What Does A Lump Mean?

Physicians find lumps all of the time. Most of them are benign and transient (of course the pregnancy "lump" is transient but may not be so benign).  So how does a doctor know which lump merits concern and investigation?

The basic tools are straight-forward. A simple history, which addresses a variety of issues including some of the following, may lead to the correct clinical impression: Have you ever had cancer or any unusual growth on your skin or elsewhere?  What surgery have you had?  How is your appetite? Have you lost weight recently?  Have you had sweats at night or experienced fevers which have no obvious explanation?  Have you been exposed to toxic environments or  materials in your work or personal activities?

And then, the doctor takes the time to perform a competent examination, examining the lump, skin, lymph node areas, thyroid, abdominal organs, breasts, testicles and other areas which may harbor malignancy and which are accessible to palpation or examination.

Only then, does the doctor consider the differential diagnosis and possible laboratory and radiologic tests which may help to establish a diagnosis and differentiate a benign from a more serious condition.  And then,  after a discussion with the patient, the doctor orders the standard tests - and  specialty focused tests such as fine needle sampling (biopsy) of the tissue in question.

Then the doctor and the patient (and those the patient wants to be involved) discuss the findings, the diagnosis and the treatment options and plan. 

Medicine is not television drama. The physician - who has been carefully trained to understand and require each step that I have outlined - collects all necessary information to form an evidence-based diagnosis.  Scientific evidence trumps intuition and conjecture.

A Long Day

Because I have been ill, my blogging has been curtailed.  To give you a sense of what has been going on - I'll describe yesterday.

Phone rang once at 5:20 AM. No one there.
As instructed, I appeared ( accompanied by my spouse) at the University Medical Center at 7:20 AM. Confusion prevailed since the department's computer had me scheduled to show up at 9:30, though someone from the department had called the night before with instructions to show up before 8:00 AM.  Sat and waited.

Called into the pre-op room, changed into hospital garb, climbed into the preop "bed,"  answered a lot of questions the answers to which were pretty much in the electronic medical record, though not entirely accurately in the electronic medical record. Nurse was very thorough and competent. Started on IV.  Waited.  Waited. A Fellow appeared and we discussed the proposed procedure, discussed my history, went through a limited physical exam, and negotiated some issues which were important to me relating to lab tests and operative procedure related events. Faculty member came and we had a sensible and appropriate (more mature) discussion of his plans and recommendations, the proposed procedure and the likelihood that my procedure would be significantly delayed because he had to treat a child and we agreed the child should come first (which was the faculty member's plan anyway). More waiting.  More waiting. Reminded nurse that I needed a simple blood test done and it was done. Told that the procedure was going to start soon.  It didn't, but eventually it did. Brought by a pleasantly chatty nurse to a high technology room containing 5 people and placed on a hard narrow table. IV running (fluids, pain relief and sedation). O2 running. Monitors running. Local anesthesia for a biopsy provided. Biopsy done with little pain or discomfort and lots of instruction for the Fellow who was there learning. Off the table to the wheeled transport. To another room for  recovery and two hours of fitful dozing. Then to another room for final awakening and sitting up. Then to a wheelchair to my car. Then home where I arrived after an almost 11 hour day.  Now the wait for pathology and lab results.