You may have read that a new lesion was seen on my liver a couple of weeks ago. Even though I had my first Dx (diagnosis) 4 years ago, I still have to think twice about what the medical people mean when they say lesion or tumor or cyst.
Four years ago, I had a bad cough. My PCP (primary care physician) could not determine what it was, even with a chest x-ray. So he ordered a CT scan. The next morning I had the CT scan. That afternoon he called and told me to go to the hospital immediately. Not for my lungs but because the CT scan had showed a large mass in my liver!
I spent about five days in the hospital. They took a sample from a small spot on my lungs and determined that it was only a virus colony. They never even treated it and the cough went away. I was seen by seven doctors and interns. The thing in my liver was being called a cyst. It was just about 6 cm which is almost as big as a tennis ball. They put a drain into it in a CT scan assisted procedure. Fluid drained from it for four days. The fluid was sent to the lab for biopsy. My understanding is that it was sent back to the lab several times for more tests because every test they did came back negative. The sixth day I was sent home. They said that they thought it was a benign cyst. One doctor asked for more tests. The day after I went home, he called. The lab finally had done a test which told them that the cells were consistent with neuroendocrine tumor. The doctor said “I don’t even know what that is, but it is a cancer.” The next day I had CT scan assisted needle biopsy. The biopsy was conclusive for neuroendocrine cancer, specifically carcinoid cancer.
The following definitions are from the Merriam Webster MedlinePlus Medical Dictionary.
- lesion – an abnormal change in structure of an organ or part due to injury or disease; especially : one that is circumscribed and well defined.
- tumor – an abnormal benign or malignant new growth of tissue that possesses no physiological function and arises from uncontrolled usually rapid cellular proliferation—see cancer .
- cyst – a closed sac having a distinct membrane and developing abnormally in a body cavity or structure.
- benign – of a mild type or character that does not threaten health or life.
- malignant – tending to produce death or deterioration <malignant malaria>; especially : tending to infiltrate, metastasize, and terminate fatally <malignant tumors>.
- I question that a 6 cm (2.4 in) sphere in your liver is benign in any case, but I’m not a doctor.
- It appears that both tumors and cysts can be lesions.
- Tumors can be cysts and vice versa.
- Lesions, tumors, cysts can all be classified as benign or malignant.
It does not appear to me that the above are used very consistently by the medical profession.
Notice the phrase in the tumor definition “arises from uncontrolled usually rapid cellular proliferation”. Neuroendocrine cancer growth is uncontrolled without question in my opinion. But the “rapid cellular proliferation” part trips up many practitioners and their patients. Doctors and patients alike are used to thinking of cancer as fast growing. Patents are sometimes told that their neuroendocrine cancer is not malignant or even not cancer. Absolutely not true! Neuroendocine/carcinoid is recognized as a cancer (See the NIH Types of Cancer). So it is recognized by the National Institute of Health (NIH) as a cancer. It is typically malignant even though slow because it metastasizes readily (according to the NIH carcinoid cancer is about 80% likely to metastasize) and grows much larger sometimes in the metastases. It is dangerous to the patient’s health also because it can typically generate neurotransmitters uncontrollably. These things like serotonin, gastrin, insulin and others can cause many health problems and ultimately death.
Well now maybe I will have that straight the next time I think about it.