My Marble Mass – benign or malignant?

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Benign or malignant?  that is the question.  Another chapter in “Here we go again!”  The legacy of one cancer leading into another.  I am just a little anxious.  The odds are in my favor.  I noticed it last spring – a small, pea-sized, pea-shaped structure in the corner of my jaw.  It rolled around in my fingers … which is a good sign.  The medical word for that is encapsulated.  This suggests that it is not attached to anything, that it behaves more like a cyst.

I casually showed it to various physicians.  The common opinion – “I don’t know what it is.  You probably better have it looked at / scanned / investigated.”  But it does seem encapsulated which is good.  I am a world class procrastinator.  I showed it to a variety of physicians – primary care, dermatology, dentist, hematologist.  Just never the right one.  I knew I really needed to show it to a head and neck guy, an ENT, an otolaryngologist.

So this winter, when I noticed that it had increased to the size of a marble and that I seemed to be salivating, drooling on the same side as the marble, I asked for recommendations from my nursing colleagues.  One Dr. Goldenberg.  He took my history, examined the lump, then told me his thoughts.  If it’s inside my parotid gland there is only a 20% chance of malignancy.  If it is outside the gland, those chances increase to 50%. Benign or malignant, the mass will need to be taken out,  excised is the big word for that. But first let’s see what we’re dealing with.  Let’s get a CT scan to better visualize and locate it in relation to other structures.  Then we’ll do an ultrasound-guided biopsy, send the tissue samples to the pathologist, and get a definitive idea of just what in the heck is growing there.

In the meantime I have my yearly appointment with my transplant doctor who doesn’t like the lump at all.  His motto: “any mass is malignant until proven otherwise.”  He reminds me that stem cell transplant survivors are “at risk” for head and neck cancers.

Step one, the CT scan, is done.  Been there, done that.  Most of you have also.  The warm feeling that washes over your body when they push the intravenous dye made me feel almost nostalgic.  The results show that it is inside the parotid sort of, but not entirely.  1.3cm x 1.6cm x 1.8cm.  The differential diagnosis – the list of possibilities – is always scary to read.  The pathologist attempts to cover all his bases, legal and medical.

Mine reads:  “Warthin’s tumor with concern for malignant transformation; consider oncocytoma versus primary intraparotid or metastatic lymph node.”

I have written about patient’s various dilemmas related to waiting.  And I have observed before, waiting for a path result is among the hardest.  So it could be a long weekend.  Once my otolaryngologist gets the results, we’ll set up a time to talk.  We’ll make our plans.  Then I’ll got in hospital to get a slim new scar, this one will curve gently around my jaw.  If it is benign, that will like be the end of that chapter in my medical life.  If it is malignant… well, we’ll just deal with that as it comes.  When we become patients, whether newbys or veterans, dealing with it is what we do.

Take care, Dennis

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About Dennis Pyritz

Dennis W. Pyritz, RN, BA, BSN, has been a cancer nurse since 1987 and a cancer and bone marrow transplant survivor since 2004. In December 2001 he was diagnosed with t-cell prolymphocytic leukemia (T-PLL), a rare aggressive form of chronic lymphocytic leukemia (CLL). Dennis was treated with the then new monoclonal antibody, alemtuzumab (Campath) as this disease has a median survival of 7.5 months. He achieved a 26 month remission but relapsed in February 2004. He was retreated with Campath and went into a second remission. In August 2004 he underwent an allogeneic peripheral blood stem cell transplant with his brother, Mark, as donor. Dennis has remained in remission since - a near miracle. Throughout his career as cancer nurse and patient, Dennis has had the opportunity to speal to both lay and professional groups. Dennis has spoken on cancer topics and survival issues across the country as well as in the United Kingdom, Norway, Austria, Portugal, Honduras, Panama, Guatemala, Trinidad, United Arab Emirates, Jordan, Cyrpus, Israel, and India.

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