IBD or lymphoma? Sorting out the feline GI puzzle

In this episode of the Vet Blast Podcast, host Adam Christman, DVM, MBA, sits down with Craig A. Clifford, DVM, MS, DACVIM (Oncology), to talk feline lymphoma, from that "something's just off" exam to what comes next. Clifford explains how the large cell and small cell forms show up differently in the clinic, and which diagnostics give primary care teams the clearest picture. He also covers where treatment stands today and why cats may soon have more options for treatment. Plus, he shares tips for working with cat owners on a budget when the difference between IBD and small cell lymphoma isn't clear-cut.

Below is a partial transcript, edited lightly for clarity.

Adam Christman, DVM, MBA: As a primary care veterinarian, when I see a cat that could be suspected of feline lymphoma, what are some of the clinical signs that we could look for?

Craig Clifford, DVM, MS, DACVIM (Oncology): When we think of feline lymphoma, the way I try to look at it is I break it into 2 basic groups: We have what's called our intermediate- to large-cell, or aggressive lymphoma, and then we have our small-cell, or low-grade, less aggressive lymphoma. Each one presents differently.

What you are alluding to would be the large cell. That's commonly a situation where the cat is doing okay, and then all of a sudden it is not eating and is having gastrointestinal signs, because the most common form of intermediate- to large-cell lymphoma is GI. It's not like dogs—like the [golden retriever] that's on your schedule coming in for a lump. You lay a hand on him, and in 5 seconds you know the dog has lymphoma. Unfortunately, with cats, 80% of them, if not more, are going to be gastrointestinal. It's all internal, which is a big downside we have in cats: We just don't catch it early. So, usually, it's going to be loss of appetite, weight loss, vomiting, diarrhea, things along those lines that are going to necessitate them coming in to see the primary care.

On the other hand, the small cell is completely different. You're looking at some signs that are present, but they're present for weeks and months. So, their clinical signs literally overlap and mimic those of IBD. There's a vast difference in presentation.When we think of feline lymphoma, the way I try to look at it is I break it into two basic groups; we have what's called our intermediate to large cell, or the aggressive lymphoma, and then we have our small cell or low grade, less aggressive lymphoma. Each one presents differently.

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