Castiel is an awesome panther. He is strong and brave, and loved beyond measure. We got some terrible news this past week. Castiel has not one but two new cancers – a thyroid carcinoma and a very slow growing lymphoma in his intestines. No one is worried about the lymphoma. He could live out his life with it and it is treatable but the thyroid carcinoma is a nightmare. His oncologist does not think it is related to the fibrosarcoma that led to the amputation of his front left leg. The cancer is big. Egg shaped. It measures 4 x 4 cm and it encapsulates the right thyroid and then some. It extends forward and back. It’s like an iceberg, with only a smaller portion sticking out front. He has now had an ultrasound, a CAT scan, numerous fine needle aspirates, and blood panels.
His oncologist thinks surgery is his best option. Today, we had a surgical consult at SAGE Dublin with a board-certified surgeon. The surgeon thought a high dose radioiodine therapy might be a good option. She called around to U.C. Davis, SAGE in Redwood City, and a place in Chino, CA. The first two don’t do the high dose radiotherapy and we haven’t heard back from the last. The literature seems to suggest the high dose radioiodine therapy is a good option, but we can’t find it anywhere — and Castiel does not travel well.
We don’t know how fast this tumor is growing. The oncologist didn’t want to do a biopsy for fear of a bleed, so we don’t know how aggressive it is or what stage it is at. We just know it has cells indicative of thyroid cancer. We could wait and watch it for a few weeks but the risk of spread increases, as does the risk that it grows and becomes inoperable. We can keep searching for a place that does the high dose radioiodine therapy, but the surgeon thinks cats might need to stop the thyroid medicine for a week before proceeding with therapy and Castiel might have to be there weeks afterward to reduce the radiation. And could we even get him to a place that has this therapy if we could find it? Castiel panics on all forms of transit except his three feet, so that in itself is risky.
The other option is surgery. The surgeon says it would be a complicated surgery with serious risks. The biggest risk is hemorrhage. The tumor is in a very vascular area, and it is fixed. It is adjacent to carotid artery and jugular vein. One millimeter the wrong way or a tear during detachment, and it could go very badly fast. There is also a small nerve that runs alongside the larynx that would need to be lifted and that could be damaged. If damaged, it would limit the opening and closing of the larynx. There is a second nerve that works with this nerve on the opposite side of the larynx, but he could potentially be down to one –and we don’t know how difficult this might be for him. The surgeon estimates that the surgery has a 25 percent risk of a serious complication. We don’t know what to do.
We talked with the surgeon again tonight and we have agreed to surgery tomorrow with ground rules. The first rule is keep Castiel alive. The second is if the surgeon goes in there and it’s a nope, she closes him up again and we are fine with that. We don’t try to scrape the tumor off the side of dangerous vasculature. We accept that clean margins are not a possibility. We debulk, especially around the trachea, as possible and we remove only what is possible. No excessive risks. The whole thing is risky, but we remember that Castiel is an awesome, strong cat and we do what we can. We keep positive. He is going to survive this surgery. We look to regular radioiodine/chemotherapy afterward to help with what the surgeon cannot do. We hope and pray that we buy time. With surgery and adjunct treatment, he could live up to three years. We are optimistic and that is okay. We know that there are lots of reasons not to be, but we choose to be anyway. It is not fair for one little panther to have two rare cancers, and a third cancer to boot. No one should have to endure this and certainly not a sweet little black cat.
Please, please keep Castiel in your thoughts and prayers. Employ whatever kind of luck you believe in. We need it all. We are so scared. We need you to help us be brave.