After "unbearable" pain forced Toronto's mayor into hospital Wednesday, Rob Ford learned he has a tumour in his abdomen. He is awaiting results of tests to determine if that tumour is benign. Although Ford has been given a "working diagnosis," medical authorities and Ford's family have not commented and are not speculating on what the outcome might be.
When tumours are discovered, doctors note on patient charts any family history that may indicate a heightened genetic risk of cancer. Ford's father, Doug Ford, Sr., died of colon cancer in 2006 at the age of 73.
Doctors will also look for risk factors that would increase the chance of a patient having cancer, including smoking, alcohol use, obesity, lack of physical exercise.
The tumour – which, according to Humber River Regional Hospital CEO Dr. Rueben Devlin, is in Ford's "left lower quadrant" – was picked up by a CT scan. Even a sophisticated x-ray like a CT scan is only going to pick up a real tumour, moderate-size or larger. (Small tumours can be missed.)
Tumours in the left lower quadrant can be caused by colon cancer. The other organs are too far: The liver lives in the upper right side, the stomach and pancreas are upper midline, the left kidney is too high and bladder tumors are lower but midline. (The diagnostic possibilities expand for women, including having left-sided ovarian cysts or cancer, tubal pregnancies, uterine fibroids and so on.)
Dr. Khalid Enver, a general surgeon at Groves Memorial Hospital in Fergus, Ont., explains that in cases like this, doctors first check the CT scan to determine if the condition is a local infection (which could be caused by diverticulitis, in which little bowel pouches can become blocked and infected), a polyp or a tumour.
Further tests are used to reveal the identity of the tumour, how deeply it has invaded the colon and if it has left home and spread across the body. This diagnostic exercise, known as staging, is vital. It will literally determine everything that follows.
Most important, doctors must get a piece of the growth. That is usually done using colonoscopy. That secures the all-important "tissue diagnosis," which alerts doctors about the nuances – the "personality" – of the tumour. That will then dictate what combination of treatments are best: surgical resection, radiation, chemotherapy or all of these, and in what order.
A blood test that is of particular interest is the CEA (carcino-embryonic antigen). This is a tumour marker, and a high score alerts doctors to the presence of cancer, its virulence, even tumour size and if treatments are working.
Dr. Shafiq Qaadri, MPP for Etobicoke-North, is a Toronto family physician, Continuing Medical Education (CME) lecturer and medical writer.