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The histopathology results were devastating.  The mass was taken from the mid proximal (upper) left humerus (front upper bone).  It was an oval mass measuring 2.5 cm in diameter. The dermis and subcutis were infiltrated by a “densely cellular pseudoencapsulated, moderately well-demarcated invasive neoplasm.”  Cancer. The report continued, “Neoplastic cells  are arranged in  interlacing bundles, streams, herringbone patterns, and occasional whorls, with moderate amounts of basophillic, wispy stroma and collagenous stroma.” These are indicative of a sarcoma.  “The neoplastic cells focally extend to one deep margin and abut the lateral surgical margin (separated from the surgical margin by only a few collagen fibers).” Bad news.  What all this was saying was that he had a malignant subcutaneous fibrosarcoma that was incompletely excised. The margins weren’t clean.  It was still there…growing, potentially spreading.

The tumor was classified as Grade II, intermediate.  Again, we felt so guilty for not catching it earlier. Why hadn’t we seen it? Felt it? The pathology report said that cats with a grade II soft tissue sarcoma “had a median survival time of 514 days,” but the pathologist cautioned that “the grading scheme had not yet been validated by other studies.” He wrote that “feline fibrosarcomas in general tend to be highly locally invasive, with a metastatic potential that is low initially but appears to increase over time.” He continued stating, “In this case, neoplastic cells extend to deep margins, and there is high concern for local reoccurrence.”  The report stated, that “aggressive surgical excision with wide margins appears to contribute to extended tumor-free interval and survival times in cats.” He recommended a consultation with a veterinary  oncologist to discuss possible adjunctive therapies.

The report also said that there was “no overt histologic evidence to suggest this may be an injection site sarcoma (no peripheral aggregates of adjuvant-containing macrophages, no lymphoid follicle formation, no numerous multinucleated giant cells or marked pleomorphism).”  The histopathology suggests it was a spontaneous fibrosarcoma. Bad luck.   We checked the veterinary inoculation records. There is no record of him having a vaccine in that location. We had never given him the FeLV shot as he is indoors only but he had received the rabies vaccine as required by California law but not in that location.  However, we adopted him at 6 mos. It is possible (likely) that he had vaccines prior to our adopting him.  It is also possible a vet technician might have mixed up a left and right leg or that Castiel was being difficult at shot time, so the technician gave it elsewhere and didn’t note it in the paperwork. So many unknowns. He was also found by the rescue at a Maritime Academy, so he may have been exposed to something there or from his mum.  Vaccine associated sarcomas have a worse prognosis than non-vaccine associated sarcomas, we’re told. We couldn’t be 100 percent sure which type it was, according to the vet. The vet said that it should be treated as though it was a vaccine induced sarcoma.

Every article I had been reading said the first surgery was the best chance to get all the tumor. We hadn’t gotten it.  Would this lead to cancer seeding –spreading? These kinds of cancers are very difficult to get — they send out tentacles and they aren’t visible to the naked eye.  Our vet had tried her very best but the monster was still there. And how long would it take to get an appointment with a veterinary oncologist? One place said they could see us in late December — too long.  We called SAGE, they could get us in next week. Everything was taking so long but the report did  say it was slow to metastasize so maybe there was hope but we worried, ” how long has it been there?”

The only encouraging news was that the X-rays looked clear and the blood work was mostly normal, only the globulin was slightly elevated. We made an appointment for Castiel with a veterinary oncologist and went home and collapsed.

Everything stopped. The wet laundry sat in the dryer growing mildew.  The dishes sat in the sink. No one made dinner.

 

Castiel underwent surgery at his local vet to remove the lump so that it could be tested to determine if it was benign or malignant. We remained hopeful…maybe we would get the entire lump and good margins and all would be well. We were hoping… and my husband was thinking this could happen but I knew that cancer sends out tendrils and I was worried. The fact that it had grown considerably in the last week was alarming. I had been reading everything I could on feline fibrosarcoma. I went nuts on Pubmed, I plowed through veterinary journals. But I was aware that all my Googling and reading wasn’t equal to a Veterinary degree and years of practice. I learned enough to ask some questions – enough to be scared.

Castiel did well in the surgery. Thankfully, he had no issues with the anesthesia and came out of it quickly. His surgical scar was enormous but the lump appeared to be gone.  We hoped it was gone.  Castiel spent the afternoon recovering at our vet’s office and came home that evening. She told us he might be groggy, that we shouldn’t let him jump or move around much, that he might not be hungry.  She put an Elizabethan cone on him. He fussed with the cone on the way home, plotting its removal.

When we arrived home, he flew out of the carrier like a bat out of hell and immediately shirked his way out of the collar and  gobbled down his sibling’s leftover supper. He  wasn’t interested in keeping still. We had to settle him down as he was making his suture bleed. We gently cleaned the suture and replaced his cloth cone. He sulked. He kept tripping over it when he walked and it made it hard to eat. We drove to the pet shop and bought an inflatable doughnut cone. He hated that one too. Back to the cloth cone.  He was still drugged so he wasn’t in pain — that happened at about 3 am. We gave him the pain medicine the vet prescribed  and he napped until breakfast time. Never one to miss a meal, he was up meowing as soon as the sun began to rise.

It took another three days to get the histopatholgy results.

We showed our vet the lump. She seemed calm… she always seems calm even when she is being bitten or covered in cat poo, as is usually the case with Castiel.  He always pees and poos when he is nervous — a real nightmare at vet visits. Our vet’s office takes these nervous movements in stride, even when he smells up the whole office so bad that we’re left gagging. No amount of fasting solves the problem, we’re convinced he saves up poo for car rides and vet visits.  We come prepared with pads and cat wipes. We often joke that we should get our vet a full raincoat that she can reserve for his visits. Our vet is super nice and gentle — and calm. And she was calm while she felt the lump.

She mentioned that lumps could be lots of things.  I think she was hoping it was something else too. We clung to that hope — even though, I didn’t think the result would be good. She did a Fine Needle Aspiration. She took X-rays of his leg and thoracic area (lungs). The X-rays didn’t show anything, just a little arthritis in that leg. We had to wait three days for the FNA. They were painstaking. We wanted it to be a lipoma or a cyst but it wasn’t rubbery and it didn’t hurt but still we wanted to believe it wasn’t malignant.

Three days later, we received a call from our vet with the results — it showed inflammatory cells and spindle cell proliferation.  The report said there was “concern for sarcoma” but more testing was needed.  The pathologist couldn’t say for certain. We clung to hope. Spindle cells don’t necessarily mean cancer — but they often do — they often mean some kind of sarcoma.

Our vet suggested we do a surgery to remove it. We scheduled the surgery for the first available date –early the following week. We wanted to test sooner but there were no appointments.  We debated if we should have the surgery at a specialty vet hospital but our vet was confident she could do the surgery. I wonder if maybe she thought it might be something else too. We still had hope it might be something else. In retrospect, we probably should have gone to the specialty hospital when we suspected sarcoma, but we didn’t know it was sarcoma and we were still in diagnostic mode.

In less than a week, the lump grew. Cancer means rapidly dividing cells. Benign things don’t grow that fast, I told myself.

It was an ordinary Tuesday when I came home from work and my husband told me that he had found a lump on Castiel’s left front leg.  It was big, irregular, and felt hard and rough. It was like a peach pit had become embedded in the tissue of his leg. It wasn’t rubbery, it didn’t move, and it didn’t hurt.  I’m a human osteologist, I knew this was bad. My husband had already booked a vet appointment for the following day.  Family suggested that it could be a cyst but I didn’t think it was. I thought it was some kind of sarcoma and I was terrified because while my husband didn’t know what that meant, I did.

The lump seemed so big — how did we not notice it before? We snuggle with Castiel every night… we give him multiple daily belly rubs… but he is a big cat (a bit chonky) and it was kind of tucked in the inside of his arm.   We felt like the worst cat guardians ever.  We started looking back and re-examining every little thing. He’d had a limp for two years on that front leg. We’d brought him to the vet multiple times. He’d had X-rays and blood work, other than a little arthritis in that leg they said the tests were normal.  We thought it was arthritis or because he was a bit overweight. He had started limping after a blood test not a vaccine.  He was on a slimming plan and had slowly lost some weight. We remembered that he used to play chase more and jump more. He didn’t do those things as much now. We thought at nine years old that he was just settling into middle age.  Could the cancer have been slowly growing for two years? We should have asked for more extensive tests and investigated the limp further.  If we had watched his diet better, we would have noticed it earlier. If we had spent less time working. We spent the entire night on “what ifs.” We felt terrible…so terrible. He depended on us and we felt like we had failed him. We meant well but we had failed.

We vowed that every cat in the household would get full weekly pat downs from now on; that we would always investigate things – that when we heard quacking we would consider zebras.  We went crazy with guilt. It was if our whole world came to a crashing halt.

Castiel is our adorable goofy parlor panther. He is a 9-year-old black cat named after an angel who doesn’t quite get humans from the tv series Supernatural. We adopted Castiel at 6 months of age from a local rescue group. It was love at first sight. I swear our hearts double in size every time we look at him. He has two adopted much loved tiger siblings, one-year-old Clover and three-year-old Aleksandr. We all live in the SF Bay Area, and all the cats are strictly indoors as we live in an area with coyotes, hawks, and mountain lions.

Castiel is possibly the most food motivated cat on the planet. He is constantly plotting to steal his siblings chow. He is an expert at breaking into cupboards and is not opposed to helping himself to leftovers. He is a big long cat whose people and vet have him on a strict slimming plan, which he thinks stinks.

Castiel has had a few prior health issues but nothing serious. He got blocked up something fierce after chewing up a double roll of toilet paper as a kitty – about $800 worth of enemas and care solved that issue. He has suffered some constipation issues over the years that resulted in a vet prescribed small Miralax dose but otherwise he is a pretty typical cat.

He spends his days lolling around the house, following sunbeams, lying across jigsaw puzzles, playing with his siblings and catnip toys, and playing fetch and feather toy.

Less than a month ago everything seemed perfect, and then we found a lump.