My 8 year old cat Squeak had a lumpectomy to remove a growth (malignant melanoma) from his right ear back in December of 2022. Surgery went well with clean but narrow margins and there were no complications. Nine months later in September of 2023, I noticed a small lump had appeared at the base of the same ear. I took Squeak for an oncology consultation and it was recommended that he have a procedure called a TECA-BO.
The entire ear canal and middle ear was removed. It was VERY expensive! Consults, diagnostic imaging, medications, the surgery and overnight hospitalization totaled over 10K.
Squeak recovered very well and I took him to see my primary vet for check-ups regularly. Chest x-rays showed no sign of abnormality and bloodwork was, as my vet said, "Beautiful!" I was feeling so hopeful that all would be fine. However, that was not the case. Recently, Squeak has been shaking his head frequently and scratching at the area where his ear was removed.
I brought him in to see my vet who prescribed a course of Baytril and prednisolone for 2 weeks to treat what he believed might be an infection. Unfortunately, Squeak did not respond to this and now I am faced with the real possibility of a regrowth of the cancer. I was advised to get a CT scan which I have made arrangements for at a specialty veterinary hospital.
I'll be bringing my boy in for a surgical consultation tomorrow morning. I'd be lying if I said I wasn't scared to death. I'm a nervous wreck! Anyone reading this have a TECA-BO done and then have their dog or cat experience complications from the surgery or regrowth of the tumor? Wish me and Squeak luck for tomorrow's appointment!
Also, if there are any veterinarians out there that are familiar with or have done a revision surgery after TECA-BO, I would REALLY appreciate your input. Thanks!
Hi Brooklyn,
I'm sorry to hear about this in your kitty. As you have probably learned, malignant melanoma is a rare skin cancer in cats so we don't see it too often, but it's a really dangerous one. Unfortunately, recurrence even after successful surgical removal is common, even months later, because at the time of removal, the cancer has already spread microscopically to other places. The TECA-BO (total ear canal ablation-bulla osteotomy for other readers not familiar) is a challenging proecdure only done by specialist surgeons but often necessary if the cancer is present deeper than just on the outer ear flap. Unfortunately, it still provides no guarantee the melanoma won't show up somewhere else later. Radiation therapy is recommended sometimes if there is concern about margins. Chemo is a rare recommendation with this type of cancer but may be discussed if surgery or radiation are not options. It sounds like it's not clear yet why Squeak is scratching at the TECA site, but I would agree the lack of response to the ear infection/inflammation approach warrants further investigation. I really hope the CT scan doesn't reveal anything very serious but please keep us posted.
@chris-vanderhoof
I got a phone call this morning regarding Squeak's cytology results and sadly it was what I was dreading. The pathologist's interpretation was "Lymphocytic proliferation and many atypical multinucleated cells; suspicious for lymph node with metastatic amelanotic melanoma." I managed to keep it together during the call but had a real meltdown after I hung up. The vet said she will get back to me after she consults an oncologist about "treatment" options. She mentioned another surgery, and also radiation and/or chemo as possibilities. I was emailed a copy of the cytology report (most of which I don't understand) and a copy will be sent to my primary vet. I will follow up with him after he reviews it. He always explains things to me in a way I will understand and patiently answers any questions I might have.
I am absolutely devastated at the moment. If only it was all just a bad dream and I can wake up and everything will be right again. I am at a loss as to what I should do next. The hard part is accepting the fact that there is no cure for Squeak's disease. I had always been hopeful that we would beat this but at the same time the thought of the cancer returning was always lurking around in my head. Of course, I will do whatever it takes to make my boy comfortable for the time he has left with me. Just typing those words has started the tears flowing again. I've spent hours on my computer researching about melanoma in cats (I'm aware that it is not common) and have posted on numerous cat health forums. I though it would help to get somebody else's point of view (a medical professional or just a cat owner whose cat had this cancer). However, I have gotten no response except for yours. So, now that you know the cytology results, could I ask if you would give me any advice at all about what I can do for Squeak? I would really like to hear your thoughts about this. Should I consider having another surgery done or would it just be pointless? I want to do what is best for my boy who I love with all of my heart.
@chris-vanderhoof
Thank you so much for your reply! I was beginning to think that I was not going to get a response. This morning I had a consultation with a surgeon at a specialty veterinary hospital. She examined Squeak and did a fine needle aspirate of a subcutaneous mass which was easily felt at the TECA site. The CT scan was supposed to be done today but unfortunately, the machine was down so there will be a delay. Meanwhile, I am waiting for a call to inform me of the cytology results. Here are the remarks that were on the surgeon's report:
Subjective: BAR
Objective:
EENT: Eyes clear. Pinnectomy AS with crust present (self trauma), firm subcutaneous mass along the length of where the ear canal was, no draining tract, pruritus.
Peripheral lymph nodes: No significant findings.
Cardiovascular: No murmur or arrhythmias detected. Pulses strong and synchronous.
Respiratory: Eupneic. Normal bronchovesicular sounds.
Abdomen: SNP
Urogenital: External genitalia appears normal.
Rectal: Not examined.
Musculoskeletal: Ambulatory X 4.
Neurological: Mentally appropriate. No ataxia noted.
Integument: Hair coat normal
Diagnosis: Mass effect AS r/o granulation tissue vs tumor regrowth
Follow Up: Pending cytology.
So, that's where things stand right now. Very worried.... I will keep you posted. Thanks again for your response.
Hi Brooklyn,
I'm sorry to hear about those results. The oncologist is going to give you the best detailed information about what the options look like. As this is a rare cancer, I can't be sure what treatment options will give you x, y, or z results. But once you have those options from the oncologist it's important to have a full understanding of what kind of prognosis those options give you and what quality of life that looks like for Squeak (and you). For example, if they tell you an additional surgery may be very invasive and painful and may buy you a short time, like 1-2 months, you may have to really consider if that would be in his best interest also considering the financial cost of a short and uncomfortable prognosis. But if the same procedure can provide something like 6-12 months, perhaps that would be worth it. You try to balance the time period an option provides and what type of quality of life and comfort a pet has during that time.
When one of my own cats had nasal cancer at the age of 6, I was told he would have a 1-2 year prognosis. Blessedly, he had 6 great years. The radiation therapy he went through was tough on him for 3 weeks, but considering the outcome it was well worth it for both of us. When he developed a different type of nasal cancer at the age of 12, I knew the benefits would not be the same and that at his older age it would be far worse for him to go through with a shorter and less comfortable outcome, so I decided not to pursue treatment a second time. I kept him comfortable until I knew he needed to pass and I am still comfortable myself with that decision because I think it was the best one for him.
See what options you're presented with and keep those factors in mind. It's hard to go wrong if you keep a pet's comfort and quality of life at the forefront of decisions.
My own cat had more of the traditional radiation therapy, which as opposed to stereotactic radiation therapy (SRT) I believe is referred to technically as intensity modulated radiation therapy (IMRT). I know that SRT is a newer radiation therapy approach that ends up delivering the same total dose over a shorter period of time compared to IMRT alone. It has been in use in human medicine for a longer time and has been adapted more to veterinary medicine in the last several years. It may not have even been available when my cat had his radiation therapy. I'm no oncologist to be clear, because the choice of what therapy to use depends on the tumor type and location and they are much better versed in those approaches, but medically this would be a sound approach from a quality of life standpoint. It requires very few total treatments, is non-invasive, and of course doesn't require three weeks of anesthesia. I don't know its expected effects for Squeak's type of cancer, but hopefully the radiation oncologist will be able to provide that type of specific information. I'll be out of town for a few days but I wish you guys the best of luck coming up!
@chris-vanderhoof
It's me....again. After spending many hours researching cancer treatment options for cats on the internet, I have pretty much made up my mind to try stereotactic radiotherapy for my Squeak. I have discussed this with the veterinary surgeon that did the FNA and she seems to think this would be a better option than another surgery. I also called my primary vet this afternoon and and he told me that he had attended conferences where SRT was discussed and the results were very promising. However, he said I should be aware of possible side effects. I have a telehealth appointment set up for July 9th with a radiation oncologist who has been sent all of Squeak's medical history. I hope to get all my concerns and questions answered before treatment begins. I'm really scared and hope I am doing the right thing. Are you familiar with SRT at all? You mentioned that one of your cats had radiation therapy for 3 weeks and was cancer free for 6 years until a different cancer developed at the age of 12. I'm sorry that your cat had a recurrence but at least he had 6 great years. That's wonderful! I don't think I could put Squeak through a lot of radiation sessions. It would be way too traumatic for my boy. He HATES going to the vet and I've had to sedate him with gabapentin to calm him. I was excited about SRT because it will only require 3 sessions over 3 consecutive days. I think that will be doable! I just hope that Squeak responds favorably to the radiation. In some cases SRT can be curative (THAT'S what I'm going for!) but I know that I shouldn't get my hopes up too much. I really want this to work!
Anyway, I just thought I'd let you know what's going on. I can't thank you enough for taking the time to comment on my posts. Your compassion and sound advice have meant so much and helped me tremendously. I will keep you posted!