Concepts and Usages of “Bukol,” Bump, Mass, Lump, Nodule, Tumor and Cyst in the Philippines

Concepts and Usages of “Bukol,” Bump, Mass, Lump, Nodule, Tumor and Cyst in the Philippines

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

April 6, 2012; April 9, 2012

In the Philippines,  a health issue or concern is the discovery of and confusion over the usage and meaning of a conglomeration of terms relating to “bukol,” “bump,” “mass,” “lump,””nodule,” “cyst,” “tumor,” and the like (there are other numerous related terms but these are the more common ones heard from Filipino physicians, patients and lay people).

To simplify my writing, I will use the acronym “BBMLNTC” to refer to the conglomeration of terms.  However, I will use the specific terms when I discuss them individually.

In this log, I write down my thoughts, perceptions, opinions, and recommendations (TPOR) to assist my patients and interested readers in negotiating the medical jungle on “BBMLNTC.”  In my TPOR, aside from the concepts and usages, I will include broad recommendations on what matters most in health and diseases and general approaches in dealing with a “mass” or “bukol.”

Bukol” is a Tagalog term which I will explain after I am done with the concepts of the English terms.

I will present the definitions and concepts of the English terms as derived from various online medical dictionaries and sites.

A “bump” is something that bulges out or is protuberant or projects from its surroundings. (http://www.mnemonicdictionary.com/word/bump) Synonyms are bulge, excrescence, extrusion, gibbosity, hump, jut, prominence, protrusion, protuberance and swelling.

A “mass” is a lump or collection of cohering particles. (http://www.medical-dictionary.thefreedictionary.com/mass)  A mass is unified body of matter with no specific shape; a grouping of individual parts or elements that compose a unified body of unspecified size or quantity. (http://medical.yourdictionary.com/mass)

A “lump” is a a piece or mass of indefinite size and shape; an abnormal mass or swelling such as a neck lump. (http://www.merriam-webster.com/medical/lump)

A “nodule” is small collection of tissue. (http://www.medterms.com/script/main/art.asp?articlekey=4576)

A “tumor” is a swollen or distended part; an abnormal benign or malignant new growth of tissue, called also neoplasm. (http://www.merriam-webster.com/dictionary/tumor) Synonyms are excrescence, lump, neoplasm and growth. Related words: outgrowth, polyp, cyst, tubercle, wart.  In another online source, a “tumor” is a swelling, one of the cardinal signs of inflammation; morbid enlargement;
neoplasm; a new growth of tissue. (http://www.medical-dictionary.thefreedictionary.com/tumor)

A “cyst” is an abnormal closed epithelium-lined cavity in the body, containing liquid or
semisolid material. (http://www.medical-dictionary.thefreedictionary.com/cyst).  In another source, a “cyst” is a closed sac or capsule, usually filled with fluid or semisolid material. (http://www.medterms.com/script/main/art.asp?articlekey=288)

If one looks at the various definitions from the online medical dictionaries or sites, one can be overwhelmed with the big number of related terms and the difficulty in discriminating and deciding which ones matter most.

If one looks at the various definitions, one can deduce that bump, mass, lump, nodule, tumor and cyst are essentially the same, that is, loosely speaking. These terms do not connote an etiology as the cause can be anything, ranging from being cancerous and non-cancerous, and for the latter, from being inflammatory and non-inflammatory.  However, if one looks more closely, the word “cyst” somehow differs from the rest of the English terms as it specifically describes the nature of the contents, “usually filled with fluid or semisolid material.”  Strictly speaking, a bump, mass, nodule, and tumor can be cystic (with fluid or semisolid materials), solid (with solid materials) or complex (combination of fluid, semisolid and solid materials). Thus, the words, “cystic,” as well as “solid” and “complex” are descriptive of the nature of contents within and composition that made up the bump, mass, lump, nodule, and tumor.

In the Philippines, one very often hears the use of these three terms, namely: “bukol,” “tumór” and “sis” in Tagalog, to refer to bumps, masses, lumps, nodules, and tumors noted in any part of the body either palpated or reported after x-rays, ultrasounds,and other imaging diagnostic tests are done.

Strictly speaking, among the three terms, only “bukol” should be the Tagalog term to use to refer to bumps, masses, lumps, nodules, and tumors in which the etiology and nature of contents are not specified. Based on my experience, “sis” is most commonly used than “bukol” and “tumór” and “sis” and “tumór” are used with local connotations different from the concepts I presented above.  How the local connotations came about, here are my perceived reasons.

In the past, when the word “cancer” was an extremely dreaded word in the Philipppine community, Filipino physicians would use “tumór” instead of “cancer” or “kanser” to break the news or declare the diagnosis.  For the non-cancerous counterpart, the word “sis” was used.  “Sis lang ho!” a physician would declare, or “Tumór ho.” With the frequent usage of “tumór” to connote cancer, over the years and up to the present, the word “tumór” has come to mean cancer which strictly speaking is erroneous as this is a term for something that can either be cancerous or non-cancerous.  For the same reason, “sis” has come to mean a non-cancerous “bukol,” “bump,” “mass,” “lump,” and “nodule.”

Thus, to clarify things, all bumps, masses, lumps, nodules, and tumors are “bukol” with no specification as to whether they are cancerous or non-cancerous yet.  More data, particularly from palpation and diagnostic tests, are needed to determine whether they are cancerous or not.  “Tumor” in medical parlance is a non-specific term which does not automatically mean cancer. It can still be non-cancerous.  It can also be an inflammation or infection mass.

Another clarification that I have to make – all bumps, masses, lumps, nodules, tumors and “bukol” are said to be cysts or cystic only when on further evaluation, findings suggest they contain fluid or semisolid material.  In medical parlance and strictly speaking, as seen in the definitions and concepts above, a “cyst” is not synonymous with a “bukol,” “mass,” “lump,” “nodule,” and “tumor” as the latter can be solid or complex in content and composition.  Also, although majority of cystic “bukol” will turn out to be non-cancerous, a cyst or cystic “bukol“ is not always non-cancerous.  In a very small percentages of cases, a cyst may be cancerous or. It may also be an inflammation or infection cyst.

In the end, after the above presentation of concepts and definitions of terms and clarification of the use of “bukol,” “tumór” and “sis” in the Philippines, you and I ask: what now and what matters most with regard to the “BBMLNTC”?

To simplify things and to limit ourselves to what matters most in health and disease, I recommend focusing on the terms “mass” in English and “bukol” in Tagalog. Use these two terms synonymously to mean the same thing.

Use “mass” or “bukol” to mean an unusual and abnormal collection of tissues occupying a space in any area or part of the human body.  It may be of any size or shape. It may be any consistency.  It may be cystic, solid, or complex.  By itself, it can be of any etiology, either cancer or not cancer, until determined by further assessment.

The “mass” or “bukol” may or may not be seen on the surface of the human body; may or may not be felt by the palpating fingers of any examiner, whether lay, medical or surgical; or may or may not be detected on medical scopes, x-rays, ultrasounds, CT scan, MRI scan, nuclear scan, and other imaging procedures on the human body.

Example of a mass seen on surface of the human body.

Example of  a mass detected by palpation and not very evident on inspection (looking).  This patient has mass on the right scrotum which is not very evident on inspection (see H-1).  On palpation, the mass as outlined in H-2 is felt.


Example of  a mass detected by inspection and palpation during an operation.

Example of  a mass detected on a medical scope (a mass in the rectum detected on sigmoidoscopy).

Example of  a mass detected on X-ray.

Example of  a mass detected on ultrasound.

Example of  a mass detected on CT scan.

 

A “mass” or “bukol,” once determined to be present, is a red flag, signifying it demands more attention and investigation.  It needs to be evalatuated further to decide whether it is mass associated with cancer or not.

A “mass” or “bukol” must be differentiated from prominence, induration and swelling of tissues and enlargement of organs.

Prominence of a tissue means it is more protruding than usual but there is no space-occupying mass.  Examples of prominence of tissues are a prominent part of a jaw, muscle, and rib.

Induration of a tissue means it is thicker and harder on palpation than usual but there is no space-occupying mass.   Examples of induration of tissues are calluses on the sole of the foot, thickening of a part of a skin due to chronic irritation and inflammation, and scars.

Swelling of tissues without an accompanying space-occupying mass is mere swelling.  In the absence of an accompanying mass, the swelling may be due to inflammation of the tissue or fluid retention, such as edema of the legs.  Note: swelling of tissues may be associated with a space-occupying mass in which case the focus of evaluation is on the mass.

Enlargement of an organ without an accompanying space-occupying mass is mere enlargement.  In medical parlance, this is called hypertrophy or hyperplasia.  Note: enlargement of an organ may be associated with a space-occupying mass in which case the focus of evaluation is on the mass.

Example of prominence of right cheek with no mass.

Example of prominence of right bicep on contraction with no mass.

Example of thickening of skull bone with no mass.

Examples of induration with no mass.

Example of swelling (of foot) with no mass.

Example of enlargement (with no mass) of the left breast.

 

To conclude this TPOR of mine, as a way of summarizing and emphasizing, I will repeat what I said earlier.

To simplify things and to limit ourselves to what matters most in health and disease, I recommend focusing on the terms “mass” in English and “bukol” in Tagalog. Use these two terms synonymously to mean the same thing.

A “mass” or “bukol,” once determined to be present, is a red flag.  It needs to be evalatuated further to decide whether it is mass associated with cancer or not.

At times, it may not be easy to differentiate a “mass” or “bukol” from a non-mass situation such as prominence, induration, swelling and enlargement.  In such instances, a physician who is an expert in palpation, usually a surgeon, will have to be consulted. If needed, the physician may recommend diagnostic procedures to do the differentiation.

Once a “mass” or “bukol” is assessed to be present, the next thing that a physician will do is to evalatuate further to decide whether it is cancerous or not.  How he will or should do this evaluation in the most effective and efficient way possible – wait and watch out for my TPOR on this.

For feedback and queries, email: rjoson2001@yahoo.com

You are welcome to visit my blogs, websites,and facebook pages for more of my TPORs.

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5 Responses to Concepts and Usages of “Bukol,” Bump, Mass, Lump, Nodule, Tumor and Cyst in the Philippines

  1. alma lucero says:

    Thank you sir for your continuous medical education. I will adapt your recommendation of using the terms mass or bukol in tagalog when talking to patients. Thank you also for the pictures you included. They are very clear. These pictures make things easier to understand. I’m looking forward on your next TPOR on evaluation of mass.

  2. alma lucero says:

    Thank you sir for your continuous medical education. I will adapt your recommendation of using the terms mass or bukol in tagalog when talking to patients. Thank you also for the pictures you included. They are very clear. These pictures make things easier to understand. I’m looking forward on your next TPOR on evaluation of mass.

  3. Glenn Villanueva says:

    Thank you sir for that information. I may now use only the term “bukol” to simplify the use of words when talking to my patients, so that they would clearly understand. The photos were a big help to visualize the statements. Thank you sir for your continued sharing of knowledge.

  4. rojoson says:

    Feedback on
    Concepts and Usages of “Bukol,” Bump, Mass, Lump, Nodule, Tumor and Cyst in the Philippines

    From Residents of the Department of Surgery of Ospital ng Maynila Medical Center
    April 12 – 13, 2012

    Again thank you for this sharing of knowledge to us, your students.

    This write up clearly discusses how we, doctors, and lay people, should use the terminologies mentioned. I myself before use the term tumor in some of my discussion to patients connoting to a malignant condition. I have changed that though now. The term that I use now is “mabagsik or masamang bukol” connoting to a malignant mass, and “ordinaryong bukol” for benign mass. I also use the term cyst for masses that on my physical examination contains more or less fluid.

    This write up will help us in our explanation to our patients about our findings. I can also teach this to them so that in future discussion will be using the same term, mass or bukol.

    Even my relatives, when they do consult to me about a mass, the term that they are using is cyst, regadless if it’s solid or fluid containing, which medically speaking, only the latter is thye true meaning.

    Lastly, with your permission sir, I would like to share this TPOR using facebook so that my relatives and friends could also have a better understanding about the proper terms to be used in describing a growth on their body parts.
    John

    Thank you sir for your continuous medical education. I will adapt your recommendation of using the terms mass or bukol in tagalog when talking to patients. Thank you also for the pictures you included. They are very clear. These pictures make things easier to understand. I’m looking forward on your next TPOR on evaluation of mass.
    Alma

    Thank u for this sharing po. This is really enlightening for us and it really helped us especially in doing our physical examination with our patients. I think we should reinforce every physician to standardize these terms so it would be easier if we communicate with our colleagues especially during referrals. With this write-up, we will be guided and we can avoid mismanagement due to misdiagnosis brought about about by improper usage of terms.
    Thank u very much sir!
    -Jen

    Thank you sir for sharing this information. It is true that we Filipinos generally used the term “bukol” for lumps, bumps, tumor and anything that bulges out from the skin. This information will definitely help us in our physical examination in describing what we Filipinos called Bukol. It is really important to determine whether it is a tumor, a simple bulge a lump to help us more in our differential diagnosis and later on coming up with a diagnosis

    Miong

    Good am sir. Thank you sir for this write up. This is very much evident even in our institution. In my experience, a lot of patient that I have seen has the same wrong perception with the terms “tumor” and “sis”. In my opinion, these terms may have originated from 2 sources. First from a wrong interpretation of patients on a physician’s advice. Second, coming from a not properly explained physician’s advice.

    On the lighter side, the use of the terms “mass” and “bukol” as has been recommended by this write-up simplify things up and makes it easier to understand. One step to promote this recommendation is to start informing the public with this concept. This could start in our institution through the patients that come to see us for consult.

    Celzo

    Sir Good morning, Sir I am very thankful that you brought up this topic/concept into our awareness as physician/surgeon. I agreed that often times the concept between these terms BBMLNTC were use interchangeably by many physicians including me and sometimes this made me difficult to differentiate them in Filipino or Tagalog terms particularly when explaining to most of my patients. On my own way of explaining a mass whether cancerous or benign with my patients, I usually use descriptions as ” bukol na di kumakalat” (benign or non-cancerous mass/ tumor) and “bukol na kumakalat” (malignant or cancerous mass/tumor). Most of my patients were satisfied with these Tagalog descriptions.

    Oni

    Thank you sir for extending your information to us. The definitions you have presented gives us a clear cut understanding of the physical findings we so often encounter. “BBLMNTC” is a compressed term to be used in understanding these findings and that in tagalog is very descriptive of the term, “bukol”. I sometimes encounter problems in discussing such examination findings on the patient.

    Voltaire

    Thank you again sir for that informative write-up. This will help us in teaching our patients and avoid any confusions for their part. with this, we could explain clearly to patients the disease and the management of the disease.

    Jess

    Sir, thank you yet again for this write-up. I agree that the terms you have mentioned have been used interchangeably for such physical findings. I also agree that using “solid”, “cystic” and “complexed” is needed to describe a “BBLM” (bukol, bump, lump, mass). With regards to the use of the tagalog terms such as “bukol” or “sis”, I think the idea surrounding its meaning has been greatly influenced by the media.

    Princess

    I often encounter patients with a mass as a reason for consult and sometimes use the word mass even when speaking in tagalog. It is much more convenient and appropriate to use its tagalog word in relaying to the patient our diagnosis of a mass, or “bukol”. Thank you sir for always guiding us.

    Lucas

    Good morning sir. Thank you for the new information you have imparted on us. One would think that those simple terms would be easy to define and differentiate from one another, and yet they all seem so confusing, probably even more confusing to individuals not connected to the medical field. With the write-up you have provided us, I can now explain physical examination findings to patients more clearly now and be able to address any follow-up questions they may wish to clarify.

    Marco

    Thank you sir for presenting us with this write-up. These data will simplify things for us and the patient and somehow obliterate any confusion regarding the different terms used. With this, we can convey more clearly to our patients what disease they have and our plan of action.

    Rembo

    Thank you sir for that information. I may now use only the term “bukol” to simplify the use of words when talking to my patients, so that they would clearly understand. The photos were a big help to visualize the statements. Thank you sir for your continued sharing of knowledge.

    Glenn V.

    In the practice of surgery, this write-up is very helpful as we often encounter patients with the complaint of “bukol”. Very seldom do we encounter patients who can describe to us thoroughly the “bukol” and they often think that these different terms-BBLMNTC are all the same. This write -up reminded us that when talking to patients, we need not confuse them by using other terms as “bukol”. Thank you very much Sir for your continued patience in teaching us and enlightening us, specially on topics that we encounter in our daily lives. We may neglect it and leave it as a question in our minds, yet you always provide us with the answers. Thank you Sir.

    Sheena

    Sir Thank you for this topic because it serves as a refresher for me. The importance of knowing what the concept is all about and it will help me in diagnosing our patients and what I expect to do.

    Angel

  5. snowlyjam says:

    hello

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