Dir Sir/Madam!
My problem is a little bit complicated, and I hope you can give the best and the most detailed answers that you can.
The problem is regarding to my wife. She is 43 years old. 6 years ago she was diagnosed with early-stage breast cancer. She
had a mastectomy and her arm-pit lymph nodes were removed. They discovered that only 1 out of 11 nodes was infected with cancer. She was sent on chemotherapy just to be sure.
For 6 years there was no problem. All of her routine checks (liver ultrasound, bone mapping etc.) were good.
1.5 years ago a marker called CA125 was elevated. Her oncoloogist
immedialtley sent her to full-body CT. No unusual evidences were
found. A blood test which was performed later discovered that CA125 lowered back.
The major problem began 2 months ago. After having chest imaging and bone mapping which came back fine, her liver ultrasound discovered lesions in her liver. Her oncologist again immediatley sent her on abdomen CT. The CT discovered no unusual evidences at the liver. The oncologist and us thought that this was the end of the story, but a hospital committee decided to send her again to ultrasound test. The ultrasound once again discovered the unusual lesions. The Oncologist wanted to send my wife immediatley to fine needle aspiration biopsy, but another physician recommended on nuclear liver mapping and labeled RBC tests. She had those tests, which discovered "filling defects"... Though, they could not tell what those lesions
are. The only thing it said for sure, is that those are not
hemangiomas. Then the oncologist sent my wife on a CT guided FNAB, which was performed yesterday. We have been told that my wife has 2 mass lesions, aperently very small (once of them couldnt even be reached by the needle) and they both are partly outside the liver, on it's border. One mass lesion is between the liver and the pancreas, and once mass lesion is between the liver and the duodenum. We have been told that the results will be back in a week, and my wife is currently in a very serious mental state. She is extremley afraid and cannot do anything.
We need some answers for now just to relive the pressure.
My questions are the following:
1) I understood that a CT is better than US. How could it be that
the ultrasound could detect those lesions, but the CT did not?
2) the CA125 marker: I have been told that this marker is NOT a
specific marker for liver metastases, and can elevate and lower without any cancerous presence in the body. Is that true, and how could it be up and down if my wife actually did have metastatic movement in her body?
3) Could cancerous metastases of the liver be located on the border of the liver, or is it a rare condition?
4) Does having metastases on the border of the liver instead of inside of the liver is relativley a better condition?
5) My wife had gained in the last year about 10kg. Could this be a reason to develop a fatty liver syndrome, as she is not using
any drugs or alcohol AT ALL?
6) Could fat cells of fatty liver be located on the border of the liver?
7) My wife's oncologist said that those lesions are defeniatley not hemangiomas, and apearently not fats or cysts (not sure about that) What other benign liver lesions could those lesions be (regarding to their location and their small size)?
8) I did not quite understand - If the physicians found "mass" lesion, does this mean that there are several lesions in the same location?
9) Ultrasounds and CT both indicated that the liver has a fatty layer around it and it has mixed echogenicity. Could this be a symptom of fatty liver?
10) This one is quite general question: I read that primary liver
cancer is a very serious condition with poor prognosis. Does
liver metastases are any differect in their prognosis than primary liver cancer? (My wife's oncologist said that even if my wife has liver metastases it is definiatley not a terminal condition and it can be cured).
I would appriciate if you could answer my questions ASAP, as I said that we are very afraid and need some answers.
Thank you very very much for your help and cooperation.
Dear Eran,
It would be inappropriate to comment on the details of your wife's condition but some broad comments regarding the liver are appropriate.
CT scan can miss small lesions in the liver if the size of the abnormality is less than the 'window' of the scan. The only way to know the cause of the abnormality is pathologic examination, therefore, the need for the fine needle aspirate.
Weight gain can produce a fatty liver even in the absence of alcohol use. It would be unusual for gatty liver to present as a focal discrete lesion. In fatty liver, there is usually a diffuse liver involvement.
The common benign conditions of the liver include cysts and hemangiomas. Rarely benign tumors (e.g. adenomas)can be detected.
best of luck.
This information is presented for educational purposes. Ask specific questions to your personal physician.
HFHSM.D.-rf
*keywords: cancer, metastasis, liver
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