Dear Dr. Roach: I am having a “push endoscope,” or forced endoscope, tomorrow. They said they found a lesion in a CT scan and want to look into it further. Is “lesion” a fancy name for cancer? — B.E.
Answer: The word “lesion” is a Latin word for “injury.” In medical parlance, it means pretty much anything that is abnormal. While it is true that doctors will use the term “lesion” to describe something that will later turn out to be cancer, “lesions” definitely are not always cancer.
Push endoscopy, also called push enteroscopy, refers to pushing a small endoscope through the stomach farther down into the small intestine, so I suspect that your doctors think that whatever abnormality was seen on the CT scan is in the upper small intestine. Cancer is rare in the small intestine, but unfortunately there are several types that do occur. Carcinoid, now considered a malignant tumor, is the most common. The enteroscopy will allow your doctor to look at the abnormality and take a biopsy, if appropriate (which I suspect it will be, if a lesion is found). Some of the possibilities include benign tumors, such as adenomas and lipomas. I also have seen times when a CT scan abnormality has turned out to be nothing at all on endoscopy. Please let me know what is found.
Answer: There are many possibilities. The first is air, which many people swallow when eating food. Most people are not aware that they are doing so, and the amount of air tends to be increased in people who are anxious or who eat rapidly. Most of the gas is eructated (that’s the fancy medical name for “burped”), but much will enter the intestine, where some will be absorbed and some passed later.
The name for abdominal enlargement after eating is “distension.” Irritable bowel syndrome is a common cause of distension, but it normally is associated with some degree of abdominal discomfort and a bloating sensation. It’s thought that swallowed air and gas produced by colonic bacteria combine with noncoordinated movement of the abdominal muscles to produce the visible abdominal distension. The vast majority of people with irritable bowel syndrome have diarrhea or constipation.
Poor absorption of food, such as from celiac disease or lactose intolerance, can cause abdominal distension, though diarrhea is common. Small-intestine bacterial overgrowth also may cause distension, but again I would expect accompanying diarrhea or gas.
There are other, less common causes, and a gastroenterologist certainly would be able to review the possibilities and discuss treatment with your daughter. However, since this has been going on for many years, and it doesn’t seem to be causing her many (if any) symptoms, I am not sure an evaluation is mandatory. Still, some possibilities, such as celiac, are worth knowing about, since there may be subtle symptoms she has learned to live with that might be improved with dietary modification.