Take your lumps and go to the doctor
Originally, the idiom “to take one’s lumps” had physical connotations, most often referring to lumps acquired via bodily injury, sustained in violent altercations, or while competing in contact sports such as boxing or football. Through time, “taking one’s lumps” has taken on more figurative connotations, essentially meaning “to persevere through adversity, to tough it out.”
However, there are many kinds of lumps and not all of them are bad. Most recipients of a lump-sum payment would consider themselves fortunate. Seafood fans will attest: jumbo lump crab meat is delectable. While I’m not a huge fan of lumpy gravy, I’m okay with a few lumps in my mashed potatoes. My family always requests extra lumps in their cream of wheat cereal. Cottage cheese is lumpy and many people enjoy eating it.
Sometimes, lumps are undesirable. A lump of coal in one’s Christmas stocking is disappointing. Lumps in paint or glue generally lead to poor end results. Lumpy milk — ICK! Lumpy pillows and mattresses can be a tad uncomfortable. Having a lump in one’s throat, or swallowing that lump is quite unpleasant. Lumps received as a result of blunt force trauma, such as bashing a shin into a coffee table, can be downright painful.
And then there’s the lump that appears without any apparent reason on the body and scares the bejeezus out of us. Because it’s not normal. Because it could be a tumor. Because it could be cancer.
Happily, not all lumps are cancerous. In fact, the definition of a “tumor” is an accumulation of abnormal cells, benign or malignant. Therefore, not all tumors are cancerous, either. But that’s just semantics. Call it what you wish, a “tumor,” “lump,” or “mass,” its sudden, unexpected presence sends cold, anxious chills down anyone’s back. It’s understandable to have this reaction; most of us have had some dealings with cancer in often very personal ways. Cancer is terrible and scary.
Back to lumps. For veterinarians like myself, evaluating lumps is part of our daily routine. All animals can get them. And just like with us, some lumps are nothing to worry about, in fact, some go away on their own, after a time. Some lumps are worrisome. How to tell the difference? Many years of practice in the field, loads of experience surgically removing lumps, and a little bit of intuition. The important thing to realize, however, is that without a surgical biopsy of a tumor, there is no way to be sure of the diagnosis.
Yes, there are tests other than biopsy that can be done on lumps to try to make sense of what type of cells are involved. A fine needle aspirate is a procedure that uses a syringe and needle to collect a sample of cells from a tumor, which are then placed on a microscope slide for examination. An impression smear is made by pressing a microscope slide directly onto a tumor that has an open, weepy or ulcerated surface — the cells adhering to the slide are then examined microscopically. This type of examination is called “cytology.”
With cytology, the cells that are examined are not “in situ,” which means they are (in a manner of speaking) taken out of context. Much like pulling random quotes from a speech out of the context of the speech, cytology readings can be misconstrued. Statistically, cytology samples examined by a cytologist (a laboratory science specialist) are approximately 50 percent accurate. Not because the cytologist isn’t good at reading the slides, but because the method of collection and the sample preparation with this mode of study are notoriously inconsistent. In fact, the cells of interest may be mostly damaged during the process of collecting and preparing the samples! Using cytology can help rule in/out some tumor types, but it is not definitive.
So, while it may seem daunting to schedule a surgical lump removal and biopsy, it has the potential to accomplish two things at once: achieve a diagnosis, and effect a treatment (perhaps, even a cure!) A biopsy can give a prognosis, a recommended course of further diagnostics or treatment, or in happy cases, provide peace of mind in determining the removal of the mass was complete with “clean surgical margins.”
When is it time to remove a lump and biopsy it?
1. It is in a bad location and is causing discomfort (eg. between the toes, on the eyelid, over a joint.)
2. It is bothering the animal or, it is bothering the OWNER! (If you are losing sleep because you are worrying about a lump on your pet, it should be removed and biopsied.)
3. It is changing character (eg. was smooth, now is lumpy; was soft, now is firm; is losing the hair around it, is infected or bleeding.)
4. The lump is getting larger. Please do not wait for it to become larger than the animal itself.
Daverio is a veterinarian at Williamsport West Veterinary Hospital. Her column is published every other Sunday in the Lifestyle section. She can be reached at firstname.lastname@example.org.