When to Worry About a Lump

by Enzo Castillo

C hildhood is full of lumps and bumps as kids jump, climb, leap -- and, yes, fall. But as people grow up and slow down, lumps and bumps become more unusual so any appearance of one can be cause for alarm. Why that peculiar lump on my arm? Why do the glands in my throat seem bigger today? What's the bump on the back of my neck? In truth, lumps and bumps are almost never anything to worry about. But that said, some are definite cause for concern and should prompt a call to the doctor because certain lumps and bumps might signal one of several types of cancer. How do you know what's what? When to worry and when to "ignore" it and wait for it to go away?

To get information and insight on this subject, I called Ellen Warner, MD, who is a medical oncologist and researcher at the Toronto-Sunnybrook Regional Cancer Centre in Canada. She says the type of lump or bump (or in this case actually a swelling) that is the most common cause for concern has to do with lymph nodes. These nodes exist throughout the body and in numerous locations -- the head and neck, under the arms, in the chest and abdomen, in the groin area and in the legs. They also appear in approximately the same place on either side of the body. Lymph nodes are part of the body's immune system and swell in response to any type of infection and inflammation as part of their role in helping to fight it off or resolve it. However if a node swells and stays swollen on just one side or in several lymph nodes, and if there is seemingly no reason, such as a sore throat or other recent illness, Dr. Warner cautions that it must be checked out. Cancer of the lymph nodes (as opposed to cancer that metastases to nodes from another location) can be one of two types -- Hodgkin's or non-Hodgkin's lymphoma. Dr. Warner explains that the difference between the two mostly has to do with cellular structure that shows up under the microscope. But they also have different survival rates. Hodgkin's is the more curable of the two with an 85% survival rate while the non-Hodgkin's rate is 60% after five years. However, both types are rare, especially Hodgkin's. This year it is estimated that there will be 7,800 cases of Hodgkin's lymphoma diagnosed in this country as opposed to approximately 58,870 of non-Hodgkin's lymphoma diagnosed in the same year. Hodgkin's tends to be more common between ages 15 and 34 and at age 60 and over, though non-Hodgkin's is more common in older adults, 50 plus, and people who have compromised immune systems.

What to watch for: A considerable (not slight) swelling in a lymph node that may or may not be tender or possibly painful on one side, or in several lymph nodes, especially in the neck, and less commonly in the armpits or groin, when there has been no recent illness. Usually the swelling is under the chin, along the side of the neck. While there is no way to detect internal swelling of lymph nodes, there are symptoms such as itching, fatigue, coughing, fever, night sweats, weight loss and chest or abdominal pain, says Dr. Warner.

CANCEROUS BUMPS

Another frightening but even less common cause of dangerous lumps and bumps is cancer of connective tissue, a form of sarcoma called soft-tissue sarcoma. Fortunately, this type of cancer is extremely rare, accounting for less than 1% of malignancies diagnosed in this country each year. However, it can appear in numerous places in the body and is sub-classified according to which soft tissue it develops. Do not confuse soft tissue sarcoma with fatty nodules called lipomas, which are benign. These are extremely common, usually appearing just under the skin in the arms, legs and trunk of the body.

Dr. Warner says lipomas are generally round and smooth with what she calls a roly-poly feel to them... they grow slowly and can become quite large, even several inches in diameter, and they are not malignant. Soft tissue sarcomas, on the other hand are almost always malignant and the tumor can grow quickly, most often appearing on the limb. But, it can show up on the abdomen or in other parts of the body as well, including the head, neck and trunk.

What to watch for: A sudden swelling that may or may not be tender or painful, beneath the surface of the skin, usually over a fairly large and diffuse area and a lump that does not have distinct borders. Do not hesitate to see a doctor immediately since the survival rate for soft tissue sarcoma that is diagnosed while the tumor is still small and shallow is over 80%.

CANCER PATIENTS PAY ATTENTION

Finally, Dr. Warner says that anyone who already has cancer should be alert for any lump or bump that appears elsewhere on the body seemingly unrelated to the primary site. As is true with any mysterious lump or bump -- one that cannot be explained for ordinary, every-day reasons such as a recent infection or fall -- go to the doctor and insist on getting it checked, especially if it seems to grow quickly or change character, or becomes itchy.

No need to panic. Just be aware of your body and its changes. Careful observation can make a big difference in the long run.