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Thaleia-Rengina Stathopoulou, Lecturer in Anaesthesia and Analgesia and Celia Figueroa Gonzalez, Senior Clinical Training Scholar in Oncology

Harry was an approximately 20-year-old male neutered Bengal cat. He was diagnosed with an oral squamous cell carcinoma (SCC) involving the left maxilla. The tumour was invading the nasal cavity and the periorbital tissues, making surgical excision not a feasible option.

Despite his age and diagnosis, Harry was a lovely and active cat and maintained a good quality of life. However, due to the location and the invasiveness of the tumour he was showing dysphagia and marked signs of pain.

Palliative care strategy

His family looked for all the possible options to make him happy for as long as possible without prolonging any discomfort. Taking into consideration Harry's diagnosis, the extensity of the tumour, and the relevant prognosis, Harry’s family decided to undergo palliative care, aiming to maintain his quality of life.

Just before Christmas, Harry and his family visited our Pain Clinic, following a consultation with the Oncology Service, to provide further analgesia options. He was already receiving a multimodal analgesia regime that included various groups of medications for treating pain, aiming to reduce side effects and treat pain through different cellular pathways.

It included meloxicam, for relief from the neoplasia related inflammation, pregabalin, aiming to alleviate the neuropathic pain, and cannabidiol (CBD) for additional pain relief. He had also received buprenorphine sublingually, a partial mu opioid proven effective in various cases of oral pain.

At presentation Harry was bright and alert and soon became everyone’s favourite. His physical examination was normal, and no one could believe his age. However, his body condition score was poor, revealing the chronic effect of his diagnosis. He was reacting to gentle palpation of his left maxilla, and eye and as a sign of discomfort he was trying to scratch the area repeatedly. Left eye blepharospasm was also present.

Nerve block use

We decided with his family that the best option for him to maintain his quality of life was to perform a neurolytic block under anaesthesia. The aim of this nerve block was to desensitise the nerve that was supplying the affected area temporarily, so he could keep enjoying his meals and time with his family. The duration of this intervention is reported to be two to three months, but it could vary due to the local effect of the tumour. 

Harry underwent general anaesthesia and we tried to identify the infraorbital canal to perform the nerve block. As expected, the area over the left maxilla was thickened and anatomically distorted. Aided by a previous CT scan, we were able to identify the location of the canal and dispense the injectate accurately, using ultrasound to guide our needle. Initially we injected lidocaine to provide a local analgesia effect, followed by a small volume of ethanol 70% and buprenorphine. 

After his short anaesthetic, Harry recovered uneventfully, and he received an infusion of bisphosphonates (zoledronic acid) to decrease the cancer-related pain due to osteolysis. We were extremely pleased to see Harry eating a large meal and treats. He was everyone’s favourite story for Christmas.

Following discharge, he spent close to two happy months with his family, during which he was comfortable and energetic as before. Unfortunately, during this time, he experienced bleeding episodes that were more than likely associated with the progression of the disease. After the last episode, it was decided that the best for him would be to be euthanised, accompanied by his family.

Despite the outcome, Harry remained a happy boy even up to a few hours before the final bleeding episode, and he managed to celebrate Christmas and his birthday with his beloved family.

This case is an excellent illustration that there are still options to maintain a good quality of life, despite age and diagnosis. The combination of his committed and understanding family alongside strong teamwork between the Pain Clinic and Oncology made the success of this case possible.