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Dr. Deb
Dr. Deb, Cat Veterinarian
Category: Cat
Satisfied Customers: 6099
Experience:  I have loved and owned cats for over 45 years.
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My cat Amber started out with a hard nipple, now I noticed

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My cat Amber started out with a hard nipple, now I noticed there is a lump near it beneath the skin. She is estimated to be between 12-14 years old (not sure because she was a stray when I took her in). She was spayed when I first got her, when she was around 2-3 years of age (estimated to be). She's been healthy except for her megacolon condition, but we've been treating that for a few years now very successfully. She seems her usual self, eats and drinks normally, and she is a bit over weight at around 15 lbs, but she lost a pound or two this summer when it was really hot out, and wasn't feeling much like eating. I am trying not to get nervous because I went and did a search online and am fearing breast cancer, and given her age I'm nervous about any kind of surgery. Any advice would be greatly appreciated!
Submitted: 11 months ago.
Category: Cat
Expert:  Dr. Deb replied 11 months ago.

Hi, I'm Dr. Deb. I will do my best to assist you today.

I'm sorry for this concern about Amber; I can understand why you might be worried about this mass that you've found.

I would love to be able to reassure you that what you're feeling is benign and while it might be, unfortunately, cats can develop breast cancer similar to women which your research indicated. Prevention of breast cancer is one reason why we advise early spay in cats (and dogs, for that matter) before a first heat; however, I know that the timing of her spay was not under your control.

It is often not possible to determine what a lump or bump might be based on feel or visualization alone. Usually cells need to be aspirated and examined under a microscope or sent off to a pathologist for review.
And, when it comes to treatment options, we are somewhat limited....we either monitor them or surgically remove them.

If I were presented with a case like this, I'd take chest x-rays to look for evidence of metastatic spread. If present, then I most likely would not recommend surgical removal given her age and spread of disease.

If her lungs look clean, then I'd have a long conversation with you about the pros versus the cons of removing the mass. Anesthesia and monitoring have improved significantly these days. While there is always a risk with anesthesia, the risk is greatly reduced especially if pre-anesthetic blood work is done first and her liver and kidneys look healthy.

If this mass is cancer and there's not been any detectable spread, then I would want it removed as soon as possible. I would suggest a biopsy so we'd know whether it's benign or malignant. If malignant, then you might want to consult with an oncologist for further treatment options although I can understand reluctance to do so given her age.

 

 

I realize that my answer may not be what you want to hear but I would be doing a disservice to both you and Amber if I were less than truthful and honest in my response to you. I hope you understand.

I also hope that this mass is benign...as I'm sure you do as well. Deb

 

Dr. Deb, Cat Veterinarian
Category: Cat
Satisfied Customers: 6099
Experience: I have loved and owned cats for over 45 years.
Dr. Deb and 4 other Cat Specialists are ready to help you
Customer: replied 11 months ago.

Yes I understand, and appreciate your honest answer. Statistically speaking, are the online percentages fairly accurate? They state that 90% of tumors found in the mammary glands are malignant. At that rate, does it sound like there is much chance that her tumor is not malignant for my Amber? I'm just kicking myself because the lump isn't on a part of my cat that I pet much, so I didn't notice it soon enough. :(


 


If it is cancerous and has spread, is there any kind of treatment, or do I just basically just monitor for any deterioration in her condition?

Expert:  Dr. Deb replied 11 months ago.

I'm sorry that I was off my computer when you posted your additional questions about Amber.
I know you feel awful about this and my heart goes out to you.

I am sad to say that your research is accurate: about 90% of mammary masses in cats tend to be malignant. But it's possible that Amber will be in that lucky 10%....there's no way of knowing at this point.

Removal of the entire chain has been shown to improve survival as long as there hasn't been metastasis. In fact, some vets recommend removal of both chains which sounds pretty drastic, I know, especially for a cat her age.

 

If it turns out to be cancer, then there are other options for her such as chemotherapy which would be best pursued by consultation with an oncologist after biopsy results return. The kind of tumor and staging (basically how malignant the tumor might be and if it's spread) will determine what, if any, additional treatment options you might want to consider.

You may find this article of interest in terms of survival times:

Feline mammary adenocarcinoma: tumor size as a prognostic indicator Can Vet J. January 2002;43(1):33-7. Jodi R Viste1; Sherry L Myers; Baljit Singh; Elemir Simko 1Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan,XXXXX Saskatoon, Saskatchewan S7N 5B4.

Article Abstract

Mammary carcinomas and adenocarcinomas (MACs) are relatively common tumors in cats. The postexcisional survival period of affected cats is inversely proportional to tumor size, but the reported median survival periods for different tumor size categories is quite variable. This variability diminishes the prognostic value of reported data. In our study, cats with MACs greater than 3 cm in diameter had a 12-month median survival period, whereas those with MACs less than 3 cm in diameter had a 21-month survival period. Survival periods for cats with MACs smaller than 3 cm ranged from 3 to 54 months; therefore, tumor size alone is of limited prognostic value in cats with MACs smaller than 3 cm in diameter. In cats with MACs larger than 3 cm in diameter, tumor size appears to have much higher prognostic relevance, because this study, as well as others, have indicated that cats with MACs greater than 3 cm in diameter have a poor prognosis, with median survival periods ranging from 4 to 12 months.

Customer: replied 11 months ago.

Thank you for the article, it was very informative. I was able to look a bit more closely at the lump, and the nipple looks a bit irritated, and the lump actually feels quite flat underneath it..............so here's just a question that might be a stretch.........is there any chance that it could just be irritation? Like perhaps she scratched or irritated the nipple cleaning (unfortunately the fleas did come back this year, and some of my other cats have overgroomed themselves because of it)....and that maybe this could be just something alot less menacing, perhaps a welt? I know I'm reaching and I am sorry for inquiring about so much stuff, just trying to cover my bases and look at other possibilities. I will of course, prepare myself for Friday's possible bad news, but I do hope that she might be lucky and fall into that 10%. Can't thank you enough for explaining everything in such detail to me, this is the last question I promise. :)

Expert:  Dr. Deb replied 11 months ago.
You're welcome:)
And, please don't apologize; you can ask as many questions as you want about Amber. I know you're incredibly worried about her.

I wouldn't think that irritation is likely to cause a lump but it's possible that she might have a lipoma...which is basically fat inside of a capsule.
If this lump weren't closely associated with a nipple, then an enlarged lymph node is also a possibility...and still might be depending on which nipple is involved and how close the lump is to it. Lymph nodes are located near the last two mammary glands on both sides of the body although only one might be enlarged if a skin problem is present.

I'll be keeping my fingers crossed that this isn't the worse case scenario for Amber...I know you'll be keeping your fingers and toes crossed that this is the case!

I hope you'll keep me posted about her. Even after you've rated (if you do, of course), we can still continue to communicate. I can also send you a follow up email in a few days to which you can respond when you have the time to do so.


Good luck,
Deb
Customer: replied 11 months ago.

Interesting, I do believe it is one of the last nipples that the lump is near. We shall see what happens on Friday, I will definitely keep you posted for sure! And yes definitely keeping fingers AND toes crossed for her! Will be in touch as soon as I get an update. The info you have given me was so very useful, thank you for your honest input about my Amber's situation.

Expert:  Dr. Deb replied 11 months ago.
I just wanted to thank you for the rating; it's greatly appreciated.

It's been my pleasure to help you about Amber and I'll look forward to chatting with you after the vet visit. Take care, Deb
Expert:  Dr. Deb replied 11 months ago.
Hello:
I'm just following up on our conversation about Amber. How did her vet visit go? Deb
Customer: replied 11 months ago.

So sorry for the delay! The vet visit on Friday was actually a very positive one! While it is definitely a mammary lump, he felt it was a small one that could easily be removed with surgery. And despite her age, he felt that as long as the bloodwork came back ok (and it did today!), she would be fine to have the surgery, which is estimated to only be about 40 minutes long. He answered every question and concern of mine, and I think this is the right decision. His main concern is that with her Megacolon condition, that being put under anesthesia might slow things down a bit. So he is going to send home a mild laxative to help things along. I was afraid the visit might be all "doom and gloom", but I feel much better about things, and he is confident that if we act now and remove the lump while it is small, she will have a much better prognosis than if we were to wait and see or operate later when the lump is much bigger. We are going to do a set of x-rays first before surgery takes place, just in case the lump is malignant and somehow already spread, but he thinks that isn't likely given the size and feel of it. But we want to know for sure before he starts the surgery. Thanks so much for asking about her! We are keeping our fingers crossed for her surgery to be a success, it is taking place on Monday August 26th....I took some days off of work so I can be home for the first few days of her recovery. I will keep you posted on how things go!

Expert:  Dr. Deb replied 11 months ago.
What great news about Amber! I know you won't stop worrying about her until after she is safe and sound back home with you after her surgery ....well, probably you won't stop worrying until the biopsy results come back.....but this is really good news so far.

I'm so glad that your vet is giving you a cautiously optimistic result for her.

I'll look forward to continued updates about her next week:)

I'll be sending positive thoughts her way. Deb
Customer: replied 10 months ago.

Hi Deb! Just wanted to give you an update about Amber:


 


Surgery went really well......the lump was successfully removed and it was sent out for biopsy, we should have the results back by Monday hopefully. The vet said that this was one of the few cases where it was a good thing that Amber was a bit on the chubby side....because the lump was pretty much attached to the fat, not muscle, so it was easier to remove. He said it had a moderate blood supply, and that was the only thing of his concern. Otherwise he thinks her prognosis is really good. Anesthesia was a bit rough on her, yesterday after coming home she was a bit wobbly, and was pretty out of it. But as the hours go on, her appetite returned and she was a lot more steady on her feet. Hearing her purring up a storm was a wonderful thing! So she is starting to look more and more like her usual self as time goes on. :)

Expert:  Dr. Deb replied 10 months ago.
Thanks so much for taking the time to send me an update about Amber, especially this sounds like very good news so far.
I'm not surprised that she took a little longer to recover from anesthesia, especially given her age, but glad she seems to be returning to normal.
Now, if the biopsy results come back benign, she'll be good to go, as they say:)

Please let me know the results when you get them. Take care:) Deb

Customer: replied 10 months ago.

Will definitely relay the results to you when I get them, fingers crossed for it to be benign! :)

Expert:  Dr. Deb replied 10 months ago.
Everything that can be crossed, is crossed:)) I look like a pretzel...and not a very attractive one at that!!!

I'll look forward to chatting with you with results come back. Deb
Customer: replied 10 months ago.

LOL but it is much appreciated! Will talk to you in a few days!

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Expert:  Dr. Deb replied 10 months ago.

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Customer: replied 10 months ago.

So as the week went on I realize that Amber had in fact, NOT gone #2 in the litter box yet. (Keep in mind she is a Megacolon kitty--motility of her digestive system after surgery was a huge concern) I started to get real nervous heading towards Labor Day weekend, and was afraid that if she didn't move anything by mid afternoon Saturday, that my opportunity to bring her to the vet for help if need be would pass and it would have to be an emergency visit if she ran into trouble somewhere in Jabip, since there are no GOOD emergency clinics near me. So yesterday I got a prescription laxative from the vet to help things along, and today I was so happy, it worked.....she FINALLY went. So today when I went to pay off the rest of my surgery bill, I wanted to ask the doc if I needed to continue using the laxative since she already went (I was figuring no of course, but wanted to ask just in case). Well I was able to speak with the doc, and I was surprised they let me into one of the rooms to talk with him for that one question. But it turns out they let me into one of the rooms not just to ask that one question, but because the doc just happened to have gotten the biopsy results back today. Turns out, apparently the test can tell you whether you have gotten all of the mass or not, and while he removed the mass itself and surrounding tissue, there apparently are "feet" that spread out from the mass, that branch out real fine from the mass that you can't really see.....and the test revealed somehow that he did not get all of it despite removing quite a bit around it. He said that while that is not the result we were hoping for, it wasn't all bad, or a death sentence by any means. He did say there is potential that the mass could grow back, but there is also potential that it might not grow back at all or spread in any way.....especially considering that the mass was soley attached to fat, and apparently that is much better than being attached to muscle tissue, makes it harder for it to spread. Of course her x-rays taken before surgery revealed her lungs were clear, and nothing looked like it had spread anywhere or in any way, and her lymph nodes were not swollen. So I guess long story short........despite it being confirmed as a mammary mass that wasn't 100% completely removed....and not something less threatening......the pluses outweigh the minuses.

Expert:  Dr. Deb replied 10 months ago.
What was the specific biopsy results? Did your vet tell you?
Customer: replied 10 months ago.

Well, I was running on two hours of sleep and was trying to wrap my mind around things.............I asked him if the mass was basically considered 100% malignant, and he said no.....that it was just confirmed as a mammary mass (we were hoping for it to be something less ominous)......but he made it sound like we weren't technically out of the woods yet.....but is that because benign tumors can become invasive and grow as well? Honestly I wasn't expecting the results back until Saturday or even Monday, and today was a rough day at work and mentally my brain was shot.

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Expert:  Dr. Deb replied 10 months ago.
Trust me, I've had similar days where my brain feels like mush and I'm not processing like I should:)

It might be helpful to ask them for a copy of the biopsy results and then pass on the information to me.
I understand the part about the mass being incompletely excised but not sure I understand why it wasn't categorized as malignant or benign.
Benign mammary masses are benign...they don't become malignant.

Deb
Customer: replied 10 months ago.

I'll be sure to do that, I have to have her stitches out soon so I'll ask then. I don't think he was implying that the mass would turn malignant, he did mention that he's seen some benign tumors continue to grow, then rupture later on spreading infection......he might have been thinking more along that line........I could be wrong, but I kinda got the impression that the biopsy results come back kinda "inconclusive".....meaning it isn't overtly obvious about being either benign or malignant. I could be WAY off too.....I'm burned out from a week of worry with the surgery, after care, and the unfortunate need to go back to work Thursday through Saturday. I just wish I was home ALL the time, hate being away from my furkids, especially when there are medical issues with them.

Expert:  Dr. Deb replied 10 months ago.
I do understand that some biopsy results are not as clear-cut as we'd like but usually that's not so much the case when a large sample is submitted. Aspirates are often inconclusive which is why pathologists like more tissue to evaluate.

I know you've been sick with worry...probably literally and well as figuratively!
But as you say, this isn't the worst news and even more importantly, she's doing well now that she's having bowel movements.

Well, one more day to get through and then you can pamper her to your heart's content on Sunday:) Deb
Customer: replied 10 months ago.

Exactly! I'm gonna stay positive regardless, I've given her 11 years of love so far, and I hope to have many more years with her. Can't wait till Sunday (or rather, the end of my shift on Saturday!

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Expert:  Dr. Deb replied 10 months ago.
I'm a huge fan of the power of positive thinking...I really think it can make a difference.

Sunday will be here in the blink of an eye:)

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