Liver lesions

[judybee61]

In Feb 2007, I had a kidney stone for which they took a ct scan.  Two liver lesions were detected and I was sent for a followup ultrasound and contrast ct scan.  It was determined that these had nonspecific enhancement patterns and were benign.  I have had a followup ultrasound at 4 months, 8 months, and 10 months with no change in the lesions.  My liver enzymes are normal as is all of my other blood work.  I have had a mammogram, and visited the eye doctor, dermatologist, and gynecologist with a clean bill of health.  My question is, is it still possible that these lesions are cancer?  Wouldn't cancer have grown or spread in 10 months?  My new doctor has sent me for an MRI tomorrow, and I am still worried.  Please advise!

[Kevin Pho, MD]

I agree with the workup thus far.  It is reassuring that the liver lesions are not enlarging.  

Further evaluation would indeed include an MRI, which you said has been scheduled.  If that test is negative, the possibility of a liver cancer is less likely.

If the lesion is amenable to biopsy, that can also be discussed with your personal physician.

A referral to a liver specialist, preferably at a major academic medical center, can be considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[momto2]

Hi! I sure know what you are going through! I went for a CT scan Jan '07 because I was having stomach discomfort.  They found 2 lesions on my liver as well. I am 41y/o with 2 kids and I was terrified. After many tests labwork etc. I was found to be healthy just as you are. They think my tumors are adenomas ( They do have a slight risk of turning to cancer) I have to have periodic MRIs. So far they haven't really changed much so it's just a wait and see approach. I have met with a liver surgeon and my GI doc has discussed this with a hepatologist at a larger institution. Apparently, they see this so often that they think the risk of surgery is greater than the risk of the tumors being cancer. The hepatologist recommended a liver spect scan as well. My surgeons and GI Drs. here do not recommend doing a biopsy because there is a risk a bleeding. That recommendation is probably different for each individual. The Dr. did not really answer your question about if liver cancer would likely spread or grow in 10 months. I would like to know that as well. Keep me posted on your progress and good luck with the MRI. I'll bet everything will be fine!

[judybee61]

Thank you for sharing your experience and your words of encouragement.  Just knowing that someone else is going through what I am is comforting.  I had my MRI today - it was fine except they had to stick me four times trying to find a vein!  So now I wait...I will keep you posted.

[momto2]

Hi again! Did you find out the results of your MRI? I was just wondering what you found out and what treatment your Drs. are recommending. It is nice to find someone who is dealing with the same things I am. Keep me posted.

[judybee61]

Hi!  Sorry I didn't get back sooner.  My MRI came out inconclusive...again!  Probably benign - hepatic adenoma, focal nodular hyperplasia, or atypical hemangioma, BUT cannot rule out metastatic disease given my age. (I'm 46).  I have decided to see a liver specialist at the University of PA in Philadelphia.  I just cannot believe that after a year, they still can't give me a diagnosis.  How are you making out?  

[momto2]

You said you were 46y/o. That doesn't seem old to me,especially when talking about the possibility of metastatic disease. I'm 42 and I hope the Drs. are not just blowing me off. I have discovered over the past year that I have to take responsibility for my own health care because they sure are not going to! They think my adenomas are the result of taking birth control pills. Did your Drs. tell you that? By the way, I think the diagnosis of adenomas are a diagnosis of exclusion, they couldn't find any thing else. Like I said, I have not had a biopsy. How big are your lesions? One hepatologist that was in contact with my GI doc said to get a liver spect scan. They said it would show if it was a hemangioma or even cancer. I had one but am not very familiar with it. My scan can back normal as did my Abd US. Weird that they show up on some scans but not on others huh? I feel OK other than knowing the tumors are there. How are you feeling?

[judybee61]

Hey - my lesions are:  2.9 cm and 4.3 cm.  I just came back from my gp and he said that they are absolutely NOT CANCER!!  He said if it was metastatic disease it would have spread or killed me (lol) in a year.  But he said to put my mind at ease (I have an anxiety problem) to definitely go to a gastroenterologist,  So, as I previously told you, I am going to a liver specialist at the U of Penn next Tuesday.  I will probably make a day of it - my parents and sisters live near there.  Maybe they will order a biopsy to diagnose this for once and for all.  Of course, I know if it is adenomas, they will probably want to remove them, but I am trying not to think that far ahead!  How big are your lesions? (I hate that word, don't you?)  Take care!  

[momto2]

Hi Again! It sounds like you have at least got an answer about weather it is cancer or not. My lesions(adenomas they think) are 2.3cm and 2.5cm. I have not had an MRI since August so I hope they have not grown. I had a consult with surgeons and they recommended not doing surgery. I think opinion differs greatly between physicians about that. They said it is major surgery and I would be in the hospital 4-10days. The risk of surgical complications is apparently greater then just watching the lesions. I will be interested to see what your liver specialist says so keep me posted. In case they recommend surgery, I read somewhere that the the Hospital in Rochester(sorry I can't remember the details)Minnesota is doing some experimentation with removing benign liver lesions with just laser laproscopic surgery. The patients are home the next day! From what I read the lesions have not returned in 5 years so far! Take care and keep me posted.

[judybee61]

Hi again!  I am back from my trip to Philadelphia.  It was pretty interesting.  They have a hepatic tumor conference every Friday morning and they will present my case.  My films will be looked at by a panel of liver specialists, radiologists, and oncologists, so hopefully they will come up with a definite diagnosis.  I will hear from them on Friday morning, so I will let you know!

[judybee61]

Great news!  Both of my tumors are definitely 100% FNH!  I cannot tell you how relieved I am.  It was definitely worth it to see a liver specialist at a major academic medical center.  Even though I had to travel over 3 hours to the University of PA Hosp, I would do it all over again just for some peace of mind.  Thank you for your support and keep me posted!

[momto2]

That is wonderful!  I would like to have that peace of mind. Can you tell me how to get in contact with them? I am in Tennessee so it is a much further drive for me, however I sure would make the effort for that peace of mind. How could they tell it was FNH? Did you have the scar that shows FNH? Keep me posted. Thanks!

[judybee61]

I would definitely recommend the doctor I saw at U of Penn.  His name is George Makar, MD and his phone number is 215-662-4633.  When you call, they will tell you to send all of your reports to his Physician Assistant (they will give you a fax number.)  I waited about 2 or 3 days and they called to schedule an appointment.  The appointment was the next week - I thought that was pretty fast!  I brought all of my disks to my appointment.  They have a liver tumor conference every Friday morning, and mine was one of the cases presented.  A team of liver specialists, radiologists, and oncologists review the disks and come up with a diagnosis.  Most of the time they can make a definite diagnosis, but if they can't, they will send you for a biopsy.  I really don't know the characteristics of my tumors, or how they came up with the diagnosis - I guess I can request a copy of my records for that.  I think it is really worthwhile to see a specialist - keep me posted!

[soupy166]

I was just diagnosed with a 1.1 cm indertiminate hapatic mass on CT scan.  I had an MRI on Friday and am waiting for the results.  Scared.....to say the least.  I am in Ct. and am 37, married with 2 sons (7 and 11).  Just need moral support.

Thanks,

Sue

[momto2]

Hi! Welcome aboard.  For some reason it seems pretty common for young women to have liver tumors.As I mentioned above, the physicians seem to think there is a increased incidence of liver tumors in women who have taken birth control pills. Who knows. I would be willing to bet more women have them then we actually know because most liver tumors are found incidentally when looking for something else. Did you have some kind of symptoms to lead to the MRI? Your tumor is small and only one so I bet it will be just fine. Did you read about Judybee and her final tumor diagnosis? Things turned out fine and I would be willing to bet you will be fine as well. It is scary though until you have definate answers. It has been a year for me and I still don't have a definate answer but my Drs. don't seem concerned. Your Drs. will probably want to keep an eye on your tumor for a while. Keep us posted and good luck!

[judybee61]

She's right - benign liver tumors are pretty common in women.  We both know what it's like to be scared and not getting answers.  You're in the right place for moral support though - keep us posted!

to momto2
Do you think you are going to call the U of Penn?

Judy

[soupy166]

Thank you both, hopefully the MRI results will be in today.  I had the MRI after a CT scan found the mass.  I have been feeling sick for weeks.  Chest pain, nausea loss of appetite etc.  The MDs all thought it was my reflux and ordered another endo.  Just mild espohagitis found though.  Then the CT scan was ordered.  They don't feel that this mass is causing my symptoms though.  Still really scared.  Very little usage of birth control pills over the years.  Did have infertility problems though.  needed added progesterone for a few months to help hold onto my second pregnancy.  That was over 8 years ago and only in my first trimester.  How did they come to find your lesions?  Were you not feeling well?

Sue

[momto2]

Hi again! You sound just like me a year ago. I started with a lot of nausea and it felt like a burp was stuck in my throat. I was basically dismissed by my Dr. because of a history of irritable bowel. I demanded a CT which showed the tumors then of course a MRI followed. The rest is history. I have had 2 more MRIs since then. They say the liver does not have nerve endings so you should not feel pain, however the sack around the liver does have nerve endings so if that is stretched you may feel some discomfort. I have slight discomfort occasionally.After a year of episodes of nausea I finally got an endoscopy and guess what? I have esophagitis just like you! Apparently it can cause chest pain and arm pain, I have had horrible pain in my shoulders and sometimes in my chest. I am trying prilosec and prevavcid for a couple of months but the side effects are yucky. Are you taking a PPI? Have they checked your gallbladder?
Keep your head up and let us know about your MRI.

Judybee61- I think I will give them a call. It can't hurt and maybe with their experience they can give me a definate diagnosis. I probably would not be able to travel that far so I don't know if they will help me out or not.

[soupy166]

I have been on PPI's on and off for the better part of 4 years.  Early on they thought this was reflux esophagitis and I had an endoscopy in 2004 and just a week and a half ago.  The PPI's really don't bother me.  The cost is the real trouble.  I've been on Aciphex (just went off of it) Protonix (headaches and joint pain) Nexium, and Now this week Prevacid.  Prilosec OTC as well as thee 40 mg dose did nothing for me.  I never really felt any heartburn despite the erosions???  Sometimes I feel as though i am light headed and going to pass out along with the nausea.  My MD thinks that the nerve inervation to the esophagus and heart are so close that the GI stuff may stimulate cardiac like symptoms.  I am gloing to call my MD soon to see if he got results.  His wife and I have been friendly for years so I feel like he is on my side.  (unlike my GI doc)

[soupy166]

Its a small hemangioma...says we don't need to moniter.  At least that is good news.  Still don't feel good will discuss with MD at physical next week.

Sue

[judybee61]

Hi!  Hemangiomas are the most common type of benign liver tumor.  I think I read that up to 20% of people have these.  I think that it's great news!  Take care!

[momto2]

Hey girls! A small hemangioma is great news! I'm jealous because now I'm the only one without a definate report... I am going to push for some kind of diagnosis. You know, I never felt heartburn with esophagitis either. All I had was pain. In fact, I had a complete cardiac workup to make sure it was not heart related. Does your physicians keep samples of meds in their office that they would be willing to give you? I got an entire month of prilosec from my GI doc at no cost.

Judybee61, I called the number you gave me but unfortunately they will not look at my films unless I come for an appointment. It is a 10-12hour drive for me. I asked if they could recommend a liver group closer but they didn't seem very encouraging so I guess I'm back to square one.

[soupy166]

My primary MD will give samples, as I said I am friends with his wife.  Also, the Gasto gave me a 20 day supply of prevacid.  Ususally if they know I am a nurse they will help out....but there is only so much they can do.  I occassionally try to go on Zantac 150 twice a day but will end up with more pain if I do it for too long.  My husband calls me a chemist (I'm always trying to find the lowest effective dose of things).  There must be a large medical center within a few hour radius of you.  I have Yale 45 minutes north of me.  I'm also about 1 hour outside of NYC.  

Good luck in finding some answers.  this has been a crazy time for me.  The anxiety level was through the roof.

Sue

[judybee61]

Sorry that U of PA didn't work out.  You must have a major academic Medical Center near you that you can call.  I'll do some research and get back to you on it.  Talk to you soon!

[judybee61]

Go to utmedicalcenter.org and click on Find a Doctor.  There are 5 or 6 gastroenterologists listed and they are in Knoxville.  Hope this helps!