Incidentalomas Explained With Case History and Humor.

Turn on the television these days and it's impossible to escape news stories describing breakthroughs in cancer diagnosis and treatment.  Excluding squamous cell and basal cell cancers of the skin, over 1.6 million Americans were diagnosed with cancer last year.  This file has some great graphics and up-to-date data on America's cancer statistics from 2012.  Unfortunately, I believe  our cancer societies have failed to properly recognize the biggest threat to public safety since the invention of the doctor.  What might that be, you ask?  Incidentalomas.    I searched the  entire pdf file linked above and I couldn't find a single reference to this kind of tumor.    What is an incidentaloma?  Wikipedia has a nice review on the rapid rise in prevalence of this tumor.  Here is their definition:
In medicine, an incidentaloma is a tumor (-oma) found by coincidence (incidental) without clinical symptoms or suspicion.
What does that mean Wikipedia?  No clinical symptoms?  No suspicion?  Suspicion of what?  This sounds like a conspiracy theory to me.  Not to mention, what is the patient supposed to think about all this?
ER:  Hi ma'am.  Remember that CT scan you demanded we get?  It shows you have an incidentaloma.
Ma'am:  An incidental what?
ER:  An incidentaloma.
Ma'am.  Did my boyfriend do this to me? I'm going to kill him!
ER:  No ma'am.  It's not his fault.
Ma'am:  Who's fault is it?
ER:  It's a tumor, ma'am.  Nobody gave you this tumor.
Ma'am.  Are you saying I have cancer?
ER:  No.  It's not cancer.  It's benign.  At least I think it is.
Ma'am:  You think it is?
ER:  You know, in medicine, nothing is 100% certain.  Would you like us to stick a needle in it just to be sure it's not cancer?
Ma'am:  I came in here by ambulance saying I had chest pain so I could get through triage and get my free pregnancy test  with my Medicaid card and now you want to stick a needle in my lung? What's wrong with you?
ER:  I take that as a no.
Ma'am:  I'm taking my tumor outa here and going to MickyDs.
ER:  If there's anything I can do to make you happy before you leave let me know. My job is to make sure I get great satisfaction scores for me and my hospital before you leave. Would you like a free coupon to the Golden Corral?
Enjoy this original Happy Hospitalist ecard, part of a collection of hundreds on Pinterest.

"No ma'am.  Your boyfriend did not give you the incidentaloma.  Please don't go home and kill him."

No ma'am.  Your boyfriend did not give you incidentaloma.  Please don't go home and kill him nurse ecard humor photo.

I am ashamed at our cancer societies for not recognizing the incredible physical and mental burden incidentalomas are causing Americans.  It's  time to include these tumors on all their fancy charts and graphs.  These tumors are a cancer of our soul.  In fact, I recently read a discharge summary  on a patient of mine who visited the Mayo Clinic.  That's right.  The Mayo clinic.  There it was.  Discharge diagnosis #5:  Left adrenal mass incidentaloma:  No further work up necessary.   I suppose if the resident at the Mayo clinic isn't worried about incidentalomas, I shouldn't be either.    But, try being the patient with the tumor.  All they hear is, "I have a tumor".  Try going through your life with that nagging feeling that maybe the doctor isn't right.  Maybe it is cancer.  Maybe I should get a biopsy.

Many doctors reserve use the term incidentaloma to describe  tumors that are benign non-issues.  Why?  If your doctor found a tumor incidentally and it looked malignant and they recommended further workup,  they want to take credit for finding it.  There is no coincidence in these cases.  These tumors were not found incidentally.   Your doctor is the best doctor in the world for finding your cancer when nobody else could.

Why are incidentalomas being diagnosed with such frequency?  The rapid rise in advanced radiology imaging has lead to their discovery.   Every CT scan patients demand or physicians order to rule out a diagnosis, however unlikely, risks finding an incidentaloma.  Once this diagnosis is made, physicians and patients must go through painful decisions and wishy-washy informed consent to decide what to do next.

Should that spot on the lung be biopsied?  Should that tumor in the adrenal gland be ignored because it's just an adrenal incidentaloma?  Should that asymptomatic pituitary tumor undergo a transsphenoidal biopsy (sticking a needle through the nose into the brain) just to be sure it's not cancer?

The more scans we order, the more incidentalomas we are going to find. Should these tumors be ignored?   Should they be followed through time with highly radiating CT scans that will surely cause cancer that makes the charts and graphs in the future?   It's times like this I'm glad I'm a hospitalist who can write an order to:
Follow up with PCP regarding incidentaloma.  No inpatient workup indicated.
This post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.

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