My best friend Stefanie wrote the following about her beloved Roxy:
I took Roxy to see an Oncologist yesterday. She was recently diagnosed w/ a fibrosarcoma they believed was brought on by a series of vaccines she received in 2001 at the Humane Society where I adopted her (it's called feline vaccine-associated sarcoma or VAS). The oncologist obviously knew his stuff and was very kind on top of everything. I left the hospital and cried the whole way home thinking I'm a bad person for considering the financial impact b/c he obviously recommended radiation therapy post-surgery (we had the tumor removed on 6/25)... but it's going to cost $5K - $6K. I felt so hopeless.
I ended up calling him back a few hours later w/ a couple more questions about statistics and prognosis, and the confession that the financial impact was probably going to be too great to bear. I was grateful that he took the time to ensure I was clear on worst/best case scenarios and average statistics, and especially when he sanctioned the path I'm most likely going to take.
Here's the bottom line:
Unfortunately, my regular vet made a mistake in not sending the extra tissue from the surgery (I had a special surgeon do the surgery at my regular vet; $2400 on top of the $750 already spent on diagnostics) to the pathologist in order to determine whether or not there were clear margins on the tumor. Apparently, the surgeon took the tissue from her in two steps: the first was the majority of the tumor itself, which was huge, and the second step was to then go in and remove about 2 extra inches around the excision to ensure they got any stray cancer cells (this type of cancer is particularly aggressive and it branches out so there could be microscopic cancer cells still left behind). My vet only sent the tumor itself to the pathologist, not the extra tissue the surgeon took to ensure he got it all. On the tumor itself, there were not "clear margins," meaning there was not enough good tissue around it to indicate they got all the cancer. Since they didn't send the rest of the tissue, which could have indicated clear margins, we will never now know. This means, of course, that it's even harder for the oncologist to determine whether radiation is definitely needed or not. The only good news is that the surgeon does believe he got it all (but, of course, there are no guarantees).
In the absence of knowing for sure whether there were clear margins, and b/c the likelihood of the tumor growing back in the face of surgery alone is 50%, the oncologist is recommending radiation as the best possible thing to do to mitigate recurrence.
However... these are the facts:
WITHOUT RADIATION:
Worst case scenario - the tumor was not completely removed and it comes back quickly, which is anywhere from 2 weeks to two months post-surgery.
Best case scenario - the tumor was completely removed and she's in the 50% percentile of no recurrence; she lives out the rest of her natural life.
Average scenario - the tumor was not completely removed and comes back w/in 6 - 9 months.
IF I DO RADIATION:
On average, I buy her 1.5 years, and possibly up to 4 years of disease-free life. But, of course, there are no guarantees; it could fail.
Based on just the statistics alone, I don't buy her that much more time on average. Plus, even though cats tolerate radiation way more than humans, and putting aside the cost, I would have to take her in every day except weekends for 19 sessions and she would have to go under anesthesia each time. She hates to just go see the regular vet annually!
Truth be told, if money were no object, I would probably do it; but the reality is that I don't have this money and am already in debt. So, given that it is still possible the surgeon got it all and she could be "cured" (best case scenario), I think I'm going to take my chances and go another route... which the doctor completely sanctioned (he even said that if he thought I was putting her life in great danger, he would tell me). That is, I am going to be hyper-vigilant about looking for any new lumps near the site. The good news is that these tumors usually grow back in the same place or in an area where the "branching finger cells" infiltrated close by. So, it should be easy to find if one does. He also recommended maybe even bringing her in to see my regular vet for a more professional evaluation of the same thing (which is only about $40) every two months or so. The other other good news is that this cancer does not often metastasize (only 20-25% do). If the tumor grows back, then I can re-consider radiation and another surgery (which is more successful than surgery before radiation, which we did)... or let her live out the rest of her days as comfortably as possible knowing that she's had a pretty good life at 11 - 12 years old, and being strong enough to make the tough decision to end her suffering at some point along that path if it comes back.
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We went through this several years ago. No way could we afford the radiation treatments. Zuzu survived 3 months after the surgery. The tumor grew back so quickly. I hope Roxy comes out of this better than my ZuZu. She was a striped tabby too.
Posted by: Grace | July 05, 2009 at 02:09 PM
So sorry to learn that the whole tissue couldn't be analyzed and there is still uncertainty for Roxy and her human. I hope her tumor doesn't return and that she lives a long and healthy life.
Posted by: Ailurophile | July 05, 2009 at 05:20 PM
What a sad ordeal to have to endure but I know by your writings that you love Roxy and are doing the best you can for her.Good luck!!
Posted by: heidi | July 05, 2009 at 10:01 PM
Awww...she looks just like my little Miss PennyKat! I hope shi will be okay.
Posted by: Lisa - Alterity | July 06, 2009 at 09:40 AM
I, for one, support whatever decision is made about the future treatments for Roxy. Putting your family in financial troubles, especially with the economy as unstable and uncertain as it is right now, seems to be an unwise choice. Personally, I would reject radiation and pray that they got all the tumor during the surgery. You're still in my thoughts and prayers. I'm sending loads of positive energy your way. Many blessings.
Posted by: Brenda @ Split Rock Ranch | July 06, 2009 at 11:30 AM
My most heartfelt thanks to all of you for your comments, thoughts and prayers. I am praying like crazy that they did get it all. However, last night I felt a little pea-size lump in the exact area where the tumor was. Needless to say I am beside myself w/ worry and sadness. I'm going to continue to try and think positive and not panic. I'll keep everyone posted.
Last, but not least, my continued thanks to "MariaMichelle" for calming my mind and heart every day... you truly are an angel.
Posted by: Stef | July 07, 2009 at 12:06 PM
Hi MariaMichelle! Me again... just dropping by to let you know that I gave you the One Lovely Blog Award today!
Go here to pick up your award:
http://splitrockranchllamas.blogspot.com/2009/07/one-lovely-blog-award.html
Sorry to hear that there might be another lump on Roxy. I'm praying like crazy for her!
Posted by: Brenda @ Split Rock Ranch | July 07, 2009 at 01:18 PM
Roxy will be in our thoughts. Hope she has a wonderful recovery and no further problems.
Posted by: NanjoDogz | July 08, 2009 at 07:56 AM