thereof.
The signs of cancer vary depending upon where the cancer is. Obviously an external growth is hard to miss, but unfortunately the symptoms of cancer are often vague and hard to detect, particularly in a cat, who cannot tell you how s/he is feeling. Plus they are often the same as symptoms of other diseases.
In some cases, you may see lethargy - Harpsie became less and less active, which we initially ascribed to his arthritis and to his epilepsy medication.
One common symptom is weight loss, despite the cat continuing to eat normally. This is often accompanied by muscle wasting, which is known as cachexia. Nutrition and cancer: exciting advances for 2002! (2002) is a presentation by Dr GK Ogilvie to the World Small Animal Veterinary Association Congress, which explains how this happens and the stages involved.
In more advanced cases, you may also see ascites, fluid build-up in the abdomen. Harpsie had this towards the end. Health A to Z explains more about ascites.
American Veterinary Medical Association - possible cancer symptoms to watch out for.
ZZ Cat also has lists of possible symptoms (scroll down a bit).
If your cat has cancer, ideally you should ask to be referred to a veterinary oncologist (cancer specialist). The same type of cancer can present very differently in two different cats, so you really want a treatment plan tailored to your cat's particular needs. In addition, treatments such as chemotherapy and particularly radiotherapy can often only be administered by a specialist.
ACVIM has a list of oncologists in the USA.
It must be emphasised that often cancer treatments cannot get rid of the cancer completely, but they may be able to make your cat more comfortable and prolong his/her life, which is important.
Gulf Coast Veterinary Specialists - information on what to do when you are told that your cat has or may have cancer.
Feline Advisory Bureau has a very helpful overview of the main treatments available for feline cancer.
What can I do for my cancer patient and his/her owner? is an excellent article by Dr CG Couto of Ohio State University College of Veterinary Medicine.
It appears that, putting it into very simple terms, carbohydrates can "feed" a cancer, so the best diet tends to have relatively high amounts of high quality protein and fat, and relatively little carbohydrate. Since we knew Harpsie's cancer was incurable and untreatable, we decided to let him eat whatever he wanted - we wanted him to be as happy as possible during his last days.
Nutrition and cancer: exciting advances for 2002! (2002) is a presentation by Dr GK Ogilvie to the World Small Animal Veterinary Association Congress, which explains more about suitable diets.
Nutrition and cancer: frontiers for cure! (2006) is a more recent presentation by Dr GK Ogilvie to the World Small Animal Veterinary Association Congress, which explains more about suitable diets.
Vet Info briefly discusses suitable diets.
If your cat has a tumour which can be safely removed via surgery, this is good news, because this is the treatment that is most likely to effect a cure. Sometimes removing the tumour will not save the cat's life because the cancer has spread to a site elsewhere in the body where it cannot be treated, but removing the tumour may still be worthwhile because it may improve the cat's quality of life for the remaining time s/he has left.
I'm not personally familiar with this type of treatment, because it was not an option for Harpsie, but it is commonly performed on cats with cancer, often with favourable results. One interesting point to bear in mind is that cats simply do not appear to have the same reaction to chemotherapy as humans - they do not lose their hair, and they do not develop severe vomiting (though some vomiting may occur, it is usually manageable).
Chemotherapy and radiotherapy are often used in combination.
Upstate Vet Specialists has a good overview of what chemotherapy entails, and the pros and cons thereof.
University of Illinois Veterinary Teaching Hospital has a FAQ (frequently asked questions) section about chemotherapy.
Veterinary oncology is an article by Dr K Crump which discusses commonly used chemotherapy drugs and side effects.
Current chemotherapy in oncology (2002) is an article by Dr SM Cotter about the types of chemotherapy used for various forms of cancer.
This would have been an option for Harpsie if he had indeed had a brain tumour, as was suspected in October 2004, but again, it was not an option for his final illness.
Radiotherapy entails aiming radiation (similar to that emitted from x-rays but usually more powerful) at the tumour in order to completely remove it or at least shrink it. Often the treatment has to be given daily Monday-Friday for several weeks. General anaesthetic is required to ensure that the cat stays still so that only the tumour is targeted - I had reservations about so much anaesthesia, but radiotherapy sessions are not long, so I think I would have agreed to try it.
Chemotherapy and radiotherapy are often used in combination.
Corticosteroids are commonly used to treat, or at least control, cancer in cats. In some ways, they are a form of chemotherapy, particularly for lymphoma, but they may also be prescribed to cats with other cancers in order to improve general wellbeing and appetite; they may also help with nausea. Harpsie was given corticosteroids to help maintain his appetite.
The most commonly used corticosteroid in cats with cancer seems to be pred (prednisone or prednisolone). Cats metabolise prednisolone better than prednisone (they have to convert prednisone into prednisolone in their bodies anyway before they can use it) so it is usually better to give prednisolone in the first place. Vet Contact reports on a study entitled Bioavailability and activity of prednisone and prednisolone in the feline patient (2004) Graham-Mize CA & Rosser EJ Veterinary Dermatology 15 (s1), pp 10 which supports this view.
If a cat is prescribed steroids, they should not be stopped suddenly, but rather the cat must be weaned off them. This is because using corticosteroids may suppress the adrenal glands' ability to produce cortisone naturally; so tapering the dose minimises the risk of adrenal insufficiency occurring as a result.
Corticosteroids cannot normally be used in diabetic cats. If your cat develops congestive heart failure (CHF) within a week of starting corticosteroids, the steroids may be the cause. One study, Corticosteroid-associated congestive heart failure in 12 cats (2004) Smith SA, Tobias AH, Fine DM, Jacob KA, Ployngam T The International Journal of Applied Research in Veterinary Medicine 2 (3) pp159-170 found that some cats developed a unique form of congestive heart failure within seven days of starting steroids. Five of the cats died, but the seven that survived did much better than the typical CHF patient once taken off the steroids.
Newman Veterinary has helpful information about steroids.
Veterinary Partner discusses pred and explains how corticosteroids work.
Mar Vista Vet discusses the potential problems of ongoing steroid use, though with cancer the benefits usually outweigh the risks.
Cats with some forms of cancer may develop fluid build-up in the abdomen, known as ascites. This is very uncomfortable and also potentially dangerous, so the fluid should be removed. Diuretics in pill form are commonly used to remove excess fluid, but these take a few days to take full effect. For immediate relief, centesis (needle aspiration) may be performed: this entails inserting a fine needle into the abdomen and drawing the fluid off. It sounds horrible, but Harpsie had this done to remove his ascites and he didn't even flinch. However, it is a delicate procedure, and skill is required to insert the needle in the right place and remove the correct amount of fluid. But it can be lifesaving.
American Veterinary Medical Association - possible cancer symptoms to watch out for.
Gulf Coast Veterinary Specialists - information on what to do when you are told that your cat has or may have cancer.
ZZ Cat has links about every type of feline cancer.
About - this site contains a variety of feline cancer links.
Vet Info - a site from an American vet.
Mar Vista Vet - information on symptoms and treatments for lymphoma.
Washington State University College of Veterinary Medicine has a clear overview of lymphoma in cats.
Woodstock's Page - the story of one cat's battle against lymphosarcoma (kidney cancer).
Feline Lymphoma Caregivers aims to help people with a cat with lymphoma by offering support and information, particularly regarding treatment options.
Feline Cancer Support Group - a list for those with a cat with cancer offering advice and support.
Feline Lymphoma Support Group - a list for those with cats with lymphoma.
Endless Love Support Group - a list for people with either a cat or dog with cancer.
In retrospect, I wonder if the first early signs of cancer in Harpsie began in December 2005. He became slightly quieter, and was less impressed by his prescription diet for food allergies, which previously he had wolfed down. However, the manufacturers had changed the formulation and the girls wouldn't eat it either, so we assumed that was the problem. He saw the vet that month and was given a clean bill of health and received his rabies shot (essential for him to avoid quarantine when returning to the UK).
Harpsie continued to be a little fussy about his food in the new year, and he slept more. But there were still many signs of the old Harpsie. In February, however, he was vomiting and off his food, so we went to the vet. The vet could see certain changes in Harpsie's pancreas which made him suspect pancreatitis. Harpsie was also mildly constipated. A chest x-ray was also performed, and it was absolutely clear.
Five days later, Harpsie became terribly ill and we rushed him to the vet. We never did work out for sure what the problem was exactly, but it appeared to be a combination of phenobarb toxicity and really severe constipation.
Harpsie seemed to recover. He was still a little quiet, and he gradually began to interact with us less. He would ask to join us on the sofa, for example, and would happily lie on our knees and purr, but would then soon want to lie next to us rather than on our knees. But he had arthritis, and we thought perhaps the sofa was more comfortable for him than our knees. He also moved location more frequently, but again, we assumed this was because of his arthritis.
But he continued to eat, albeit only Hill's a/d, which he had switched to exclusively during his February crisis. He washed his paws afterwards, he drank, he visited his litter tray, and he occasionally chased Indie around the room. And he was still very much The Boss: if one of the girls was in a bed he wanted, he would simply stand in front of it, and the offending girl would immediately surrender the bed to him.
On the first Friday in May I took Karma to the vet, and when the vet asked about Harpsie, I told him Harpsie was a little quiet but basically OK. I said I was wondering whether to bring Harpsie in for another check up, but I wasn't sure it would be of much benefit since extensive tests in February (including bloodwork, urinalysis, ultrasound and x-rays) had shown nothing, and Harpsie was continuing to eat. Harpsie hated going to the vet, and the vet agreed that at this point it was not really worth stressing him out, but he told me to bring Harpsie in if his eating worsened.
The next day I groomed Harpsie and I noticed that he began to breathe faster. I assumed this would soon stop, but it didn't. All day Harpsie's breathing rate was between 50 and 60 bpm (it should be between 20 and 30 bpm). My husband had left on a business trip that morning, so I wondering if it might be stress-related. Harpsie continued to eat, drink, wash his paws, use his litter tray.
The next day Harpsie's breathing was still fast, so I spoke to the vet. He agreed it was cause for concern but not yet an emergency, so we arranged that I would bring Harpsie in the next day, Monday. Harpsie continued to act normally; the only change in him was the faster breathing.
On the Monday, 8 May, I took Harpsie to the vet. They ran a number of tests, including more chest x-rays, and the results were devastating. The chest x-rays clearly showed a large number of small growths, which simply had not been there at all only ten weeks earlier. The vet told me the most likely explanation was secondary lung cancer. And, being secondary (i.e. not the first cancer to develop), it was untreatable!
They then did an ultrasound. The pancreas still looked unusual, and worse than it had, but there were also other areas of abnormality in the abdominal cavity, including near the liver. There was no one specific tumour though, so the vet told me he believed Harpsie had carcinomatosis. This is a type of cancer where the cancer is so diffused throughout an area (in Harpsie's case, the abdominal cavity), that it is not possible to say for certain which organs are cancerous.
The vets did not think Harpsie was in pain, but said we would have to consider euthanasia when his breathing became too laboured. They estimated that Harpsie had about two weeks left to live, but at the same time they were anxious that my husband was away, and could not guarantee that Harpsie would hang in until he returned the following Friday (four days away). Still, since this was Harpsie we were talking about, they gave us 30 days worth of pred (steroid). They said we had to subject him to as little stress as possible.
I took Harpsie home, and he was absolutely exhausted from his outing (see photo left), and was breathing even faster, but he did eventually recover, and ate several platefuls of food (and this was before he had been given any steroids). I then had the horrible task of calling my husband on his business trip and breaking the news to him. He was devastated, of course - he and Harpsie adored each other.
We needed to know we had done all we could for Harpsie, so I asked the vet for a referral to an oncologist for a second opinion. He agreed, but recommended that we should not take Harpsie with us because it would be so stressful for him. We made an appointment with the oncologist for the following Friday.
I started delivering Harpsie's food to his bed, to save him the effort of walking to the kitchen. He became very skilled at eating the food balancing on the edge of his basket, and he could even step out of the basket without knocking the plate the basket rim!
Harpsie managed to hang in there until my husband returned the following Thursday night, having brought his flight forward so he could go to the meeting with the oncologist on the Friday. Harpsie was actually no different than he had been the previous week, with the exception of the faster breathing. He was so thrilled when my husband returned, it was wonderful to see them together, but bittersweet, of course.
On the Friday we went to see the oncologist. He was a little surprised that we did not have Harpsie with us, but he examined Harpsie's records, including the x-rays and ultrasound results, and concluded that sadly our vet was correct, that Harpsie had incurable, untreatable cancer, and that we should just make him as comfortable as we could until it was time to say goodbye. He did say one further thing which terrified me though: he said that whilst he thought that Harpsie would eventually have to be put to sleep because of the secondary lung cancer, there was also a risk that the tumours in Harpsie's abdomen could suddenly rupture at any time, and he told us that this would be extremely painful and we would have to rush Harpsie in for immediate euthanasia. I was horrified at the thought of this happening to Harpsie, and although I was hardly ever leaving him alone at this point anyway, I resolved to spend even less time away from him just in case.
The next few days Harpsie acted about the same. He continued to happily eat his Hill's a/d, his breathing was still between 50 and 60 bpm, he continued to move around as if he could not get comfortable but did not seem to be in actual pain. I did speak to the vet and asked if Harpsie should be given painkillers, but the vet said that most painkillers would affect Harpsie's breathing, which would be dangerous in view of the lung cancer. Since he did not believe Harpsie was in pain, he recommended holding off on painkillers at this time.
The following week Harpsie seemed to me to be gaining weight. It was as if he had a little football in his abdomen. I spoke to the vet on the Wednesday, and he said that Harpsie had only had a tiny amount of ascites in his stomach the previous week, and that whilst it would certainly need tapping at some point, he did not believe it would be necessary at this point. However, Harpsie's abdomen continued to swell, and he seemed less comfortable, so I arranged to take him in on the Friday. The vet was astounded to be able to remove 490 ml of fluid from Harpsie's abdominal cavity. He was also horrified to hear what the oncologist had said and explained that, since there was no visible tumour in Harpsie's abdominal cavity, there was nothing that could rupture. This was a great weight off my mind, but I was angry that I had been worrying about this non-existent possibility unnecessarily for a week - I had barely slept all week for checking on Harpsie in the night in case something might have ruptured.
The vet told us that having the ascites removed should make Harpsie more comfortable, and hopefully he would have a reasonable weekend. Unfortunately Harpsie did not really seem ever to bounce back from the tapping. He vomited a couple of times on Friday, and again on the Saturday morning. He was perhaps eating a little less. He had been sleeping in our bedroom each night since diagnosis, but at this point we decided to keep him in the bedroom so he did not have to walk as far to his water bowl and litter tray. He never left it again.
On the Saturday we started trying to find a vet who would come to our apartment to remove Harpsie's ascites a few days later, and also to perform euthanasia when it was required. We were terrified of having to take Harpsie out of the apartment in New York City when he would be in respiratory distress - even in a taxi (assuming we could find one), it would take at least 20 minutes to reach the vet, probably longer at most times of the day. It was a nightmare finding a vet who would help in this massive city, but we finally found a lovely vet called Dr Howe who agreed to drive in from Long Island on the Tuesday to tap Harpsie.
Harpsie was able to hang in there on the Sunday and Monday, but it was obvious that he was finding it harder to breathe (he wasn't breathing faster, but he needed more rests after doing anything, such as visiting the litter tray) and he began hiding under the bed at intervals. He was losing weight at an astonishing rate and developed a very bony spine - clearly he had cachexia. However, he continued to eat and to wash his paws afterwards, and he sometimes purred (though we weren't entirely sure if this was good or bad purring - cats can purr to comfort themselves when they don't feel well. The continued eating was despite the fact that I stopped giving him the steroid on Monday, because, having tolerated almost seven years of daily pilling without objection, he seemed to be finding it increasingly stressful to be pilled.
There is a connection between Inflammatory Bowel Disease and abdominal cancer. I will always wonder if Harpsie might not have developed the cancer when he did if only we had addressed his inflammatory issues (IBD and food allergies) earlier.
Dr Howe came to our home on the Tuesday evening. Harpsie had deteriorated during the day, and we were now contemplating euthanasia. She spoke to our vet, and we had a long talk with her. Harpsie was still eating, which made the decision dreadfully hard, but he was having to take rests inbetween mouthfuls because of the lung cancer. We were concerned at how quickly the ascites were building up once again, and we were also worried that Harpsie's breathing could suddenly worsen and that he could die from the fluid in his lungs, which would be a horrible way to go. We therefore reluctantly agreed that this was the day to let Harpsie cross. Dr Howe said it would not be the wrong thing to do.
It took her three attempts to get the catheter into Harpsie's paw, but he did not fight her - he was just so tired. She initially tried on his back paws but he was dehydrated and she could not get the catheter in. She eventually succeeded with the front paw, and Harpsie peacefully went to sleep. As he crossed, he curled his paw around her hand as if to thank her - she said this had never happened to her before, but that was Harpsie for you. We are eternally grateful to Dr Howe for her kindness to all of us on that dreadful evening.
We kept Harpsie with us in the apartment overnight. He spent that evening - when normally he would have been going to acupuncture - lying in his basket on the sofa with us while we stroked him and told him what a wonderful precious boy he was and how honoured and grateful we were to have him in our lives. The next morning we took him to our vets who kept him until the cremation company could come to collect him.
Harpsie was cremated on Saturday 3rd June. I was dreading it. Many people had told me it would probably give me a sense of peace and completeness, which I thought highly unlikely. I hated the thought of burning his lovely fur and beautiful face in particular, even though all the humans in my family opt for cremation.
We chose to attend the cremation, which I gather is unusual. But we are always present when we bury our cats, and we didn't want to do any less for Harpsie. Plus I wanted the reassurance of knowing they had got the right cat.
So we set off on the train into New York State, to the oldest pet cemetery in the USA, Hartsdale Pet Crematory (founded 1895). It was in a beautiful tree-filled setting, and there was torrential rain, which we didn't mind, it fitted our mood better.
Of course I sobbed my heart out but people were right, it was cathartic. We were given plenty of time in a private room for a personal goodbye with Harpsie. I'd been told that Harpsie might look a little different, but I'm pleased to say he looked exactly as he did when we took him up to the vet the day after he crossed. They placed him in a little casket for the viewing, with a little white satin pillow for his adorable little head, and a little cat-sized white satin blanket. We were able to hold and cuddle and stroke him, until we felt ready (after a fashion) to part with his little furry body. We were allowed to watch as they placed him in the crematorium, with a red rose from each of us.
We then went for a walk and the heavens opened, so we got soaked to the skin. We returned to collect Harpsie's ashes an hour later. We'd been considering a cherry wood urn since our house back home has a lot of cherry wood, but the wood they had was a different colour. We felt we'd run across the same problem if we tried to buy something on the internet, so in the end we opted for a pale cream marble chest with a few pinkish-red swirls - the base colour is a similar colour to Harpsie. We felt this was very fitting because when Harpsie was a kitten he loved sleeping on our carpet with his head on the marble hearth.
We brought His Handsomeness home, and he now rests in his chest under his portrait. And whilst we of course still wish that cute little face, body and personality were still with us, we do feel a sense of completeness that he is home at last.
Rest in peace, Harpsichord. You were such a special boy who brought us so much happiness, and we will always love you. It's thanks to you that I know what I know about feline health.
"And I'm going out of my mind
with a pain that stops and starts,
like a corkscrew to my heart
ever since we've been apart".
This is a type of cancer where the cancer is so diffused throughout an area (in Harpsie's case, the abdominal cavity), that it is not possible to say for certain which organs are cancerous.
Cancer Back Up explains more about carcinomatosis (this is a human site).
A retrospective study on the sonographic findings of abdominal carcinomatosis in 14 cats (2004) Monteiro CB & O'Brien RT Veterinary Radiology and Ultrasound 45(6) pp559-64
Secondary lung cancer is often treatable in humans, and it is sometimes treatable in cats if the primary cancer is treatable. Sadly, this was not the case for Harpsie.
Cancer Back Up explains more about secondary lung cancer (this is a human site).
This page last updated: 13 January 2009
Links on this page last checked: 2 February 2008
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