Cirrhosis of the Liver Community
CT Question and Diagnosis
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Cirrhosis is the end result of chronic liver damage caused by chronic liver diseases. The purpose of the community is to share support and information with Cirrhosis of the Liver patients and their loved ones. Topics in the community include: causes, clinical trials, complications, family issues, living with Cirrhosis of the Liver, prognosis, research, surgery, treatments

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CT Question and Diagnosis

Please give me some insight.  My mother is 83 and went to er for esophageal pain.  She had an EGD which showed a large ulceration and blood clot.  The blood clot was removed, biopsy taken, and Dr. does know what caused the ulceration.  She had a CT scan w/o contrast of her espohagus and lungs.  The CT showed cirrhotic morphology of the liver, large infiltrative mass on right hepatic lobe.  The lesion likely involves the porta hepatis and caudate lobe and is concerning in appearance for large primary hepatocellular carcinoma vs. cholangiocarcinoma in a pt. with no known primary.  Differential considerations include metastatic dz.  Small volume of perihepatic ascites.    She also has a right adrenal mass identified as a right renal cyst.  Adrenal metastatic disease vs primary adrenal neoplasm cannot be excluded.  Also bilateral pulmonary nodules involving both lungs presumably metastatic.  We are waiting for the AFP to see what Dr. wants to do.  Any suggestions that I can ask for from Dr?
11 Comments Post a Comment
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446474_tn?1404424777
Do you understand what is being discussed here and the terms being used?
How much do you want to know?

I will not go into detail now but give you a general idea of what they are thinking.

I guess they are waiting for the AFP liver cancer marker results to see if the liver is the source of the numerous masses on her adrenal glands and lungs.

I am very sorry to read this. This is a truly terrible diagnosis.
First, you sure make sure that their diagnosis is correct. Liver cancer can be identified using a dynamic CT scan or MRI. The other tumors I don't know how they are diagnosed.
You mother should be treated at a hospital that is experienced in caring for patients with cancer. She will probably have oncologist and radiologists look at her case.
Basically you want to advocate for your mother. Make sure she gets the best care possible. Should she be having any pain make sure the doctors provide her with what she needs.

I am very sorry to hear about your mother. I hope that is not a bad as they think it is. I wish her and yourself the best of luck possible.

Hector
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1475202_tn?1388955435


MORPHOLOGY OF CIRRHOSIS

GROSS INSPECTION.
Grossly, with the naked eye, a cirrhotic liver appears nodular, "hub-nailed", on the external surface and nodular on the cut surface. Variation in size, color, shape and consistency is relevant and may help in the identification of the etiology. The liver is usually indurated shrunken and yellowish-tan but it may be enlarged and yellow as in alcoholic fatty cirrhosis, rusty as in hemochromatosis or large and green as in biliary obstruction. It is usually the privilege of the surgeon to inspect the liver in vivo, therefore he must acquaint himself with the gross changes of cirrhosis and develop the ability of detecting discolorations of possible neoplastic nodules in order to obtain adequate samples for histological examination.
No known primary
A liver biopsy may be performed to determine the etiology (Cause).
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Hepatocellular carcinoma (HCC) is liver cancer this is common amoungst people with cirrhosis.
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ASCITES: When fluid accumulates in the abdominal cavity, it is called ascites. Cirrhosis of the liver is the most common cause of ascites but other conditions such as heart failure, kidney failure, infection or cancer can also cause ascites.

PERIHEPATIC: Surrounding the liver.

Therefore, perihepatic ascites refers to fluid surrounding the liver.
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A renal cyst is a fluid collection in the kidney. There are several types based on the Bosniak classification. The majority are benign, simple cysts that can be monitored and not intervened upon. However, some are cancerous or are suspicious for cancer and are commonly removed in a surgical procedure called nephrectomy.
Numerous renal cysts are seen in the cystic kidney diseases, which include polycystic kidney disease and medullary sponge kidney

At this point I think you need to discuss with her doctor how soon will they have a diagnosis and mention all these things sound pretty serious so how soon and effective will treatment be. I wish the very best for your mom and your family.

Randy
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Avatar_f_tn
Hello.  Thank you for your reply.  Yes, I do understand what is being discussed and want to know.  I am an RN but have been out of the medical field for the last 15 years.  I do sales and marketing but know the basics.  Any input would be appreciated.  Thank you very much!
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446474_tn?1404424777
Hi. Here are some more details about the report.

"large infiltrative mass on right hepatic lobe.  The lesion likely involves the porta hepatis and caudate lobe (The porta hepatis is 2 in. long and situated on the inferior surface of the right lobe of the liver. they are located near the inferior vena cava) and is concerning in appearance for large primary hepatocellular carcinoma vs. cholangiocarcinoma in a pt. with no known primary."

To view the anatomy of the liver follow this link.
http://www.google.com/imgres?num=10&hl=en&biw=1680&bih=925&tbm=isch&tbnid=b9y74v52e0pQAM:&imgrefurl=http://home.comcast.net/~wnor/liver.htm&imgurl=http://home.comcast.net/~wnor/liverinferior.jpg&w=481&h=422&ei=yi1IULT3OciuiALprYCQDw&zoom=1&iact=rc&dur=738&sig=104399144875687762607&sqi=2&page=1&tbnh=114&tbnw=145&start=0&ndsp=43&ved=1t:429,r:1,s:0,i:90&tx=75&ty=63


They are try to decide if the large mass is hepatocellular carcinoma (HCC). HCC is primary liver cancer and almost always develops after a person has cirrhosis of the liver. Cirrhosis is the the environment that HCC needs to develop.

I have HCC myself. I have had two tumors and may have another now. Liver cancer can be controlled if it is caught early when it is small and is not metastatic. Unfortunately if the cancer should spread outside of the liver  it is usually fatal within 6 months or so.

Cholangiocarcinoma is cancer of the bile ducts in the liver. It is a very rare disease. The cancer can cause blockage of the bile increasing bilirubin levels and making the stool clay colored.

"ascites" This is the fluid buildup that happens in patients with more advanced cirrhosis. It is a small amount  so it may not be visible to the naked eye. When ascites is full blown the patient will look like they are pregnant and may get a hernia from the stretching of the abdomen.

"She also has a right adrenal mass identified as a right renal cyst.  Adrenal metastatic disease vs primary adrenal neoplasm cannot be excluded."
A cyst is a fluid contain mass. Then they say it could be a metastatic tumor or a primary neoplasm (tumor).

"Also bilateral pulmonary nodules involving both lungs presumably metastatic."
It appears that both lungs have nodules of metastatic cancer. Where the primary source of these tumors is coming from they haven't figured out.

Maybe they are thinking it is from the liver. Liver cancer does usually spread from the liver to the lungs first. But it can also spread to the portal vein, periportal nodes, bone, or brain. I have CT chest scans along with my MRIs every 3 months to look for metastatic spread of my liver cancer. If that happens then I will be taken off the transplant list, as their is no chance of survival and I will have maybe 6 months to live. It is what scares me as I wait for my transplant.

metastases may develop in the lung, portal vein, periportal nodes, bone, or brain

If the metastatic cancer turns out to be liver cancer there is a drug now available that can prolong life for about 3 extra months. It is called Nexavar/sorafenib.
Nexavar is a biologic therapy, a treatment that employs substances made by the body or made in a laboratory to boost, or direct, the patient’s own immune system to fight the cancer. Nexavar disrupts the vascular endothelial growth factor receptor (VEGF), which is responsible for establishing blood vessels that support the cancerous tissues.

Here is a link to their web site. Just so you have the info.

http://www.nexavar-us.com/scripts/pages/en/patient/index.php?WT.mc_id=NES100014&WT.srch=1&gclid=CN6J6c-SoLICFeaDQgodox4Atg

As I said I am very sorry to hear this about your mother. This is very sad for me to have to tell you. Being an RN will definitely help your mother as you are more familiar with dealing with medical issues and the medical system than the average person. If it turns out to be liver cancer I can help you with any questions you might have. A few friends have had liver cancer and I live with it everyday. I can guide you to the best care and tell you about symptoms as they relate to liver disease as I also have cirrhosis and have had cirrhosis since at least 2007. I was diagnosed with liver cancer (HCC) June 1, 2011.

Please let me know what you find out. I am hoping for the best for your mother and yourself. If I can help in any way I will be glad to.

Hector

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Avatar_f_tn
Thank you so much!!!  They did a needle liver biopsy today, and scan of the abdomen.  I meet with the oncologist tomorrow am.  Today he said it is in the pancrease, lungs, and liver.  Probably originated in pancreas or liver?
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Avatar_f_tn
Hi still no results from the liver biopsy.  I finally convinced them to do a brain scan. We want to know the type of cancer, stage, and where the mets are if any.   All the Dr's. have said there is no surgical treatment options and she is not a good candidate for chemo.  They are pressuring us to send her home with hospice.  We are not ready to give up after one opinion and no real definite diagnosis. We are in OH so if anyone knows a good liver oncologist please let me know.  She wants to try some treatment but they are telling her she lived a good life and has maybe 3 months left.  We haven't even been given a diagnosis.  They are saying now the biopsy was sent out Friday and will be back in three days from today????  Help anyone????
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Avatar_f_tn
She has no jaundice?  No history of liver problems.
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Avatar_f_tn
First of all I'm very sorry to hear about your mother's health issues.  Sometimes people reach a stage where normal medical treatment from a hospital is just not an option.  Please take note of what I'm about to tell you and don't be afraid to try something different.  After all, what do you or your mother have to lose at this point.

I personally have a high risk of cancer in my family history.  There isn't a person in my immediate family that hasn't died of cancer, nothing else.  I've done a great deal of research and learn more each day about how much our environment has caused humans to suffer increased cases of cancer.  Do you know that in the 1900's there was as little as 3% of the population that had cancer?  Today's numbers are staggering in that 1 out of every 3 of us will experience this disease.  So much of what we eat has been affected by chemical treatments and processing of foods.  What was once good for us is now causing our bodies to function at a fraction of what they are capable.

What I've most recently learned is about what foods we should put in our bodies.  I've read countless stories about certain methods that have been found to improve and in many cases, cure cancer in individuals who were simply told to go home and die.  Please just google the term "budwig diet" and start with a site called 'budwigcenter.com'.  Download and read the diet guide and if willing, help your mother follow it to the letter.  Do not stray from the requirements if you want to see what could be her only chance to live longer.  There is no gimmick or money here just information that's already being talked by medical doctors.  This is simply about the foods we eat and what to avoid, foods that will not have any negative side effects.  Do you not already hear about health fruits and vegetables and oils?  Avoid trans fat and soda?  I hope you take the time to read up as I have and please let us know if you do try this diet and how things go.  It's at least something you both can do in the meantime as you await more testing and results, you could be very surprised.
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Avatar_f_tn
Others on this site have been talking about this diet as well:

http://www.medhelp.org/posts/Thyroid-Disorders/help-needed/show/358713

http://www.medhelp.org/posts/Hepatitis-Social/Ribavarin-vs-Ribasphere/show/496801

Please make sure that if you try the flax oil and cottage cheese diet that you blend with an emersion blender, the oil and cottage cheese completely before you add anything else.  It's these two items that turn the oil into a water soluable food that is immediately available for use by the body, bypassing the liver completely.
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317787_tn?1373214989
Hello I am very sorry to hear of your Mom's problems I feel so bad for you and your family.  Your plight has really hit home for me.

While waiting for test results or more information it would not hurt to check in to what Hospice can offer your Mom in the way of care  and support.  Hospice  can give your Mom comfort,  relief from pain as well as help for the family.

Again, I am very sorry
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1840891_tn?1383280315
I'm so sorry about this – what a dreadful ordeal you and your mother are now dealing with. Hector is "the man" here when it comes to talking about liver cancer (and quite a few other topics as well), and I have no knowledge to add, but I did want to offer my sincere sympathy. I hope your path is soon to be well-illuminated and is made as comfortable as possible.
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