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What Does A Pelvis Mass Indicate?

Posted on Mon, 21 Jul 2014

Question: I have a pelvic mass 5.2 x 5.8 x 7.4 cm. It demonstrates peripheral enhancement with internal cystic qualities. there is abutment of the posterior urinary bladder and anterior sigmoid colon without definite invasion. what does this mean? Also the CT Scan said this does not appear to be involving the prostate or the distal sigmoid itself. There is no definite evidence for obstruction. visualized bowel is unremarkable. urinary bladder is unremarkable. multiple pelvic sidewall prominent lymph nodes without definite enlargement. impression: large pelvic mass as mentioned above, not definitely arising from the colonic serosa, prostate or urinary bladder. non enlarged but prominent pelvic sidewall lymph nodes. consider tumor mesenteric origin. I understand I have a tumor somewhere, I have been referred to an oncologist. They have told me I have cancer and want a biopsy to determine the type and stage of the cancer. I went to see a specialist because of back pain, an MRI showed multiple bulging disks and found this mass. Then I had the CT Scan and was referred to an oncologist. Can you please tell me what all this means? What does abutment mean on my bladder and colon? Has the tumor attached to my bladder and colon? What does prominent lymph nodes mean? What does peripheral enhancement mean? and is the cancer local, regional, metastasized, etc? The oncologist explained it was deep down inside my pelvis close to my rectum and contributing to my back pain. I have had yearly physicals with blood work, prostate exams, for the past 14 years straight. I am 50. I have had colon polyp surgery twice in the past 5 years and had polyps removed both times, all benign. This was never found until the MRI was performed. Thank You

Answered by Dr. Prashant Sharma (1 hour later)

Brief Answer:
u should get an opinion form surgeon.

Detailed Answer:
Hi sir,

Its for sure that there is a tumor in your pelvis. But still it is not clear that it is benign or malignant (cancer).

Abutment means adherent, not necessarily invasion. Tumor is touching bladder or colon. Prominent lymph nodes mean that lymph nodes are seen in CT/ MRI scan, but can not be said that they are malignant, to confirm malignancy we have to do FNAC or biopsy. Tumor (not cancer) seems to be local till now. We have to look at other organs like liver and lungs specially to rule out metastasis. Peripheral enhancement is a characteristic finding seen on imaging that indicates towards increased vascularity of tumor.

Now it seems that the tumor is localized so it is in stage 1 or 2. At such initial stage cure is possible. The most important thing is complete removal of tumor.

Usually such tumors have a capsule all around. Biopsy before surgery may rupture such capsule and spillage of tumor cells may occur. The surgical planning is to be done after looking at the CT/ MRI films.

My opinion - if it is a localized tumor and we can remove it easily, then you should go for surgery called wide excision, along with the per-operative frozen section of tumor. I will not prefer biopsy before surgery to prevent needle site metastasis.

The primary tissue of origin will determine the significance of prominent lymph nodes (LN). If tumor is mesenteric in origin, pelvic LN have no significance. But intra operative frozen section biopsy of enlarged LN should be done to rule out malignancy.

Hope it helps. Let me know if you have more doubts.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Prashant Sharma (13 hours later)

Hi, I guess My biggest concern now is why would any doctor consider a biopsy first, over just removing the Tumor then determine if the Tumor is cancer or benign because they can determine all this after the tumor is removed. It makes no sense to me because the tumor needs to be removed anyway. They know the risk of dropping cancer cells performing a biopsy can cause the cancer to spread. What could be a reason for such a decision? And you mentioned that I should get an opinion from a surgeon. What kind of surgeon?

Thank you!

Answered by Dr. Prashant Sharma (11 hours later)

Brief Answer:
surgical oncologist

Detailed Answer:
Hi sir.

Glad to know your concern. The curative surgery for cancer is called radical excision which includes removal of tumor as well as near by tissues. So it helps in surgical planning if we know that the tumor is cancer. For benign tumors we remove only the tumor part. So the risk of tumor spillage to the benefit of surgical planning will guide a surgeon that he should go for biopsy before surgery or not. An alternative is FNAC in which chances of spillage are low.

Hope it helps. Let me know if you have more doubts.

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari