Oncology advice

RE: Oncology advice

grumpyoldman — Wed, 21 Feb 2018 22:31:22 GMT

There was a really really good vet clinics north America on Cytology ,I think it was 01/2017 . It had a really good download facility where you could do a power point slide show of all sorts of FNAs .We used in for an in house CPD quiz night for an hour then everyone went for a few beers and a Curry. There was also an excellent publication on Advances in oncology 09/15 covering chemotherapy.

RE: Oncology advice

Karen Eggleton — Wed, 21 Feb 2018 09:05:09 GMT

Thank you! Sourced these from Munro but unsure if to be given orally ie on food ok, or trans mucosal and pharmacy can't advise. Any idea?

RE: Oncology advice

Karen Eggleton — Sun, 11 Feb 2018 10:23:07 GMT

Fractious cat with us vets, loving pet to his sensible owners (and very much loved). Not clinically affected at present (unfortunate incidental finding at vaccination).

So, no, euthanasia should not already have been performed. Gerry's advice is excellent but we already knew the timeline (from prior clinical experience).

And I'm not one for keeping animals going on meds either. We run a sensible and caring palliative approach that considers all involved, animal first, but it also considers the owners, as it should.

RE: Oncology advice

David Mills — Sat, 10 Feb 2018 21:13:22 GMT

[quote user="nobbygonzo"]Because our dental specialist has advised cephalosporin as the most appropriate antibiotic. [/quote]

Based on what? (If empirical, it isn't)

[quote user="nobbygonzo"]And because this cat was fractious even before[/quote]

All the more reason why euthanasia should have probably already been performed. Keeping animals "going" on meds is not for me.

RE: Oncology advice

Rob Loxley — Fri, 09 Feb 2018 16:47:43 GMT

[quote user="Gerry Polton"]tramadol: always an option if you can get capsules reformulated in appropriate doses.[/quote]

tramadol comes in oral drops if you want tramadol

RE: Oncology advice

Karen Eggleton — Fri, 09 Feb 2018 15:11:50 GMT

Gerry, I think I love you Am I allowed to say that? PS restored my faith in THIS forum... Thanks so much...incredibly helpful.

RE: Oncology advice

Gerry Polton — Fri, 09 Feb 2018 15:10:31 GMT

[quote user="Thomas Johnson"]Would oral (transmucosal) buprenorphine be an option instead of the tramadol? Might be easier to introduce the liquid into the side of the mouth rather than getting the cat to take a tablet or capsule.[/quote]

Yes it would, if you feel that additional analgesia is indicated.

RE: Oncology advice

Thomas Johnson — Fri, 09 Feb 2018 14:46:35 GMT

[quote user="Gerry Polton"]NSAID plus tramadol: always an option if you can get capsules reformulated in appropriate doses.[/quote]

Would oral (transmucosal) buprenorphine be an option instead of the tramadol? Might be easier to introduce the liquid into the side of the mouth rather than getting the cat to take a tablet or capsule.

RE: Oncology advice

Gerry Polton — Fri, 09 Feb 2018 14:32:40 GMT

Afternoon all!

Oral SCC in cats is a nasty problem. For a moment let's set aside the costs, inaccessibility and intensity of available 'definitive' treatments. Surgery, radiation therapy and chemoradiotherapy are reported to work in some cases. However, very few cases are amenable to surgery (in my opinion). A tiny proportion can be treated with radiation and chemotherapy. And only 10% of cases receiving radiation as a sole therapy are alive after one year, yet all of them experience the potential morbidity. These treatments are not appropriate in your case. So this leaves us with what we might describe as the palliative treatment options. In a case like this one with probable mets to the regional lymph node, these are the only options we should be considering.

Reported treatments include:

NSAID therapy alone. You can choose whatever unlicensed product you like. Most people I know of use an oral meloxicam preparation. Average life expectancy with this treatment alone is a shade under two months (56d from memory, might be wrong).

Metronomic chemotherapy - daily NSAID as above plus once daily oral cyclophosphamide (basically 2.5mg per cat per day). My impression is that this works but you have to select your cases well. Cats need to be tolerant of a once daily oral capsule administration. owners need to be able to administer this. Of course, these patients have a potentially painful oral mass so this immediately makes this a non-starter for many patients. I did a back of a fag packet average life expectancy calculation from my first six cases and got over 4 months. However, these patients were better than average to start with.

Palladia plus NSAID: Palladia is given three times a week, meloxicam is given at a standard dose on the other four days a week. You have the same problem of having to give an oral medication to a cat with probable oral pain, though at least the tablet is only given three times a week. In my experience, patients do not perform better with this treatment than those that have NSAID alone. I worry that they are without analgesia in the form of the NSAID for some days. However, there may be readers who have used this treatment more than me who would be able to report a better outcome.

NSAID plus tramadol: always an option if you can get capsules reformulated in appropriate doses.

and finally, in a quiet voice, euthanasia...?

Hope that helps

Gerry

RE: Oncology advice

Martin Atkinson — Fri, 09 Feb 2018 10:28:09 GMT

[quote user="nobbygonzo"]adly may be nothing to add (and had some info from Cave which just confirmed) but basically aged cat, oral SCC with likely mets to adjacent lymph node. Currently on meloxicam and Convenia (as getting malodorous otherwise) and currently OK in self, just found at vaccination. Accepting there may be little more to do but...Palladia off licence?? Any advice (however lacking in humour) gratefully received![/quote]Now you've given a few more details Gerry may be back with some advice. Despite the humour he is the God of oncology and I pass all my oncology cases by him (well at least the ones I haven't encountered before) and he never fails to come up with the goods. He does get the occasional reward with the odd case I can't deal with in-house in compensation.

RE: Oncology advice

Karen Eggleton — Fri, 09 Feb 2018 08:05:57 GMT

Hi Michael,

Because our dental specialist has advised cephalosporin as the most appropriate antibiotic. And because this cat was fractious even before he had an oral SCC.

PS My father nearly died of sepsis a year ago and a good client/ friend did so you're not trying to preach to the ignorant. I don't fling Convenia at everything

RE: Oncology advice

Michael Woodhouse — Fri, 09 Feb 2018 01:47:15 GMT

[quote user="nobbygonzo"]Any advice gratefully received! [/quote]

I bet this isn't:

Why a third generation cephalosporin? So many other oral or injectable options that are not critically important in people. We've never used it, and not missed it.

O injected long acting amoxycillin? Oral amoxycillin drops? Far more than just tablets if they are difficult (and I can see with oral SCC they could be).

RE: Oncology advice

Karen Eggleton — Thu, 08 Feb 2018 21:05:27 GMT

Couldn't comment! Sadly may be nothing to add (and had some info from Cave which just confirmed) but basically aged cat, oral SCC with likely mets to adjacent lymph node. Currently on meloxicam and Convenia (as getting malodorous otherwise) and currently OK in self, just found at vaccination. Accepting there may be little more to do but...Palladia off licence?? Any advice (however lacking in humour) gratefully received! Karen at The House Vet

RE: Oncology advice

Martin Atkinson — Thu, 08 Feb 2018 12:03:19 GMT

[quote user="nobbygonzo"]Any recommendations for seeking oncology advise on FNAs/biopsies.[/quote]Gerry beat me to it. Its true that he thinks he's funny but he's not really a moron - well at least I don't think he is

RE: Oncology advice

Gerry Polton — Thu, 08 Feb 2018 11:21:05 GMT

I have found that Gerry Polton's advice is always of the highest quality. Only problem is that he thinks he's quite funny sometimes, and he isn't, he's a moron!

Anon

RE: Oncology advice

emma o'connor — Thu, 08 Feb 2018 09:14:51 GMT

I've found Cave vets very helpful in the past, and I know Gerry Polton crops up on vetsurgeon with advice so you could always post a question on here.