Lymphoma is one of the most common cancers diagnosed in cats. It is a cancer of the lymphocytes (a type of white blood cell) and is found throughout many areas of the body which include: lymph nodes, spleen, liver, gastrointestinal tract and bone marrow. Unlike lymphoma in dogs, viral causes of feline lymphoma are well defined, and the feline leukemia virus (FeLV) has been shown to cause a significant (~60 fold) increase in risk for development of lymphoma in cats. We typically see lymphoma diagnosed in younger cats that are infected with the feline leukemia virus, and in older cats that are not infected with the virus. Other possible risk factors include exposure to second hand tobacco smoke, chronic immunosuppressive therapy, as well as chronic inflammatory diseases.

Types of Lymphoma

Lymphoma can be subdivided into several different forms which is dependent on location of the tumor. These locations can include: Gastrointestinal Tract: The most common form is involvement of the gastrointestinal (GI) tract. This includes the stomach, intestines and liver; as well as some of the lymph nodes surrounding the intestines. Cats with this type of lymphoma often have clinical signs consisting of vomiting, diarrhea, weight loss or a decreased appetite. Mediastinal: The mediastinum is a term used for a special aggregation of lymphoid tissue in the chest. Cats with this type of lymphoma are usually young and often seen because of a sudden onsent of difficulty breathing, decreased energy level and decrease in appetite. Renal: The kidneys can be the primary sites of involvement. Cats that have this type are often seen because of signs related to kidney failure (increased thirst, increased urination, loss of appetite, vomiting). Bone Marrow: If the cancer were confined to the bone marrow, it is considered leukemia. Most patients are presented to the hospital for a decrease in energy and appetite. Bloodwork, usually reveals a change in their red blood cell and white blood cell counts. External Lymph Nodes: In a few cats, the only site of involvement is the external lymph nodes. These cats may be seen because of problems such as vomiting and loss of appetite or because the owner found “lumps” (enlarged lymph nodes) on their cat. Other Sites: We will occasionally see other sites such as the skin, nose, brain and spinal cord as the primary site of involvement

Diagnosis and Initial Evaluation

A biopsy (tissue) or cytology (aspirate) sample is required in order to make a diagnosis of lymphoma. In some cases, we can obtain a diagnosis by a fine needle aspirate, but in other situations, a biopsy to obtain a larger piece of tissue is necessary to confirm the diagnosis. The ease with which a diagnosis can be obtained depends upon where the tumor is located. The first step for any patient suspected of having lymphoma includes determining the extent of the disease which is known as staging. This includes a complete blood count (CBC), serum chemistry profile (which looks at things such as liver and kidney function, protein levels, blood sugar and electrolytes), urinalysis and FeLV/FIV testing are always recommended and provide important information regarding the effects of the cancer on body functions as well as the ability of the patient to handle chemotherapy or other treatments. Additional tests include chest radiographs, abdominal ultrasound along with possible bone marrow aspirate and CT/MRI. Once we determine the extent of disease, we can then decide on the best treatment for your pet.

Treatment and Prognosis

Chemotherapy is the mainstay of treatment for lymphoma; however, there may be situations when surgery and/or radiation are also indicated. Radiation therapy may be recommended if the cancer is localized to one site such as the nasal cavity. Specific recommendations will be discussed based on your pet’s particular situation. Fortunately, lymphoma is very responsive to chemotherapy where 50-70% of treated cats will go into remission. The definition of remission is the complete disappearance of detectable cancer; however, microscopic amounts of tumor cells can remain hidden in the body. A remission is NOT a cure but it does allow your pet to experience a good quality of life without clinical signs associated with their disease. The length of the remission depends upon many factors including the primary site, how your pet is at the time of diagnosis and the extent of disease. In most situations, the median remission and survival times (with chemotherapy) are between six to twelve months; with 25% of cats experiencing disease control for greater than one year and approximately 10-15% of cats living longer than two years. Solitary lymphoma such as nasal is generally treated with radiation +/-chemotherapy. The radiation can be considered definitive with the intent for long term control or palliative for symptom relief in order to
Improve and/or maintain the patient’s quality with minimal negative impact. The prognosis for solitary lymphoma such as nasal lymphoma is generally better with many cats achieving local control for 1-1.5 years although there is still a concern that the cancer may spread within 3-6 months. If solitary lymphoma is treated with radiation and the cancer progresses down the road, then chemotherapy can be considered at that time. The exact chemotherapeutic drugs and schedule will depend upon how aggressively the cancer is behaving, how sick your pet is at the start of treatment, any abnormalities in organ function (particularly kidneys and liver), and the goals of treatment. Chemotherapy is most effective when we used a combination protocol; therefore, most protocols generally consist of 4-6 different drugs. This is called a multi-drug protocol. Multi-drug protocols most commonly include Elpsar (L’asparaginase), Vincristine (Oncovin), Cytoxan (Cyclophsophamide), Adriamycin (Doxorubicin) and Prednisone. Initially, treatments are given more frequently (i.e. once weekly) and then, depending upon the response and protocol used, are gradually spread out and/or discontinued. Other options for therapy may consist of using a single chemotherapy drug (single agent therapy) at 3- week intervals, or palliative care which is simply designed to keep your pet comfortable at home for as long as possible. Bloodwork and/or X-rays/ultrasounds are generally repeated at regular specified intervals to monitor for side effects (such as a low white blood cell count) and to determine the your pet’s response to treatment.

Side effects

Fortunately, most cats tolerate chemotherapy very well and experience minimal side effects. Serious side effects are only seen in 5% of the patients which require outpatient care and less than 1% will require hospitalization or experience any life threatening side effects. If side effects are serious or intolerable, we can consider either lowering the dose of the offending drug or substituting a different drug. Side effects include nausea, vomiting and loss of appetite, diarrhea, extreme tiredness or rarely infection. Certain chemotherapy agents can affect organ function over time, so close monitoring with bloodwork is recommended. Cats do not lose their hair but may lose their whiskers and have a different texture to their fur secondary to chemotherapy.

Goal

The ultimate goal of any treatment is to improve your pet’s quality of life and your oncologist will work with you to determine the treatment option that you feel most comfortable with. Content Contributor: Veterinary Hospital of the University of Pennsylvania Last Reviewed: October 10, 2013 Lymphosarcoma (lymphoma) is one of the most common cancers diagnosed in cats. It is a cancer of the lymphocytes (a type of blood cell) and lymphoid tissues. Lymphoid tissue is normally present in many places in the body including lymph nodes, spleen, liver, gastrointestinal tract and bone marrow. The feline leukemia virus (FeLV) has been shown to cause lymphosarcoma in cats. We believe that the feline leukemia virus is responsible for many of the cases of lymphosarcoma. Cats with the feline immunodeficiency virus (FIV) are also at higher risk of developing lymphosarcoma. Cats of any age, breed and sex can be affected. We typically see lymphosarcoma in younger cats that are infected with the feline leukemia virus, and in older cats that are not infected with the virus.

Types of Lymphosarcoma

Lymphosarcoma can be divided into several different forms, which depend upon the primary (predominant) site of the tumor. Some cats have multiple sites of involvement and do not fit well into just one category. These are usually animals with very advanced disease.

Gastrointestinal tract

The most common form is involvement of the gastrointestinal tract. This includes the stomach, intestines and liver as well as some of the lymph nodes surrounding the intestines. Cats with this type of lymphosarcoma may have vomiting, diarrhea, weight loss or a decreased appetite.

Mediastinal

The mediastinum is a term used for a special aggregation of lymphoid tissue in the chest. Cats with this type of lymphosarcoma often are seen because of difficulty breathing due to a large mass in the chest or an accumulation of fluid around the lungs.

Renal lymphosarcoma

The kidneys may be the primary sites of involvement. Cats that have this type are often seen because of signs related to kidney failure (increased thirst, increased urination, loss of appetite, vomiting).

Bone marrow

If the cancer were confined to the bone marrow, we would call this leukemia. The signs that we see in cats are usually related to the decreased numbers of normal cells (such as red blood cells that carry oxygen, white blood cells that fight infection and platelets that help with clotting) which are made in the bone marrow. Anemia, infections and bleeding are common problems.

External lymph nodes

In a few cats, the only site of involvement is the external lymph nodes. These cats may be seen because of problems such as vomiting and loss or appetite or because the owner noted «lumps» (enlarged lymph nodes) on their cat.

Other sites

We will occasionally see other sites such as the skin, nose, brain, and spinal cord as the primary site of involvement.

Diagnosis/Initial Evaluation

A biopsy (tissue) or cytology sample is required in order to make a diagnosis of lymphosarcoma. In some cases, we can obtain a diagnosis without surgery. However, in some cases, we may need to perform a surgical biopsy to obtain adequate tissue to confirm the diagnosis. The ease with which a diagnosis can be made depends upon where the tumor is located. A complete evaluation of a cat suspected of having lymphosarcoma includes a search for tumor in other locations (this is what we call staging). A complete blood count (CBC), a serum chemistry profile, urinalysis and FeLV/FIV testing are always performed and provide important information regarding the effects of the cancer on body functions as well as the ability of the patient to handle chemotherapy. An abdominal ultrasound (sonogram) allows us to evaluate the liver, spleen, internal lymph nodes and intestinal tract for possible tumor involvement. Chest x-rays allow us to look for internal lymph nodes, lung involvement, an enlarged mediastinum or fluid around the lungs. A bone marrow aspirate allows us to look for tumor cells in the bone marrow as well as to evaluate the marrow’s ability to produce normal blood cells. Once we have these results, we can then decide upon the best treatment for an individual cat.

Treatment/Prognosis

Chemotherapy is the mainstay of treatment for lymphosarcoma. There may be some situations when surgery (e.g. to get a biopsy or to remove an intestinal mass) or radiation therapy (e.g. if the cancer is localized to one site) may also be indicated; usually this is in addition to chemotherapy. Specific recommendations will be discussed with you based on your pet’s particular situation. Lymphosarcoma is very responsive to chemotherapy and up 60% of treated cats will go into remission. The definition of remission is the complete disappearance of detectable cancer. However, microscopic amounts of tumor cells can remain hidden in the body. A remission is NOT a cure but it does allow your pet to experience a good quality of life. Because of this, chemotherapy should not be discontinued when a remission is obtained. The length of the remission depends upon many factors including the primary site, how sick an animal is at the start of treatment and the extent of disease. In most situations, the average remission and survival times are between 6-8 months. The exact drugs and schedule will depend upon how aggressive the cancer is behaving, how sick an animal is at the start of treatment and any abnormalities in organ function (especially important are changes in kidney and liver function). On a typical schedule, your cat will receive weekly treatments for the first 4-6 months. Several different drugs (L-asparaginase, vincristine, Cytoxan, methotrexate) are alternated (or combined in some cases) in order to reduce the chance that tumor cells will become resistant and to reduce the risk of side effects. Some of the drugs are given by injection and some are given orally (this can be done at home). Oral prednisone is also included in the treatment plan. Bloodwork and/or x-rays/ultrasound are generally repeated at regular intervals to look for side effects (such as a low white blood cell count) and to determine if an animal is in remission. If your cat remains in remission for 4-6 months, the interval between treatments is lengthened to every two weeks. After one year, treatments are given every three weeks for an additional 6 months. If a patient is still in remission at 1 1/2 years, treatment is discontinued. Only 10-15% of cats will ever reach the point where we can consider discontinuing treatment. If a patient comes out of remission, we can try to put them back into remission using either new combinations of the same drugs or different drugs. Unfortunately, the chances of obtaining a second remission are lower and the risk of side effects may be higher. However, there are some cats that do respond and have additional time with a good quality of life. Most cats tolerate their chemotherapy well and have minimal side effects. Serious side effects are only seen in 5-10% of the patients treated. If they are serious or intolerable, we can consider either lowering the dose of the offending drug or substituting a different drug. Side effects include nausea, vomiting and loss of appetite, diarrhea, extreme tiredness or infection. Cats do not lose their hair but may lose their whiskers and have a different texture to their fur. Please also see our handout Chemotherapy in Small Animals.

• Lymphoma, or lymphosarcoma, is a cancer of the lymphocytes, which are a type of white blood cell associated with the immune system.
• The exact cause of lymphoma is unknown.
• Cats that are positive for feline leukemia virus (FeLV) are more likely to develop lymphoma than cats that test negative for the virus.
• Boxers, golden retrievers, and basset hounds are at higher risk for the disease.
• Signs vary, depending on the part of the body affected, and may include enlarged lymph nodes, loss of appetite, weight loss, lethargy, coughing, difficulty breathing, vomiting, and diarrhea.
• Diagnosis usually requires a sample of the affected tissue.
• Treatment is usually not curative, but it may cause the cancer to temporarily go into remission.
• Chemotherapy is usually the treatment of choice for lymphoma.

What Is Lymphoma? Lymphocytes are white blood cells that normally work to protect the body as part of the immune system. Occasionally, a change occurs within the cells that causes them to become destructive and reproduce uncontrollably. This is a type of malignancy, or cancer, called lymphoma or lymphosarcoma. Dogs and cats may be diagnosed with lymphoma. Boxers, golden retrievers, and basset hounds are dog breeds that are at a higher risk for developing this type of cancer. What Causes Lymphoma? The exact cause of lymphoma is not known. However, cats that are positive for the feline leukemia virus (FeLV) are much more likely to develop lymphoma than cats that test negative for FeLV. What Are the Signs of Lymphoma? The signs of lymphoma can vary, depending on the part of the body affected. With generalized lymphoma, the pet may have enlarged lymph nodes, which can appear as swellings in the neck at back of the jaw, behind the knees, and other locations. The pet may seem relatively healthy or experience lethargy (tiredness), loss of appetite, and weight loss. Mediastinal lymphoma occurs inside the chest. Pets with this kind of lymphoma may experience coughing and difficulty breathing. When lymphoma is in the gastrointestinal tract, cats and dogs may show signs of vomiting, diarrhea, and blood in the stool. Lymphoma can also affect the spinal cord, kidneys, eyes, nose, and skin. Signs are associated with the affected organ, such as impaired movement with spinal lymphoma, increased drinking and urinating with kidney lymphoma, and raised growths on the skin with skin lymphoma. How Is Lymphoma Diagnosed? Your veterinarian will most likely recommend blood work, including an FeLV test for cats. Radiographs (x-rays) of the abdomen and/or chest can also be important to help identify affected regions of the body. An ultrasound exam of the chest or abdomen may help your veterinarian identify tissue abnormalities and affected lymph nodes. A biopsy sample from the affected tissue is the best way to diagnose lymphoma. In some cases, lymphoma in dogs can be diagnosed from a lymph node aspirate sample, which involves placing a needle in the lymph node and extracting cells for examination under the microscope. However, a biopsy is the best way to determine the exact type of cell involved, as well as the aggressiveness of the tumor, if treatment will be pursued. How Is Lymphoma Treated? In many cases, treatment of lymphoma can cause the disease to go into remission, meaning that the signs of cancer resolve. This is usually temporary, and the lymphoma eventually returns. If you wish to pursue treatment, your veterinarian may refer you to a veterinary oncologist, who specializes in cancer treatment. Additional tests may be needed to stage the disease or to determine how much of the body is involved. In cases where the lymphoma is limited to one location, such as the nose, radiation therapy may be an option, but most treatment involves chemotherapy. Animals typically tolerate chemotherapy better than humans, but treatment may require several office visits and additional blood tests, which can become expensive. If you choose not to pursue chemotherapy, treatment with steroids may help reduce the signs of lymphoma and make your pet more comfortable for a time. Can Lymphoma Be Prevented? There is no known way to prevent lymphoma, but early diagnosis and intervention can improve quality of life for pets with the disease. Early testing for FeLV can identify cats at greater risk for developing lymphoma. Cats that test positive for FeLV should be kept indoors to minimize exposure to other cats. Cats that test negative for FeLV are less likely to develop lymphoma. If your cat is negative for FeLV and must go outdoors, make sure he or she is vaccinated against FeLV. Keeping your cat indoors can help prevent exposure to FeLV-positive cats and reduce the need for FeLV vaccination. Lymphoma in cats is the most common cancer in felines. The disease is most often found in the intestines, as vaccination against the feline leukemia virus (FeLV) and testing for the feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) have reduced lymphomas in the chest, spleen, bone marrow, thymus, and lymph nodes. Early diagnosis and treatment may help your cat live comfortably for years.

Lymphoma in Cats Symptoms

The symptoms of lymphoma in cats depend on where the cancer is growing. Lymphoma in the lymph nodes comes as swellings around the neck, shoulder blades, and knees. Lymphoma of the chest (mediastinal lymphoma) causes respiratory symptoms. If your cat has neurological symptoms (nervous system involvement), you may notice changes in behavior, difficulty in walking, and fits. Regardless of the site, some symptoms are common to all lymphomas:

• Weight loss
• Lethargy
• Poor appetite

While older cats are most often affected, lymphoma can happen at any age.

Intestinal Lymphoma in Cats

Lymphoma in cats is now most commonly seen in the intestines. Intestinal lymphomas usually cause poor eating, weight loss, diarrhea, and vomiting. The blood tests are often normal, but ultrasound of the abdomen may show thickened intestines, enlarged abdominal lymph nodes, and tumors. Since these findings are common to inflammatory bowel disease, vets usually require a biopsy for a lymphoma diagnosis. Intestinal lymphomas can be large cell and small cell lymphomas. Large cell lymphomas are aggressive — they quickly grow and are invasive. Chances for survival are lower with these lymphomas. A small cell lymphoma in cats is slow-growing. Since it is not aggressive, cats have higher chances of survival.

Stages of Cat Lymphoma

Cancer staging helps vets choose the best treatment for lymphoma in cats. The feline lymphoma stages predict the behavior of the cancer and survival odds. The higher the number of stages, the more cancer has spread. Staging tests depend on the lymphoma type and often include radiographs (X-rays), CT scans, or biopsy. Your vet will choose the treatment based on the type and grade of your cat’s lymphoma. Microscopy divides lymphomas in cats into the large cell and small cell lymphomas. Cat lymphomas are also divided based on location — nasal cavity, mediastinal, multicentric, gastrointestinal, and others. Each cancer can have a low, intermediate, and high grade depending on the cell division.

Lymphoma in Cats Treatment

The treatment of lymphoma in cats is usually through chemotherapy. Your oncologist may prescribe a combination of drugs based on the location and grade of the lymphoma. These drugs are given orally or by intravenous injection once a week for a month or longer. A large mass in the abdomen may need to be removed by surgery. Nose lymphomas respond well to radiation. If a cat is not responding to treatments, vets give a steroid (prednisolone) as palliative therapy. This allows for a temporary remission of 2 to 4 months, improving the quality of life during the last stage of a cat’s life. Cats with lymphoma of the chest, widespread lymphoma, lymph node lymphoma, and large cell intestinal lymphoma will probably receive chemotherapy with a combination of three or four drugs. Almost half of the cats with lymphoma live for a year with such treatment. Two-year survival may be at 40%. Small cell lymphomas, which are not considered aggressive, can be treated at home. A steroid-based drug such as prednisolone and a chemotherapy drug your cat can take by mouth (like chlorambucil) are used for treatment. Cats usually tolerate these treatments well. Medication may help your cat survive for 2 to 4 years.

Lymphoma in Cats Prevention

Viruses FeLV and FIV often cause lymphoma in cats. Vaccination against FeLV and testing for both these viruses help with disease prevention and spread. Avoiding contact with FeLV or FIV-infected cats and areas with smoke can also prevent lymphoma in cats. Early detection of the disease can improve the chances of survival.

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