In this article, we discuss whether benign tumors require treatment at all, and if so, when and why.

In a previous post, we discussed the meaning of the word “tumor” and the differences between benign (non-cancerous) and malignant (cancerous) tumors.

Most benign tumors are completely harmless and can be simply left alone.  Small bumps under the skin (lipomas), skin moles (nevii), small fibroadenomas in the breast, asymptomatic fibroids in the uterus – these are all examples of common benign tumors which require no treatment.

However, sometimes benign tumors may need to be treated.  The following are common reasons why your doctor may recommend treating a benign tumor:

1. Functional tumor:  Certain tumors, especially those arising from endocrine organs can produce substances called hormones.  For example, a benign adrenal tumor can produce excess steroid hormones, or a pancreatic endocrine tumor can produce excess insulin.  Such tumors require treatment to normalize hormone levels.
2. Complications: Due to either size or location, some benign tumors can cause complications, and treatment is required to address these complications.
   
   1. Pressure effect: A tumor arising in critical locations can compress adjacent structures and cause problems.  This is especially true for tumors in the brain or in the spinal cord because there is no space for the tumor to grow without causing compression.
   2. Bleeding: A uterine fibroid can cause excessive vaginal bleeding.  A benign polyp in the gastrointestinal tract may bleed into the intestines.
   3. Obstruction: Benign tumors in the intestines can cause a blockage of the bowel, either due to large size or by a process called intussusception.
3. Potential for future complications:  Some benign tumors have a tendency to grow indefinitely (although, unlike malignant tumors, benign tumors grow very slowly).  Sometimes, if left alone the tumor can grow large enough to cause complications.  For example, a benign tumor in a bone can cause a fracture if it replaces a large part of normal bone.
4. Doubt about benign nature of tumor: Most often, clinical examination by the doctor is sufficient to determine if a tumor is benign.  Sometimes, further tests like radiological tests (ultrasound/CT scan/MRI, etc) or a biopsy may be required to confirm that the tumor is benign.  Rarely, even after conducting many tests, it may not be certain whether a tumor is benign or malignant.  Under such circumstances, the options are watchful waiting or surgical excision – the decision should be taken after a careful discussion with your doctor.
5. Potential to transform into cancer: The majority of benign tumors do not transform into cancer.  Some particular types of benign tumors, however, have a tendency to become cancerous – usually after a long period of time (measured in years).  For example, adenomatous polyps, which are benign tumors of the colon, can transform into colon cancer after many years.  For this reason, it is better to remove them before they have a chance of becoming cancerous.
6. Cosmesis/patient choice: Many benign tumors only require treatment for cosmetic reasons – for example, a lipoma on the face or a fibroadenoma of the breast).  Here, the need for treatment is simply because the patient desires it.

To summarize, most benign tumors are harmless.  Once your doctor is certain it is a benign tumor, most often they can just be left alone.  Others may require watchful waiting.  Rarely they may require active treatment for the reasons we have discussed above.