Aa
Aa
A
A
A
Close
565061 tn?1314241091

test monday

Monday i get a cat scan   they tried mri but i cant due the tonal ,,,,,,,,they have a short mri wear your head can be out of the toob  and its state of the art 3t 70cm bore top of the line imaging  but doctors are being hard to deal with  
26 Responses
Sort by: Helpful Oldest Newest
1477908 tn?1349567710
Are they doing a triphasic CT scan? MRI's perhaps give the best imaging of the liver. My first one was overwhelming, but now not so bad - and a good thing since I have to have one regularly because of cirrhosis.

Couple things have made it easier for me: wearing a hat on my head so the fan doesn't make my hair move and tickle my neck, warm socks, keeping your eyes closed at all times (I made that mistake only once) using the earphones for music and taking something for anxiety beforehand if needed. The newer models are a vast improvement over the old ones!!
Helpful - 0
446474 tn?1446347682
FYI:  "AFP can be elevated in intrahepatic cholangiocarcinoma (ICC) and in some metastases from colon cancer. Therefore, the finding of a mass in the liver with an elevated AFP does not automatically indicate HCC." From AASLD Practice Guidelines for HCC."

Your in Lake County? No matter where you are you need to be seeing a hepatologist. No other doctor is qualified to diagnose and manage cirrhosis and HCC. HCC is a very serious illness. It must be managed properly. I don't want to scare you, but not treated or improperly treated, it can be fatal.

You might want to think about having a doctor up in your area refer you to the U.C.S.F. liver transplant clinic here in San Francisco. They are experts at treating cirrhosis and HCC. They have one of the best Liver Clinics and transplant personnel in the whole country. They would probably have you see my doctor. Dr. Norah Terrault. She is head of hepatitis and liver transplant at UCSF and is internationally known. She has many papers and videos online. She teaches other hepatologist the latest in hepatitis and liver transplant.

UCSF also has a "Tumor Board" which has doctors of many disciplines, oncology, radiology, etc. every thing to diagnose and mange HCC. I'm having to CT scan today to see how much my liver tumor has grown since May.

I will help you in anyway I can. As it might be that we are in the same boat. I have been dealing with End Stage Liver Disease (decompensated cirrhosis) for a couple of years know and HCC since June 1.

The best paper on HCC is written by the American     AASLD. It tell you all of the best practices guidelines for doctors diagnosing, treating, managing HCC. It is for doctors but it isn't too difficult to understand.
Here is the link...
http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20practice%20Guidelines/Hccupdate2010.pdf

Excepts that are relevant to your questions about HCC and AFP and detection:

"Hepatitis C
The risk of HCC in patients with chronic hepatitis C is highest among patients who have established cirrhosis, where the incidence of HCC is between 2%-8% per year."

"Role of AFP in Diagnosis

Alphafetoprotein has long been used for the diagnosis of HCC. It has also been part of surveillance algorithms. However, as described above, the AFP is insufficiently sensitive or specific for use as a surveillance assay. Recent data also suggest that its use as a diagnostic test is less specific than was once thought. AFP can be elevated in intrahepatic cholangiocarcinoma (ICC). and in some metastases from colon cancer. Therefore, the finding of a mass in the liver with an elevated AFP does not automatically indicate HCC.
ICC is also more common in cirrhosis than in noncirrhotics. Although the incidence of ICC is much lower than HCC, the fact that both are more common in cirrhosis means that care must be taken to distinguish between them given the differences in treatment and outcomes. Since AFP can be elevated in either condition, it is recommended that it no longer be used. Thus, the diagnosis of HCC must rest on radiological appearances and on histology."

"Radiological Diagnosis of HCC

HCC can be diagnosed radiologically, without the need for biopsy if the typical imaging features are present. This requires a contrast-enhanced study (dynamic CT-scan or MR). In the arterial phase, HCC enhances more intensely than the surrounding liver.
This is because the arterial blood in the liver is diluted by venous blood that does not contain contrast, whereas the HCC contains only arterial blood. In the venous phase, the HCC enhances less than the surrounding liver. This is because HCC does not have a
portal blood supply and the arterial blood flowing through the lesion no longer contains contrast, whereas the portal blood in the liver now contains contrast.
This is known as ‘‘washout’’, although the term does not really describe the sequence of events. In the delayed phase, the presence of ‘‘washout’’ persists, and sometimes ‘‘washout’’ is only present in the delayed phase. The presence of arterial uptake followed by washout is highly specific for HCC.

Thus, to properly document the existence of HCC, a 4-phase study is required: unenhanced, arterial, venous and delayed phases."

Hang in there!
Hector
Helpful - 0
565061 tn?1314241091
Sacramento has a state of the art mri that is only 4' long, your feet and your  head  hangs out no more anxiety !!!    sutter pavilion in sac  monday i have a cat scan
Helpful - 0
565061 tn?1314241091
yes i have pacifica teem edd walkeal
Helpful - 0
419309 tn?1326503291
Both MRI and CT-Scan are considered to have an 80-85% sensitivity in detecting HCC, if that is the objective. Best of luck. ~eureka
Helpful - 0
565061 tn?1314241091
yes Monday cat scan, Tuesday talk to doc Walkeal,  my last cat scan didn't show enything and i tried two times to take a mri i cant stay in the toob im not a panic attack type person never new i was claustrophobic but that mri Evan with drugs did not work for me   i found a mri only 4 feet long 3t, 70cm  state of the art new unit at sac pavilion my head can be out of the unit and no more anxiety  but i feel im wasting my time on another cat scan  next week tells a lot  i gess, Friday i have another upper endoscopy they have alout of banding to do lots off trips.  
Helpful - 0
446474 tn?1446347682
"but i feel im wasting my time on another cat scan  next week tells a lot  i gess, Friday i have another upper endoscopy they have alout of banding to do lots off trips. "

Endoscopy tells nothing about liver cancer. It only treats a complication of End-Stage Liver Disease, varices.

Have they tried Ultrasound? The simplest of all imaging methods?
If not, why not?

"I feel im wasting my time on another cat scan"
Wasting your time? Are you serious? Do you stand if you have liver cancer and it goes untreated if left alone it can and will be fatal? Untreated HCC is a "almost universal death sentence"!
From the AASLD Prctice Guideline for HCC. "In summary, in the past decade HCC has gone from being an almost universal death sentence to a cancer that can be prevented, detected at an early stage, and effectively treated. Physicians caring for patients at risk need to provide high-quality screening, proper management of screen-detected lesions, and provision of therapy that is most appropriate for the stage of disease."

Recommendations
6. Nodules found on ultrasound surveillance that are smaller than 1 cm should be followed with ultrasound at intervals from 3-6 months (level III). If there has been no growth over a period of up to 2 years, one can revert to routine surveillance (level III).
7. Nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either 4-phase multidetector CT scan or dynamic contrast enhanced MRI. If the appearances are typical of HCC (i.e., hypervascular in the arterial phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC. If the findings are not characteristic or the vascular profile is not typical, a second contrast enhanced study with the other imaging modality should be performed, or the lesion should be biopsied (level II).
8. Biopsies of small lesions should be evaluated by expert pathologists. Tissue that is not clearly HCC should be stained with all the available markers
including CD34, CK7, glypican 3, HSP-70, and glutamine synthetase to improve diagnostic accuracy (level III).
9. If the biopsy is negative for patients with HCC, the lesion should be followed by imaging at 3-6 monthly intervals until the nodule either disappears, enlarges, or displays diagnostic characteristics of HCC. If the lesion enlarges but remains atypical for HCC a repeat biopsy is recommended (level III).

I don't know how I can make it more clear to you how serious it is IF you have liver cancer. Here is an excerpt from medicinenet.com. Maybe this will get your attention.
http://www.medicinenet.com/liver_cancer/page7.htm#tocj

"The doubling time for a cancer is the time it takes for the tumor to double in size. For liver cancer, the doubling time is quite variable, ranging from one month to 18 months. This kind of variability tells us that every patient with liver cancer is unique. Therefore, an assessment of the natural history and the evaluation of different treatments are very difficult. Nevertheless, in patients with a solitary liver cancer that is less than 3 cm, with no treatment, we can expect that 90% of the patients will survive (live) for one year, 50% for three years, and 20% for five years. In patients with more advanced disease, we can expect that 30% will survive for one year, 8% for three years, and none for five years."

As you know advanced liver disease can take 20-40 years to develop. Unfortunately liver cancer isn't usually a slow disease that develops over years. And once a tumor is found it should be treated while in its early stages to have the best odds of surviving with the cancer more then a few years.

If you are not concerned about dealing with this issue please let me know. I personality feel that if I don't tell you what I know from my own experience and research on HCC then I will feel horrible if we find out later you have treatable HCC. I am not saying take my word on this as I am an expert of liver disease of HCC. I am not a doctor and don't spend my day to day life treating patients with liver cancer. I am saying ask any hepatologist and they will tell you that HCC is a fatal disease within a very short time period for most people who are not monitored and treated for it until it reaches the later stages. Ask any doctor. There is a doctor on this forum who answers inquiries about liver disease. Better yet ask your own doctor assuming he is a hepatologist (a liver specialist). There is pretty much universal consensus of the nature of liver cancer and its outcome.

Hepman you are only 51. Still relativity young. You can have many years ahead of you even with liver failure as long as you get a transplant before your liver totally fails to function. Of course it is your life and your decision. Not mine or anyone elses. Only you know what the importance of life is to you. Just tell me either gently or not if you don't care about possibility of having liver cancer and I will refrain from commenting on your situation. All I can do is try to make you aware of the possible seriousness of the matter if rather ignore it then I hope that you do not have liver cancer and can proceed to just deal with the affects of End-Stage Liver Disease.


John Hopkins Gastroenterology & Hepatology
Alpha-Fetoprotein (AFP)
http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=551CDCA7-A3C1-49E5-B6A0-C19DE1F94871&GDL_Disease_ID=A349F0EC-5C87-4A52-9F2E-69AFDB80C3D1

Alpha-fetoprotein levels may be assessed by a blood test. Alpha-fetoprotein (AFP) is a tumor marker that is elevated in 60–70% of patients with hepatocellular carcinoma. Normally, levels of AFP are below 10 ng/ml, but marginal elevations (10–100) are common in patients with chronic hepatitis. However, all patients with elevated AFP should be screened (abdominal ultrasound, CT scan or MRI) for hepatocellular carcinoma, especially if there has been an increase from baseline levels. In our experience, a steadily rising AFP is almost diagnostic of hepatocellular carcinoma. The specificity of AFP is very high when the levels are above 400 ng/ml. Undifferentiated teratocarcinoma and embryonal cell carcinoma of the testis or ovary may give false-positive results and should be considered in the differential diagnosis of elevated AFP.

The doubling time of AFP is around 60–90 days. Therefore, it may be advisable to check AFP every 3–4 months to screen high-risk cirrhotic patients (hepatitis C, hepatitis B, and hemochromatosis) for hepatocellular carcinoma.

Good luck.
Hector

Helpful - 0
419309 tn?1326503291
Subjecting yourself to tests and such can be frustrating and demoralizing, but don't give up, and I echo Hector's sentiments about investing yourself in getting a diagnosis:  preserving your health and your life is never a waste of time.

Just because you can't do MRI does not mean further testing is a waste of time -- I wonder as Hector does if you've already had ultrasound imaging prior to CT? (Presumably your doctor has already had you undergo ultrasound?) If it happens that your scan on Monday is inconclusive, it might be worth pressing your doctor for a referral to that open-MRI as a second option.

If you are having endoscopy for banding, your cirrhosis is progressed enough that you are definitely in the at-risk category for developing HCC -- regular surveillance is a must.  If your high AFP is not correlated to any liver mass, I would also suggest you ask your physician to rule out prostrate concerns, as AFP can also be a marker for germ-cell tumors.  Keep on keeping on, hepman. ~eureka
Helpful - 0
565061 tn?1314241091
yes i have done ultra sound cat scan already,,,, but at Sacramento pavilion hospital they have the new mri from Siemens it's a 3t 70cm closed mri that is only 135cm from won end to the other the head !!!! does not haf to be  { in side of the unit for a full abdominal and lug  closed MRI }  but they ?????/   enough im going in to the visit with papers on the new set up that is not open and only 4.5 feet 135 cm  ow well wen the doc is in the room with me he has to listen    last year i went to 7 + upper endoscopy and bandings????over 40 banding its on last years post this  year their is alout on the photo lots more visits  i hope i do not need a stent in my portal vain im going to go get some chease with my wine ing
Helpful - 0
Avatar universal
I echo the information Hector stated.  It is perfectly accurate in my experience.  Take it very seriously.

The only upside, if you can call it that, to HCC, is that your MELD score will get you right up to the top of the transplant list.  Of course, if the HCC is advanced, and it can grow very quickly, then one become ineligible and that is not good.
Helpful - 0
1477908 tn?1349567710
Is the ineligibility when it metastasizes or gets to a certain size?
Helpful - 0
419309 tn?1326503291
TP guidelines do exclude patients with metastasis.  Also, if any single tumor is greater than 5cm, or total multiple tumor diameter exceeds 8cm, those conditions also make for ineligibility.  It's a pretty cold and hard risk/benefit equation -- metastasis makes for poor prognosis, as does tumor size.  Additionally, more than 3 total tumors is also an exclusionary factor.
Helpful - 0
565061 tn?1314241091
how oftan can they cure it our cant they no smoke rings please
Helpful - 0
1654058 tn?1407159066
You're hearin some great advice. I'm not that knowledgable. But I can hear your desire and your drive. Never give up. Get good info and fight hard hepman.  Xo Karen :)
Helpful - 0
565061 tn?1314241091
you must of not under stud me i do what ever they tell me !!!!!!!!!   ALL I WAS TRYING TO SAY IS I WONT A MRI........... I HAD A CAT SCAN LAST MONTH NOTHING WAS SEEN ?? i wont them to work faster ,,  sorry i talk better then i type that's wy you didn't under stand me??????????//    
Helpful - 0
565061 tn?1314241091
Monday i had my cat scan, to day i talk to doctor ???, finialy some medical input  
Helpful - 0
1477908 tn?1349567710
Good luck with your Dr. appt. Hope you get any questions you have answered and some options for the future. Remember to ask for copies of your labs and imaging for your records.....Hang in there, Pam
Helpful - 0
Avatar universal
Good for you !

Your doctor should call you with the results, or you can call him.
You are seeing a hepatologist right? Try and get some info on the phone
then try and book an appointment to see him in person.

Ask questions, take notes, it's hard to remember everything .

All my best,
Elaine
Helpful - 0
565061 tn?1314241091
they found no tumors in my body just high alpha feta proteins above im   2300  will keep track of blood and cat scans regally,   today is a good day for me my other health problems have no cur to  day so thats next weeks problem lots of veracious to be banded that's Friday's problem  
Helpful - 0
1654058 tn?1407159066
That is super news! I've been worried about you. How many times have you been banded? Is it an overnight stay? Are you on Nadolol? sry so many questions. I hope you do well wih banding. And very very happy NO tumors. Congrats.  Karen :)
Helpful - 0
Avatar universal
Wow !!!!!! congrats !!!!!!!!!!!!!!!!!!!!!!!!!!

I don't know how many varices you need banded,but I think
the procedure takes less than an hour as an out patient.

Congrats AGAIN !!!!!!!
Helpful - 0
1477908 tn?1349567710
Great news!! And a big sigh of relief, I'll bet too.

Best of luck with the banding on Friday, Pam
Helpful - 0
565061 tn?1314241091
yes that's how i spell relief  today is good jim
Helpful - 0
419309 tn?1326503291
Very pleased for you that you got good news... I know the relief you're feeling is wonderful!  

It's definitely very important to keep monitoring your AFP -- did you get a copy of the CT Scan?  It would be good to make sure that that they did what's called a 'tri-phasic' scan with contrast -- always important to get copies of your lab reports.  You mentioned they found "no tumors in your body" which is great !  Was it just the liver they scanned? ... Or have you had your prostrate checked as well?  Just something you should check into with a sustained high AFP and no liver tumor (which is wonderful, wonderful :D).

Best of luck on your upcoming procedure...hope it goes smoothly and you recoup quickly. Take care. ~eureka

Helpful - 0
2
Have an Answer?

You are reading content posted in the Hepatitis C Community

Top Hepatitis Answerers
317787 tn?1473358451
DC
683231 tn?1467323017
Auburn, WA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Answer a few simple questions about your Hep C treatment journey.

Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
image description
Learn about this treatable virus.
image description
Getting tested for this viral infection.
image description
3 key steps to getting on treatment.
image description
4 steps to getting on therapy.
image description
What you need to know about Hep C drugs.
image description
How the drugs might affect you.
image description
These tips may up your chances of a cure.
Popular Resources
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.