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Please Help! "Growth" on my dad's liver
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Please Help! "Growth" on my dad's liver

My dad had a CT scan about a month ago for left-sided pain.  Last Monday, they told him there was a 3cm "growth" on his liver.

Dad is not a drinker and does not have cirrhosis or hepatitis.  Nothing else showed up on any tests - no elevated blood tests or anything.

He can't have an MRI because of metal clamps in his head (cerebral anyeurism 22 years ago).

So, they are doing a biopsy this week.

He is diabetic and has had quintuple bypass surgery.  (No ill effects from any of his previous/ongoing health issues).

Please, can someone tell me what this "growth" could be??? There is no history of cancer in my dad's side of the family - lots of vascular issues though.  My dad and I are both prone to cysts and fibroid-type "growths."

He also has a shunt from his brain to his stomach (long-since closed off, we assume).  Could this show up on a CT as a "growth?"

What could this be???  Is it usually always cancer for a man in his 60s???  Or, could it be something related to a previous surgery or a benign "growth?"

The doctors don't seem to be in any hurry to get a diagnosis - I mean, don't they jump in there if it is cancer????

Please help!
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Avatar_n_tn
PKD? Ok, I just read some info on PKD -

My dad has almost all of the symptoms

-Intracranial  Aneurysm
-High blood pressure
-possible kidney problems (thought related to diabetes)
-heart valve issues
-this "growth" on his liver (could it be a cyst????)  If it is a cyst, then shouldn't the CT scan show that it is just a cyst???
-diverticulosis (not diagnosed, but Dad has always had 'tummy trouble.')
-urinary tract infections (several including a massive one during his hospital stay for the Aneurysm)

Hmmm - Could this be undiagnosed PKD???  If so, my problem is that the 'growth' on the liver is described as exactly that - a 'growth.'  

My parents were not given the radiology report - they were just told by the doctor that there is a 'growth' on the liver that needs to be biopsied - Argh!!  I am so mad that the doctor would not give more info (No, my parents won't ask for more info and they will not allow me to go with them to see the doctor - long story, but has to do with my dad's old-fashioned beliefs about what can be said and by whom, ha,ha)

Why in the heck was the doctor not more forthcoming with information??? It doesn't seem as though he is very worried about the results though - so frustrating...

Please answer anyone - thank you.
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Avatar_dr_m_tn
Hi.  Before giving my comments, I would first like to ask you some questions:

1.  Was a serum alpha feto-protein (AFP) test done?  If serum AFP levels are highly elevated, this could clinch a diagnosis of hepatocellular carcinoma, in the presence of a liver mass.
2.  Is the mass solitary or are there multiple masses?  From your description, my impression is that your dad has a solitary liver mass.  If this is the case, he might have a tumor originating from the liver.  If there are several masses, this might indicate metastatic lesions from cancer originating from other body organs.

Assuming that your dad has a solitary solid liver mass, then it's probably a tumor originating from the liver, as I said earlier.  This could be benign (non-cancerous) or malignant, but the possibility of a solitary liver tumor being benign is just 6-12%.  Examples of benign liver masses includehepatocellular hyperplasia, hepatocellular adenomas and benign hepatic cysts. There is at least an 85% probability of the tumor being malignant, usually either hepatocellular carcinoma (primary liver cancer) or cholangiocarcinoma (cancer coming from the hepatic or bile ducts).

The shunt from his brain to his stomach will present as an elongated structure on CT, not as a liver mass.

The best thing to do right now is to just have the biopsy done, and wait for the results.  We still don't know for sure if your dad has cancer or not, and any further speculation at this point only adds to everybody's anxiety.  Just try to stay calm.

Feel free to post if there are additional developments.
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Avatar_n_tn
Thank you for your response.  Yes, the AFP levels are normal, not elevated.

There is only one mass.  

But, aren't most masses in the liver benign?  I've read that they are, so maybe I am confused.

Why would they biopsy this mass if they think it is cancer?  I mean, why would they not just start treatment?  And I am wondering about the long waiting period (over a month now from complaints to diagnosis.)

Again, thank you for your help - sorry about the additional questions...
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Avatar_n_tn
Another point - no cancer of any kind has ever been detected with my dad or any of his family (myself and brother included).  

However, we all have many benign cysts and growths (I have had fibroids, dermoids - huge 9 pound dermoid!!, fluid-filled cysts) My dad has had similar cysts on his back and arms, forehead, etc.  

My dad's mom lived to 98 years old and died with an intestinal blockage (not cancer).  His father was killed in WWII, so we don't know what he would have developed.

His sister is well into her 70's with no cancer (lots of arthritis).  And, his brother is much closer to 70 than my dad (dad is the baby, ha) with no cancer of any kind ever.

Now, my mom's side of the family is a different story - they always joke that they 'drop dead of a heart attack when the doctor tells us we have cancer..."  Meaning, of course, no heart-disease for mom's side, but plenty of cancer.

Sorry to ramble, but I thought it would be important to note that my dad has no famillial history of cancer - He would be the first one.  

So, it doesn't all add up to me - As a doctor, would you not agree? (Actually, I am just hoping (praying) you will agree, ha.):

-No elevated AFP
-No other elevated liver tests
-No Cirrhosis
-No drinking (since college)
-No Hepatits
-No history of cancer in the family (not even skin cancer - my mom had that)
-history of cysts and fibrous tumors (benign)

I think it does not make sense to add it up to cancer.  We are very confused.

The only one possible negative factor here is that my dad was a chemical engineer for 20 years, working primarilly with plastics.  That worries me a bit.

Please answer in light of these additional pieces of information - I am grasping at straw-shaped slices of hope here, as you can tell.

Thank you so much for your guidance -


Tania
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Avatar_dr_m_tn
Hi.  I'm going to itemize your questions so the answers won't be too confusing:

Q: "Why would they biopsy this mass if they think it is cancer?  I mean, why would they not just start treatment? "

A:  A biopsy is being done precisely because your dad's doctors are not sure that the liver mass is actually malignant.  If the AFP level was greatly increased (typically more than 400 ng/ml), the doctors can safely assume that the mass is hepatocellular carcinoma, and immediately proceed with treatment.  A normal AFP result does not, however, rule out the possibility of liver cancer.  This is why a biopsy needs to be done in your dad's case.

Q:  "Another point - no cancer of any kind has ever been detected with my dad or any of his family...So, it doesn't all add up to me - As a doctor, would you not agree?"

A:  The usual cause of liver cancer is either a chronic viral hepatitis infection, or heavy alcohol intake, which induces mutations in the liver cells. Granted that your dad doesn't seem to have these conditions, and that he doesn't have a family history of cancer.  But the fact remains that he has a liver mass! Because of the mass, and his advanced age, we cannot outrightly dismiss the possibility that the mass is malignant.  At this point, the doctors are not outrightly saying that he has cancer, because they don't know yet. The biopsy needs to be done first.
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Avatar_n_tn
Thank you doctor for your help.  I will try to let you know when we get the results of the biopsy - The waiting is making us all a little crazy :)
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Avatar_n_tn
Ok, so this might be better news: My dad went in for the biopsy today.  The results won't be back till Wednesday.

But, here is the thing: My parents misunderstood the initial CT report.  The lesion is 3mm, not 3cm...

The doctors said they are not sure if they even FOUND it today during CT-guided biopsy.  Am I foolish to start hoping for a better outcome?

Does this sound like a probable better outcome? I mean, they told my parents today that the lesion was 'microscopic.'

Are microscopic lesions usually cancer in the absence of elevated blood work?  Also, my dad has no jaundice and no weight-loss (and certainly no slowing of his food consumption, ha).  Any additional information you can give me would be wonderful.

Thank you for your help Doctor.  You have been so very kind.
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