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; April 29, 2016; March 30, 2017

(Note: I revisited this TPOR written in 2012 in April 29, 2016 and in March 30, 2017.  I feel the TPOR is still apt in 2017.  I added the concept of a “dominant mass” in April 29, 2016 – see bottom of this TPOR.  I did not add anything in March 30, 2017 – as is.)

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,” “tumor,” “cyst,” 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 evaluate 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.

xxxxxxxxxxxxxxxxxx

ROJoson’s Notes (16apr29):

Frequently, we encounter the phrase “dominant mass” used by physicians, usually clinicians and radiologists.  When a physician declares there is a “dominant mass” present,  he is also saying that there is is a “mass” or “bukol” present.

A palpable (breast) mass is considered dominant if there is a three-dimensional lesion distinct from the surrounding tissues and asymmetric relative to the other breast.  http://www.aafp.org/afp/2012/0815/p343.html

A dominant mass is  one that stands out from the surrounding tissues.

The finding of a dominant mass is just a red flag – an alarm – a warning that more evaluation has to be done. The mass could either be benign or malignant depending on the other characteristics present.

xxxxxxxxxxxxxxxxxxxxxx

In 2012, I wrote (see above) – Once a “mass” or “bukol” is assessed to be present, the next thing that a physician will do is to evaluate 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.

Let me put a closure here now.

A mass can be an inflammatory mass; a malignant mass; or a non-malignant mass.

This is how I usually diagnose a mass.

If there are signs of inflammation or infection (pus, redness, tenderness, warmth), then the mass is an inflammatory mass.

If there are no signs of inflammation or infection, then the mass is either malignant or non-malignant.

Look for signs for malignancy first. If there are signs of malignancy (signs of spread or metastasis; signs of invasion like fixation and ulceration of overlying skin; and ill-defined border), then the mass is most likely a malignant mass.

If there are no signs of malignancy, then most likely the mass is non-malignant one.  A reliable sign of non-malignancy is the cystic nature of mass.

Above are just general rules to guide in the assessment of a mass.

ROJ-TPOR@16apr29;17mar30