If your cat has just been diagnosed with oral squamous cell carcinoma, the most common oral cancer we see in cats, you’ve come to the right place. This is really a serious cancer. I hope you found the first part where I talked more about cancer, its causes, the tests we run and things like that. But in this article we are going to talk about the different treatment options with an emphasis on palliative and supportive treatment options to focus on pain and nutrition. So let’s dig deeper, discuss, let’s talk about treatment options for cats with squamous cell carcinoma. So how do we treat these tumors?
Why am I so pessimistic about the treatment?
The take-home message is that most of the time treatment has not proven beneficial. And when I’m going to recommend a treatment, I want it to help your cat. So in surgery, we need two-centimeter margins on both sides of the tumor. Guys, this is two inches. So if your cat has a two-inch injury and we need to remove six inches of tissue, that will usually be the entire face. It is very difficult. So if you only do minimal surgery the problem is they grow back. So we are often talking about moving the entire lower jaw, the entire upper jaw. You know, if the lymph nodes are enlarged, remove them too. And they are really big operations. And most of the time they still grow back, and it hasn’t been shown to increase survival times and what we call the disease-free interval when cancer returns. And for tongue tumors, surgery is not an option. So surgery doesn’t really improve survival time. Radiation, when the mouth is irradiated, can have many acute side effects. And in general, the response was not very good. Now there is stereotactic radiation, but again, waiting for new results.
The only kitten I made when we started doing stereotaxic radiation at the hospital I was in did really well, but I had other cats that didn’t do very well. So again, you know, it doesn’t look like radiation is going to be helpful, whether stereotactic might be a better option or not, it remains to be seen. And then chemotherapy, so in general it is not the best approach to give injectable or oral chemotherapy for a measurable tumor. You want to remove it surgically or treat it with radiation. So in general take a message. Surgery, radiation, and chemotherapy have not been shown to be effective. Some people have looked at Palladia, this oral drug, and again, the hard thing is you give your cat pills three times a week, and they have an oral tumor there, and that can be challenging too. These are some of the options we are analyzing. I really hope there is new data and new information to share, but at this point, I mostly focus on comfort, pain relief, and nutritional support So that’s what I mean by palliative management. Palliative support. Softening is soothing to make the pet feel better. So one of the things we are going to do often is a non-steroidal anti-inflammatory, you are not going to give your cat non-steroidal anti-inflammatory drugs or NSAIDs, but there are some we can use on kittens. Kittens are very sensitive to nonsteroidal anti-inflammatory drugs. So we have to dose them safely. We have to be careful if they already have kidney disease, check their kidneys and liver. And sometimes it can cause stomach irritation or ulcers. We often combine the medication. Your vet will dose and monitor it accordingly. And not only do we use nonsteroidal anti-inflammatory drugs for pain, but it is also believed to have an anti-cancer property, so it can help treat and soothe cancer. So that’s one of the things that I normally recommend for my scaly cats.
Often other painkillers are also needed. So we bring different painkillers with different modes of action. We are never going to give two NSIDs that would be dangerous, but we can use something from the opioid family, such as butorphanol or something similar. And sometimes you have to get these drugs in combination so that they are in liquid form for easy administration because again it can be challenging to give oral painkillers to a cat who is painful. And then nutritional support. Again, one of the things that will be very important is to weigh your cat regularly and keep track of the weight. Many of these cats need soft food, right? So wet food, canned food, will be very important as it can be painful for them to eat it. And the other thing to consider is the feeding tubes. And I know when I say tube feeding there is often a negative connotation.
It’s like, “Oh, feeding tube. That sounds bad.” But we can often insert a feeding tube. And that can be a really good way to get them to eat because otherwise, they feel good. They’re just, you know, we’re dealing with their pain now, but they just can’t eat. And so it’s esophagus tubes, E tubes that can go to the neck, and then pin tubes, which can go to the stomach. And so you can help get your calories in by putting them through your probes. And then you can also put your painkillers and any other medicines in it. And then when they start to eat on their own, you just feed them less through their E-tube or their peg-tube, but you can still put their medicine in there. They sound a bit scary, but many owners are quite happy with them. So that’s something our internist will often put on our squamous cell carcinoma cat if she’s not eating properly. For palliative care, I cannot underestimate the importance of appetite. And I was talking about tube feeding, but I also want to talk about appetite stimulants. And of course, I have separate articles there.
But for cats, there is a great relatively new drug called Mirataz. It is mirtazapine that stimulates appetite. We used to take cat pills or get a compound in a liquid, but now it’s in an FDA-approved form for cats that’s transdermal that you’re going to put in their ears. So every day you change your ears, you wear a glove when you put it on, but it’s approved for weight gain. So by using this drug you will stimulate his appetite and help your cat eat and gain weight. You must go to Mirataz. Ask your vet about Mirataz as cats need appetite stimulants. And that doesn’t mean it’s a bad thing. You know that some people are really reluctant to take these drugs, but it can actually make them want to eat. And painkillers can keep you from wanting to eat. So they take painkillers, they are painful. Those are the things that tip the balance into not wanting to eat. So by giving them Mirataz, you can tilt the seesaw back a bit to help them eat. So ask for Mirataz. It is my favorite appetite stimulant.
So it’s sort of a summary of this challenging cancer. You know, the prognosis is not very good. And in most studies, the message to take home is three to four months, almost no matter how aggressive we are or don’t treat them. Again, that’s why I switched to this comfort-oriented treatment. So in most of the studies, if you have surgery, you know, radiation or chemotherapy, it takes about three to four months. That said, one of my patients recently received palliative care and nonsteroidal anti-inflammatory drugs for about six months. So there will always be a range on all sides. And I always hope that your pet lives longer, is comfortable and happy, you know, and gets the care it needs. There are some longer-term studies, better grades with a combination of surgery, radiation, and feeding tubes.
There is an investigation in which those kittens were out of the game for 14 months. So more than a year. And just under 60% with a one-year survival. But again, the big problem with surgeries is that they often come back, they grow back. So they need radiation. And there are many side effects of radiation. So if you are ready, if you are ready for aggressive therapy, be sure to consult a medical oncologist and radiation oncologist. And this is one where you probably want to see a board-certified surgeon, because the surgery, you know, has to be a major aggressive operation. So if that’s something you want to deal with aggressively, then you want a team of specialists working by your side to achieve it.
There are also other things you can do to stimulate the appetite, see my article on things to do when your pet is not eating. Some of them are simple things like eating food and other things like that. But Mirataz is one of my favorite medications, and you don’t have to give your cat pills, and which of the cats best not to take the pill, a cat was something that happened in his mouth. Sometimes these cats get infected with mouth tumors and need antibiotics, so they don’t want to eat either. So appetite stimulants are so important. Don’t forget to ask your vet about it too.
As I said, it’s not my favorite cancer. I would be so happy if I could connect and tell you there is a new therapy for this cancer or a better way to track it down sooner because that’s always my goal. Early detection, better treatment options, but stay tuned. I’ll let you know when we have more information. Thank you for reading.