Methos metastatic pancreatic cancer neuroendocrine type

SmallestSparrow

SmallestSparrow

Very Active Member
Hello everyone,

I’m posting here because otherwise I’d need to post in Lantus, PZI, and Cushing forums. Mods feel free to move it if you want.

I want to give you all an update on Methos—PLEASE don’t respond with condolence messages, I am not up to discussing my loss right now. I promise I will post in the grief section in the next few weeks for that. If anyone has questions about his symptoms or tests, because they think it may apply to their kitties I’m happy to explain or give more details but I cannot at this time deal with condolences—Im using compartmentalization to discuss this to give closure to those who wonder about him and have done so much to support us this past year.

As you know Methos had hyperadrenalcortisolism (Cushing’s) and hyperaldosteronism (Conn’s) from a functioning right adrenal tumor—a rare tumor often cancerous in cats. Because he was too old and fragile for surgery he was treated off label with Vetoryl, spiranolactone, and potassium. These conditions led to diabetes, treated first with Bexacat and then insulin. In September 2024 he was changed to insulin because of elevated pancreatic enzymes and spec fPl. Follow up testing over two months showed continued elevations and ultrasound showed his adrenal tumor was much larger, and new abnormalities in his pancreas which could be cysts or tumors. We considered possibly doing doppler flow studies of those tumors if he became stronger, to determine if the they were cancer, but it wouldn’t change his treatment as he couldn’t have surgery and likely couldn’t tolerate chemo. He also had thickening of an area of his bowel, which might be lymphoma but obviously we weren’t doing a biopsy of that either. An internist felt even if it was, he was probably producing his own steroid treatment from the adrenal tumor.

As those in the Lantus and Prozinc groups know, his blood sugar never reached good control, and if I got a decent nadir I had to struggle to keep him from going too low. With each passing month his glucose became more unpredictable, and in the final month there were days I knew I’d given a fur shot and his blood sugar would crash. Other times I knew he had definitely got the insulin into him and his sugar would climb despite additional regular insulin. It was a dangerous balancing act between all of his conditions and medications to keep his potassium levels neither too high nor too low. He had a borderline DKA episode that I treated at home as they felt he would die in the hospital if they admitted him. Throughout this his appetite was less and less, and feeding him was a struggle.

At the end he began having violent vomiting. I took him to the ER in the middle of the night because I was afraid to keep giving insulin to him without knowing his potassium levels. He was again at the slight DKA point, and his WBC was 67,000, 32% lymphs, 62% neutrophils. His abdominal ultrasound showed his abdomen was full of tumors, that appeared to come from the pancreas and was completely obscuring other organs. The ER doctor, his primary doctor and the internist all said he would not be able to recover, whether this was lymphoma, metastatic adrenal cancer, metastatic liver cancer or metastatic pancreatic cancer. I will talk more about his end later, I cannot do it now. I will just say I am so blessed to have his primary Dr Kintworth and if any of you don’t like or trust your vet you really need to work on finding one you do like and trust before things reach a decision point.

His necropsy showed the adrenal tumor, but I told them I didn’t need testing of that to show if it was cancer, since we were testing all the metastatic tumors (even with the discount my vet kindly got for me necropsy testing is hugely expensive and obviously not covered by insurance). He had metastatic growth in the liver and throughout the abdomen and covering the omentum. This was found to be metastatic pancreatic cancer (rare, and especially rare in cats), of the neuroendocrine type (so rare in cats there are just a few anecdotal reports). The lab could only test for insulin and glucagon in the tissue samples, it didn’t make either of those. It could be that his cancer produced somatostatin, which they couldn’t test—this could explain his inability to make his own glucose when he needed it. Or it may not have been functional and his blood glucose swings were from his adrenal tumor, or a combination.

Having had two cats now with “extremely rare” tumors I do wonder if these are more common but not found since they tend to occur in older cats, the tumors don’t produce symptoms or are difficult to see on ultrasound until the disease is advanced, and the testing is very expensive. I don’t know how many cats get treated medically rather than with surgery for adrenal tumors (surgery is the gold standard treatment) but I’m grateful for the extra two and a half years we had, as well as the extra year we had after his pancreatic cancer showed on ultrasound (without any treatment)—I think this is longer than most cats reported.

Again, PLEASE NO CONDOLENCES. I promise to come back in a few weeks for that but I’m barely holding it together right now and talking about him or his end will put me in a dark place.
 
Hello Colleen. Thank you for the detailed explanation of what was going on in Methos. As someone who has lost a cat to pancreatic cancer - FNA inconclusive so no details on type, and has a current cat with a pancreatic lesion found on U/S, I found this post very interesting. And led me down a rabbit hole.

I too wonder about some of the cat conditions we see here that are supposed to be rare, especially in older cats. As you know, acromegaly was in that category until around 2015. Even then, that finding was an accident not intentional. The researchers were trying to exclude acros from a study and found out just how many of them there were by screening for it.
 
While it can be totally coincidence, both Erik (my other adrenal tumor cat) and Methos were very large—tall and long, not overweight. Erik especially was not house-cat sized and Methos was the upper end of the spectrum.

There admittedly was a good chance Erik was a wild cat hybrid but Methos was pure domestic cat. I sometimes wonder if growth hormone could have played a role, or a genetic predisposition to cancer that also happens to make some cats larger than others—Otoh Christine, Erik’s sister, was also larger than a housecat and lived 20 years. so size may be unrelated.

Since many cats don’t live to an age when these cancers show up, and if they do tend to be euthanized without further testing or necropsy (and I totally understand that) once the diagnosis is made it may not be a question ever answered. Even in humans, where of course we try very hard to diagnose and treat, pancreatic cancer remains a very bad diagnosis to get so it may not matter if we underdiagnose cats. I did see one report of a cat diagnosed early (no metastasis seen, not looking for cancer), treated with surgery and long term chemo that lived I think more than a year. But the other reported cases ended differently —measured more in days.

I do however think many tumors in general are underdiagnosed in cats because many don’t have insurance, it’s more difficult to see tumors in their smaller organs, and they tend to be older when problems occur. I understand the difficulty many have paying a lot of money trying to diagnose and treat an older pet who usually had little money invested in them to that point. I hope someday technology advances to the point where costs come down and tumors more easily seen
 
There's also the factor that our furry friends are so good at hiding pain and can't "tell" us that they feel off. So things are well along by the time we find out something is wrong.
 
Wendy&Neko said:
Hello Colleen. Thank you for the detailed explanation of what was going on in Methos. As someone who has lost a cat to pancreatic cancer - FNA inconclusive so no details on type, and has a current cat with a pancreatic lesion found on U/S, I found this post very interesting. And led me down a rabbit hole.

I too wonder about some of the cat conditions we see here that are supposed to be rare, especially in older cats. As you know, acromegaly was in that category until around 2015. Even then, that finding was an accident not intentional. The researchers were trying to exclude acros from a study and found out just how many of them there were by screening for it.
Click to expand...
I hope your current kitty does well and the pancreatic lesion turns out to be nothing.
 
I think Methos’ pancreatic tumors were seen earlier than if he weren’t on Bexacat. Because of the Bexacat he was getting frequent blood tests—he was totally asymptomatic for pancreatic problems (other than the diabetes which was adrenal related). while he had had several ultrasounds for the adrenal tumor we had no plans for doing more at that point unless his symptoms changed. But because of the enzyme changes he got another ultrasound. Otherwise he may have had the same course of most other cats who were diagnosed very close to the end. Since he already had so much going on with his health it’s hard to say if he would have appeared sick if all he had was pancreatic cancer.
 
Thank you, Colleen, for the detailed medical information. I find it very interesting.

I too suspect that some of the “rare” diagnoses aren’t as rare as vets are taught — just under diagnosed. We had a reputation at the university for bringing in the “zebra” cases but the IM vet and I long ago decided it’s probably more likely because we push for answers rather than simply treating symptoms. It’s getting harder and harder to do so, though, given soaring vet prices.

I’ve seen far too many cancers in my crew over the years, including adrenal, pancreatic, and liver. Thank you again for posting what you learned. Now I too am going to go down the rabbit hole of reading.
 
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