Recently a friend of mine in Australia messaged me about a lump on his cat's jaw. He had an appointment with his regular vet in a few days, but he wanted my take on it. The cat was older, and a few differentials popped into my mind, some of them not very good. I asked a few questions that would help me narrow it down:
Where exactly is it located?
Is it hard or soft?
Can you move it around in the tissue, or is it fairly fixed in place?
Is there pain associated with it?
The answers did narrow down the possibilities, unfortunately not in a direction I liked. I had to tell my friend that I was highly suspicious that this was an aggressive form of cancer seen in older cats, particularly in the location he was describing on the mandible, called squamous cell carcinoma. I told him I really hoped I was wrong, as I had not seen the cat myself, but given the description that if I were to work up this case SCC would be at the top of the list.
It's really, really hard delivering that kind of news. Particularly when someone isn't expecting it. I knew my friend well enough to know that he wouldn't want me to bullshit him. He'd want the facts, no matter how hard they were to hear. So I warned him that this does not have a good prognosis, as even with the
most aggressive treatment (surgery to remove part of the jaw,
chemotherapy, radiation therapy), most of the time the cancer has
already metastasized by the time it's detected and the cat will die
within a few months.
Turns out that SCC was confirmed with more tests. My friend opted for palliative therapy with pain killers and soft foods to make her comfortable for as long as possible, until the other day when he had her humanely euthanized at home. He's since written me a couple of times thanking me for my help and support. I was kind of taken away by his gratitude, because from my perspective I hadn't done much other than deliver some really bad news. His vet was the one deciding course of treatment and administering those treatments to make his old girl feel better.
It's a reminder that in this career your bedside manner, empathy, and a shoulder to cry on are equally if not more important as your skills as a diagnostician and clinician.