Lily Visits the Oncologist

We took Lily to the oncologist at the University of Pennsylvania on Tuesday, October 7. The oncologist is Lili Duda.

Lily's appointment was at 11:30; we were there until about 4:30. A very long day for all 3 of us.

Here's the written report from the visit:

Lily presented to [our] Radiation Oncology service for further work-up and consultation after a diagnosis of right maxillary osteosarcoma was made by your local veterinarian.

Overall, Lily looks very good for a 15 year old cat. She has a small heart murmur, as you know. There is a 1.0cm x 0.5cm oval, ulcerated area where her upper right canine tooth used to be. There is some associated swelling and slightly decreased airflow from he right nostril. Lily is also a little thinner than normal. All other physical exam findings were unremarkable.

Preliminary review of the chest radiographs (X-rays) did not show any evidence of metastasis (spread of cancer) to the lungs. Lily does have a mildly enlarged heart and hyperinflated lungs. Although the thyroid panel performed in April was normal, we recommend repeating a thyroid level (T4) because hyperthyroidism can be the cause of both of these findings.

A Complete Blood Count (CBC) was performed prior to sedation for oral radiographs. The CBC was within normal limits. A mini chemistry panel showed normal liver and kidney values with a mild elevation of the BUN.

Interpretation of the oral radiographs is pending review with the oral surgeons and I will call you with the results.

As we discussed, osteosarcoma of the jaw bone is a locally invasive cancer (into surrounding tissues) but metastasis is relatively uncommon. Complete surgical removal of the tumor (partial maxillectomy) can be curative. It is necessary to determine how big the tumor is and how much of the bone (maxilla) is involved. We will be able to better determine whether Lily is a surgical candidate based on the dentistry service interpretation of the oral radiographs taken today. If surgery is potentially an option, a CAT scan will be needed to confirm the tumor is amenable to surgery and to help the surgeon determine the surgical margins.

Radiation therapy is another option that is available should you choose not to elect surgical resection or if the tumor is too big to make Lily a good surgical candidate. Radiation therapy is a palliative procedure that involves one treatmetn per week for up to four weeks. The procedure is not curative and is meant to shrink down the tumor and help minimize symptoms such as pain and bleeding for anywhere from a few to many months. Also, there is a variety of medications that can be used to treat infection, inflammation, and pain.

We will contact you when the interpretation of the oral radiographs are back from dentistry at which time we can proceed with a treatment plan. In the meantime, please feel free to contact us with any questions or concerns.

Please remember there are no "right" or "wrong" decisions for Lily. Rather, there are several options, each with their own advantages and disadvantages. We will support you in any decision be it using only medication for supportive care or something more aggressive.

Thank you for bringing Lily in today. She is a wonderful patient to work with and we truly enjoyed having her with us!

We felt pretty hopeful after that visit. I was willing to spring for the ~$4K for the CT scan and surgery.

But our hopes were dashed the next afternoon when we got a call from Dr. Duda. The oral surgeons felt Lily was not a good surgical candidate. They felt the tumor would show larger on the CT scan, and that with such a large tumor, there was a high risk of leaving part of the tumor behind. The truth, it came out, is that the surgeons there don't have much experience with this type of surgery on a cat. Dr. Duda said if it were her own pet, she would be hard pressed to have the surgery done. Lily would come home on a feeding tube, requiring alot of aftercare, and a large risk is that the incision could split open.

Such sadness. My Lily is dying.