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<P>Marsha, </P>
<P> I'm so sorry. I know how tough this kind of diagnosis is, having been there several times. I'm no Vet, but what you posted doesn't actually diagnose. It posits possibilities. I think where you go from here depend on your interest in treating as apposed to palliative care. </P>
<P> If you would treat, then the biopsy is pretty important (IMO). It will tell you what you are dealing with, and whether there is an actual chemo protocol that might/will help. Some cancers are treatable than others. They might also be able to de-bulk the mass, and give Harley the ability to move his jaw without pain, at least for some time. My cat Pattern had what was finally diagnosed as SCC (Squamous Cell Carcinoma) in approximately the same area you identify, but the mass extended into her mouth, interfering with her ability to eat. At the time of the biopsy, the Vet removed all she could get and used silver nitrate to staunch the considerable bleeding (I was present). SCC is pretty much non-responsive to chemo, so we decided to hospice. She was with us for another 10 _good_ months. Sounds as if Harley is looking at something quite different, possibly treatable. Before you decide, you might want to run the results past some more knowledgeable people.</P>
<P>If you aren't already a member, consider joining <A href="https://groups.yahoo.com/neo/groups/feline_lymphoma/info">https://groups.yahoo.com/neo/groups/feline_lymphoma/info</A> and <A href="https://groups.yahoo.com/neo/groups/feline-cancer/info">https://groups.yahoo.com/neo/groups/feline-cancer/info</A> . There are members and Vets there (the lymphoma list has an amazing Vet participating pretty much daily) who can help decipher the lab results.</P>
<P>Hoping for the best,</P>
<P>Margo<BR><BR></P>
<BLOCKQUOTE style="FONT-SIZE: 10pt; TEXT-DECORATION: none; FONT-FAMILY: arial,sans-serif; FONT-WEIGHT: normal; COLOR: black; FONT-STYLE: normal; PADDING-LEFT: 5px; MARGIN-LEFT: 0px; BORDER-LEFT: #0000ff 2px solid">-----Original Message----- <BR>From: Marsha <MARTIA@LYNXE.COM><BR>Sent: Mar 15, 2015 4:36 PM <BR>To: felvtalk@felineleukemia.org <BR>Subject: [Felvtalk] Has anyone gone with radiation treatment for FeLV+ with cancer? <BR><BR><ZZZHTML><ZZZHEAD><ZZZMETA content="text/html; charset=utf-8" http-equiv="content-type"></ZZZHEAD><ZZZBODY bgcolor="#FFFFFF" text="#000000">Harley had a CT scan on Monday, and needle biopsy Friday. Saturday (yesterday) the report came back that he has cancer. It is in the area of his right middle ear and TMJ. By the CT images, it does not appear to be something operable - it does not have distinct borders and there is no room to get margins. I have many things to discuss with vets tomorrow: comfort care for the time being for sure; how effective is radiation treatment vs. benefit to Harley; are there any chemo protocols for this that can help? Also they push for a full biopsy requiring surgery because the diagnosis will be more "definitive" and they could stage the cancer then. But I question the cost (both money and physical discomfort to Harley) vs. benefit to him. How will the full biopsy change potential treatment? It will cost money, has risk due to anesthesia, location of mass, and possible infection, and will cause him some pain afterwards. Is it worth it for the extra bit of detail? Below is the report if you're interested, and able to read the technical stuff. One note on the final comment that radiographs are recommended to rule out bone involvement: the CT scan showed already showed bone lysis (erosion), but the pathologist did not have access to the info from the CT scan.<BR><BR>In the meantime, Harley has gotten meloxicam or buprenorphine when he doesn't want to eat. The anti-inflammatory effects of meloxicam give him relief for 4 days or so, allowing him to eat comfortably. I just worry about potential kidney toxicity with that drug, so they have to be really careful about dosing, and the risk goes up long-term. I wouldn't ordinarily say yes to that drug, but it helps him. And if he's not going to make it long-term, the kidney concern takes back seat to his comfort. The buprenorphine doesn't help nearly as much, but may make him feel good. He has been eating all his food for the last 5 days, and plays and grooms himself. A little more subdued than usual, but he has a big burst of energy after his breakfast or dinner.<BR><BR>Marsha<BR><BR><ZZZMETA content="text/html; charset=utf-8" http-equiv="CONTENT-TYPE">
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>CLINICAL INFORMATION:</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>Mass adjacent to/involving the right tympanic bulla; painful to open</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>mouth; bulge palpated through skin medial to the right caudal mandible</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>suspected to be the mass; blind aspirate; concern for carcinoma;</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>patient is FeLV positive; regional node (and all peripheral nodes)</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>palpate normal</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000></FONT><BR></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>SOURCE:</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>Mass adjacent to roof of mouth right side: 12 slides</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000></FONT><BR></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>DESCRIPTION/MICROSCOPIC FINDINGS/COMMENTS:</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000></FONT><BR></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>Microscopic Description: The smears are low to moderately cellular on</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>a clear background with moderate blood contamination, many scattered</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>platelet clumps and a low to moderate number of ruptured cells. Few</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>small, loosely cohesive clusters of polygonal to cuboidal epithelial</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>cells are observed. This population exhibits mild to moderate</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>anisocytosis and anisokaryosis. The cells have a small amount of</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>variably staining purple cytoplasm and a round central nucleus. The</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>nuclei have finely stippled to reticular chromatin and often 1-2,</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>small prominent nucleoli. There are also rare mesenchymal cells noted</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>displaying oval nuclei, one to three small nucleoli and moderate</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>amounts of basophilic cytoplasm. This population exhibits mild to</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>moderate anisocytosis and anisokaryosis and occasionally surrounds a</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>small to moderate amount of pink extracellular matrix. No infectious</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>agents or cytologic evidence of inflammation are observed.</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000></FONT><BR></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>Microscopic Findings: EPITHELIAL NEOPLASIA; MILD TO MODERATELY</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>ATYPICAL MESENCHYMAL CELLS</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000></FONT><BR></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>Comment: The observed epithelial population exhibits only mild atypia</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>but based on the number seen and the provided history raise concern</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>for a well-differentiated, malignant neoplasm. Cell morphology of</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>this population is most consistent with a basal cell, ceruminous gland</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>or apocrine gland population. Significance of the rare mesenchymal</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>cells is uncertain (they could be a fibrous component associated with</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>the mass/granulation tissue, connective tissue, possibly rare cells</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>associated with a well-differentiated mesenchymal tumor). Tissue</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>biopsy with histopathology is recommended for a specific diagnosis.</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>Radiographs of the area are also recommended to completely rule out</FONT></FONT></FONT></P>
<P class=western style="MARGIN-BOTTOM: 0in; LINE-HEIGHT: 100%"><FONT color=#000000><FONT face="Arial, serif"><FONT size=2>underlying bone involvement.</FONT></FONT></FONT></P><ZZZMETA name="GENERATOR" content="LibreOffice 3.5 (Windows)">
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