? How Accurate Are Endoscopies for IBD vs Lymphoma?

Got ultrasound done for my civie. The IM dr suspects lymphoma based on ultrasound and exam. Ultrasound shows thickened intestines, swollen lymph nodes and inflammation, indicative of IBD or lymphoma.

The IM feels with an endoscopy, there's a "90%" chance that she'll get a good idea of what Bonnie has. She suspects lymphoma. Am I correct to assume the IM is being incorrect in presuming she'll get a 90% accuracy rate in determining what Bonnie has?

The IM said Bonnie isn't well enough for a surgical biopsy.

The IM suggested if I opt not to do the endoscopy, I could try Leukeran first and see if it works. She insisted I'd have to get the Leukeran and not the generic, cholorambucil, saying the generic doesn't work as well. Is this true?

From what I've read, Leukeran has some unpleasant side effects. True?

 

Gosh, I'm so sorry Bonnie is having to go through this! I have absolutely no information to offer you but I wanted to send you and Bonnie hugs and healing vibes. You're all in my thoughts and prayers.

 

The chronic inflammation can become intestinal lymphoma, so treating it as if that is the diagnosis makes sense to me.
As far as the treatment recommendations for meds, if you can find a higher level vet center that focuses on cancer/complex cases (ex MedVet in Columbus, OH, or a university veterinary service), you might consider getting a 2nd opinion.

 

Cat Ma, I'm so sorry you're dealing with this. You may want to ask on the IBD Kitties FB page what people there think of the generic vs. Leuk. There are a lot of kitties there who are on it.

My IM vet didn't think an endoscopy was 90% accurate, more like 70 or less. I agree with BJ, you could treat the symptoms without paying for the endoscopy or putting her through that. (@BJM, I think this IM vet is specialized and is the second opinion).

Please keep us posted. Hugs to you and vines to Bonnie.

 

As I understand it, it's the lymph node involvement that makes vets suspect lymphoma.
I went thru the same thing but my vet would not prescribe any cancer drugs without the endoscopy which I opted not to do given my girl's circumstances.

most cases of ibd left untreated do become lymphoma - it's a precursor. Chronic inflammation of the intestinal lining worsens over time
if treatment/diet change is unsuccessful.

 

Form the Yahoo Feline lymphoma group you can't really tell IBD from lymphoma. Taking a biopsy via endoscope makes is better but to be sure a full-thickness biopsy is needed.

 

IM seems sure it's lymphoma. Just a question of which kind.

Is prednisone/prednisiolone normally given with chemo? The IM wants Bonnie to continue with Budesonide while trying Leukeran.

 

My Mario had small-cell intestinal lymphoma diagnosed by full-section biopsy. His oncologist would not give prednisolone because of his diabetes, only chlorambucil. Form the Yohoo Felin lymphoma grout that is common for diabetic cats. Also, pulse dosing of chlorambucil seems to be the preferred protocol
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092124/

 

Cat Ma, I am so sorry you and Bonnie are going through this. Keeping good thoughts and sending you healing and strength vibes (and vines!)

 

my girl was on budesonide and prednisolone.

our IM wanted us to use Gengraf so we switched to it for a while. We used the genraf and prednisolone together.
I tho't it wasn't doing much so I asked to switch back to the prednisolone and in hindsight, I wish we had stayed with the Gengraf.
Gengraf is a modified cyclosporin and new in the treatment of lymphoma/ibd. It has anti-inflammatory properties.
It's very new research and most vets haven't heard of it yet. It is not recommended for cats with liver issues.

With diabetic cats, you treat the lymphoma first and the diabetes second. Prednisolone increases the blood glucose so you just have
to adjust the dose of insulin upward.
In Shadow's example, the pred only raised her by 100 or so....
She was in remission until we started those medications.

These are options you can discuss with your vet.
There are several diabetic cats here that are on prednisolone.

 

What is an IM?

 

internal medicine

 

i recommend www.diamondbackdrugs.com for the Gengraf. It was 3x more expensive at my local grocery pharmacy.

 

Oh, Cat Ma, I'm so, so sorry you're going through this. Sending healing vines for Bonnie! I agree with the others on this page that the accuracy of the endo seems a bit overstated, and that treating first may not be such a bad plan. These decisions are never easy, but I remember being frustrated the first time Speckles underwent additional diagnostic tests that basically didn't yield much knew info. It does seem like chlorambucil and a steroid together is the most common treatment, but there's a lot info on using cyclosporine (Gengraf) also. In case you want to read some more stuff:

http://www.marvistavet.com/html/body_inflammatory_bowel_disease.html

http://www.cliniciansbrief.com/sites/default/files/attachments/Feline IBD.pdf