A TUMOR HAS JUST BEEN FOUND

People may say “a tumor has just been found” when they are talking about any of the following 3 general conditions:

1. in reality, there is no tumor, but there is a suspicion that there might be one;
2. there is a tumor that can be cured by means of proper treatment;
3. there is a tumor which, unfortunately, is already in an advanced, incurable stage, even though it has just been discovered.

1. All these cases begin with a diagnostic suspicion; in other words, we think there might be a tumor, but we are not sure.

For example, a nodule may be found in the breast. A woman may report this as “I’m very worried; I’ve just found a tumor in my breast”. While her anxiety is fully justifiable, the nodule may not be malignant at all; it may well be benign (a cyst). This is the phase of “only” diagnostic suspicion, which will be followed by tests in order to reach a diagnosis.

When the suspicion is fairly strong, a biopsy will be necessary. This means taking and analyzing a small piece of the suspect nodule; a biopsy is almost always able to establish the diagnosis in one way or the other (positive = tumor; negative = no tumor).

Biopsy specimens are analyzed under the microscope; this obviously takes time, sometimes 1-2 weeks or more. The patient may therefore continue to say “they’ve found a cancer” during the period of waiting between the time when the biopsy is taken and the report by the pathologist (the doctor who analyzes the specimen under the microscope and makes the diagnosis).

If a diagnosis of malignancy is made, further examinations will need to be carried out in order to discover whether or not the cancer has spread to other organs. This is done by means of so-called instrumental staging examinations (CT, PET, magnetic resonance, echography, etc.).

2.The same expression “a tumor has been found” may also be used to indicate the situation in which the tumor has been diagnosed, staged and already completely removed surgically.  This situation is generally favorable. Indeed, the essential steps towards a possible cure have already been taken: the surgical operation has been “radical”, meaning that the whole tumor has been completely removed.

After surgical removal of the tumor, the next step is to decide whether or not the patient needs therapies to prevent possible relapses. These therapies, which are called “adjuvants” (because they help the surgical operation to cure the patient), are generally prescribed when there is a considerable risk of relapse – i.e., that the tumor may recur. While none of these therapies can ever totally eliminate the risk of relapse, they can lower it considerably.

In short,

• when the risk of relapse is high (40-50%) adjuvant therapies are generally prescribed, as they can reduce this risk by 10-20% or more;
• when the risk of relapse is already very low, these preventive therapies are not prescribed; it would not make sense to put the patient through 6 months or more of therapy – which in any case has some toxic effects – in order to achieve only a very slight reduction (1-2%) in a risk that is already low. 

These assessments, however, are extremely delicate and subjective; some of us might consider a benefit of 1-3% to be indispensable, while others might regard it as too small to justify undergoing unpleasant toxic therapies.

3.Finally, it is not always possible to eliminate the tumor, once it has been diagnosed. It depends on the stage of the disease. Sometimes, the tumor may already be very advanced at the time when it is discovered, meaning that it is incurable right from the start. In the case of certain highly aggressive tumors (e.g. tumors of the pancreas), this unfortunate situation (the early spread of metastases to various organs) can develop at an incredible speed, prompting the question: “How is it possible when the patient was perfectly well only a few weeks ago?”. And yet, unfortunately, it is possible.