Endocrinologist Navigates Gray Area Between Malignant and Benign

There was a time in her life when Prerna Dogra, MD, avoided even talking about cancer. She was in her last year of medical school in India when her mother was diagnosed with metastatic breast cancer. During Dogra’s residency, her mother passed away.   

The heartbreak was overwhelming. 

“After going through that process, I didn’t want to talk about cancer,” she explained. “I was like, God forbid, if anybody else in my family has cancer, I don’t know if I can fight that battle again with them.” 

More than a decade has passed, and Dogra is now an endocrinologist at Moffitt Cancer Center, where she talks with people about the disease on a regular basis. Time has made the topic less painful, and she knows her expertise in endocrinology is making a difference in her patients’ lives.  

An Endocrinologist’s Expertise 

Endocrinologists treat conditions that affect the endocrine system, which creates and regulates hormones in the body. Endocrine diseases can affect metabolism, blood pressure, reproduction, sleep and other crucial bodily functions.  

At Moffitt, the Endocrine Oncology Program treats both cancerous and noncancerous tumors that pose complications to people’s health. This includes thyroid, parathyroid, adrenal and pituitary tumors. 

Typically, when people hear that a growth is benign, they assume that’s good news. However, Dogra explains that in the world of endocrinology, the classification of benign vs. malignant is not so black and white. A benign tumor diagnosis does not necessarily mean relief for patients. 

“Even if we have these tumors in your pituitary gland or your adrenal gland, even if they are not cancer by definition, they are doing something else. They are making excess hormones, or they’re in a location, such as your brain, where they could be big enough to be detrimental to the other critical structures,” she said. “So even though these are not malignant, they’re not innocent.” 

Complex Diagnoses 

The complexity of endocrine disease is what drew Dogra to the specialty. That often starts with the diagnosis.  

For example, many people who seek Dogra’s expertise have already had lab workups that are inconclusive, but they are still experiencing problematic symptoms.  

Dogra often spends an hour or more with patients during their first visit, going over previous lab work and scans, talking about their symptoms and getting to know them. 

Outside of cancer, one of the endocrine diseases Dogra initially works to diagnose or rule out is Cushing’s syndrome. Cushing’s is a rare disease caused by noncancerous endocrine tumors that produce excess cortisol. People with Cushing’s may experience weight gain, muscle weakness and fatigue.  

However, standard tests may or may not provide clues to the diagnosis. An abnormal blood test does not necessarily mean a person has Cushing’s, and a normal blood test does not rule it out.  

“There’s no single test for complex endocrine disorders such as Cushing’s,” Dogra said. “That’s what is fascinating about the endocrine system. Contrary to the common belief that your bloodwork shows a very black and white diagnosis, many times the results lack diagnostic specificity. With endocrine disease, there is a huge component of clinical decision-making, and test results frequently require nuanced interpretation within the broader clinic context.” 

Diagnosing or ruling out endocrine diseases like Cushing’s takes time. Dogra often spends an hour or more with patients during their first visit, going over previous lab work and scans, talking about their symptoms and getting to know them. 

“It does take a lot of time, but I feel that it is important for people to be heard. I want to give them that platform to tell me because I also don’t want to make assumptions, and it helps me with my interpretation,” she explained. “I get the history, and then I put my labs in those contexts. I try to explain to people why I think what I think, to make them a partner in this, so that they can think about it in an informed way.” 

Treating Endocrine Tumors 

Endocrine cancers are rare, making up less than 3% of cancer diagnoses in the United States in 2025, according to the American Cancer Society. Other benign endocrine tumors, such as pituitary and adrenal adenomas, are more common. For example, 1 in 5 adults may be diagnosed with a pituitary adenoma, which may cause no symptoms at all or could drastically affect quality of life, depending on where they are located and how they are functioning.  

Treatment for endocrine tumors, whether they are malignant or benign, often takes a multidisciplinary approach. Some tumors can be safely removed via surgery. Others may require radiation, chemotherapy and other medications. Benign tumors that are causing no symptoms may just need to be monitored. 

“Every scenario is very unique to where the tumor is, what it is doing,” Dogra explained. “I tell my patients that I’m looking at the tumor structurally, but I’m also looking at your tumor functionally. The benign and malignant definition becomes more of a semantic issue when we’re talking about what the tumor is ultimately doing to the person.” 

Moffitt is uniquely positioned to treat patients with both cancerous and noncancerous endocrine tumors, and that’s a message Dogra and her colleagues in the Endocrine Oncology Program are working to share.  

“As a physician, I am just one part of the big team. I tell patients I am the face of the team, but I’m reliant on radiologists, pathologists, surgeons, various oncologists, and highly skilled lab and imaging personnel. I’m just blessed to have these experts. We have the whole armamentarium over here.” 

A Shared Mission 

Dogra’s patient-centered approach to care reflects Moffitt’s mission. And her work at the cancer center every day makes her reflect on her own journey and how far treatment has advanced in just the past decade. 

“I have been on the other side,” she said. “But cancer is a developing field. The thing I like is how much progress has been made. When I look back, I always feel like if my mother had cancer today, the outcome probably would have been much different.”