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Diagnosed as slow growing tumour. Could benign turn into malignant? Should I be worried?

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Oncologist, Radiation
Practicing since : 2007
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I have been advised that my "right carotid bulb has less that 50% diameter stenosis: and "nestled at the bifurcation is a carotid body tumor 2.6 x 2.2 x 1.3 cm XXXXXXX I have been told that this is slow growing tumor. This does not help my mental status. What is slow growing... 1 cm per year? If this is benign but could turn malignant with increase in size should I be panicking. I believe I need surgery for this and soon. How long can I afford to wait? I would like to be hands on in finding a vascular surgeon that I would be comfortable with. Any thoughts?
Posted Tue, 10 Sep 2013 in Cancer
 
 
Answered by Dr. Dipanjan Majumder 11 hours later
Brief Answer:
Hi, Thanks for posting your query at XXXXXXX forum.

Detailed Answer:
Hi,
Thanks for posting your query at XXXXXXX forum.
I can understand your concern.
-The carotid bodies are reddish brown, ellipsoid structures, lying embedded in the adventitia of the carotid artery bifurcation.
- Physiologically, they are known to be involved in the reflex control of heart rate, blood pressure and respiration via the chemical composition of blood and its temperature.

- Carotid body tumours are very rare neoplasm constituting less than 0.5% of all body tumours.
-Carotid body tumours are usually benign. Symptoms are generally due to local involvement of the nerves and vessels.
-The malignant potential with possible metastasis has been estimated to be around 2% to 9%
-The true proof of malignancy is the presence of lymph node or distant metastases.
- Familial, bilateral or multiple paragangliomas in young patients are more prone to aggressive behaviour.

Now to answer your queries -
-What is slow growing... 1 cm per year?
The exact rate cannot be given because it has subjective difference but CBT are slow growing in nature that means it takes years to have appreciable change in size.

- If this is benign but could turn malignant with increase in size should I be panicking.
Chance of malignancy is less. Different literature mentioned in different way. The chance of malignant transformation is ~ 5 %.

- I believe I need surgery for this and soon. How long can I afford to wait? I would like to be hands on in finding a vascular surgeon that I would be comfortable with.
CBT when large in size that is > 5 cm, it will be difficult to operate due to close proximity of vital structures.
Definitive modality of treatment is surgery.
Other modality is radiation therapy.
But if general condition is good surgery will be the primary treatment. Surgery is done by vascular surgeon and otorhinolaryngologist (ENT surgeon).
You should consult a vascular surgeon and follow his/her advice.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed as slow growing tumour. Could benign turn into malignant? Should I be worried? 35 hours later
Although my blood pressure is controlled, I occasionally would experience a spike in the blood pressure ( the latest being 186/81 pulse 83) with pain in my jaws and back of the neck that lasts just a few minutes. I took 3 - 81 mg. aspirin at the time. I prefer not to have surgery. However because of the blockage of the right carotid (50%) I believe only surgery to clear the partial blockage is the only way to fix it. Are these 2 issues (tumor and blockage), not addressed at the same time.

What if any is the effect of radiation therapy on the body tumor on any future surgery either for the tumor or for the carotid "stenosis'?

Thanks
 
 
Answered by Dr. Dipanjan Majumder 27 hours later
Brief Answer:
radiation can be an effective treatment IN CBT.

Detailed Answer:
Hi,
CBT ( carotid body tumor) treatment is challenging. I have mentioned earlier that surgery would be the best choice. But radiation can be a potential alternative.
one early trial showed-
13 carotid body tumors in seven patients were treated with irradiation as sole treatment (10 lesions) or as postoperative modality (three lesions). Total dose of irradiation was of 46-60 Gy (median 50 Gy, mean 52.25 Gy) with dose per fraction of 1.8-2.5 Gy. Local control (subjective or objective) was obtained in all the patients.
3 of 13 complete response, 7 of 13 partial response and 3 of 13 no change. Follow-up range is 1-19 years. Acute side effects were minimal and mid- or long-term toxicity was absent.
Actually different data showed similar finding.
There may be persistent residual cells after radiation but tumor progression markedly decrease in some studies.
So consult a radiation oncologist in these issues.
For therapy and treat to vascular risk factors then surgery either carotid endarterectomy or angioplasty, stenting.
you should discuss with your vascular surgeon in this issue.
Above answer was peer-reviewed by
 
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