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Liver nodules ,cysts or whatever??
Remained SVR since 5/09 Pegasus for 2b . MRI of liver in July 2013 deemed abnormal. Second MRI in Oct results possible malignancies. There is something in the left lobe which my gastro pointed to and stated we will run another MRI in Jan 14. Three Dr's have the same opinion wait and see. See what ? Why are they waiting ? Is there something else that could be done . My enzymes are normal AST 27 ,ALT 18, platelets 96 .INR 1.1, AFP 2.0. I feel great no pains and lead a normal life . Has anyone been down this road before or have any input to relieve my anxiety or suggestions on what to do now . TY
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Did you have cirrhosis of the liver when you became SRV in 2009? If you didn’t have cirrhosis it would be very rare for you to develop HCC now. If you did have cirrhosis than being SVR does reduce the chances of developing HCC, but does not reduce it to the level of risk that a person who never had cirrhosis has. So there always is a possibility if a person had cirrhosis in the past at any time they can develop HCC. That is why HCC surveillance is recommended for patients even if they are now SVR.
Let me make a few assumptions here to save time.
First, I am assuming these MRIs and doctors that are treating you are at a liver transplant center such as Tampa General Hospital or another center? It is only at a transplant center that they have the multidisciplinary team of specialist doctors who can properly diagnose and treat HCC (liver cancer). I assume that a hepatologist, a radiologist and maybe on oncologist are some of the three doctors you say all have the same opinion to wait and see. Gastroenterologist are NOT qualified to diagnose or treat HCC.
The “wait and see” approach is the standard protocol when the lesions are too small to determine exactly what they are. If it is HCC in time the lesion or lesions will grow large enough so the doctors determine the nature of the lesion. If this is the case then they are taking the proper action and you should be reassured that you are getting proper treatment.
“Is there something else that could be done?”
Not knowing all of the particulars of your health situation I can’t say but generally there is nothing to do but wait. Meanwhile I would ask my hepatologist why they are taking the “wait and see” approach. They will explain to you just what I have said. That should relieve some of your anxiety.
Here is the current AASLD (American Association for the Study of Liver Diseases) protocol for detecting small lesions.
“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).”
“My enzymes are normal AST 27, ALT 18, platelets 96, INR 1.1, AFP 2.0.”
HCC can only be detected using Imaging (ultrasound, 4-phase multidetector CT scan and dynamic contrast enhanced MRI and sometimes AFP blood tests. Not all HCC causes elevated AFP levels. Some tumors produce AFP and other don’t. That is why AFP levels alone are not used to diagnose HCC. Imaging studies are how HCC is commonly diagnosed. MRI is the most sensitive imaging method for detecting HCC. So your doctors have used the best tool they have for seeing lesions in your liver. Other blood levels are not used to diagnose HCC. So AST, ALT, Platelets, INR and not relevant to liver cancer.
“I feel great no pains and lead a normal life.”
HCC commonly has no symptoms until it is in its final stage. Like many cancers. That is why surveillance is so important.
“Has anyone been down this road before or have any input to relieve my anxiety or suggestions on what to do now.”
I had HCC tumors for 29 months before having a liver transplant 3 weeks ago so I am very familiar with HCC, its diagnosis, treatments (I had 8 liver cancer treatments) and prognosis.
Unfortunately you may have to wait again for another study for the doctors to determine what the lesions are. HCC is something you want a definitive answer about. Diagnosis of HCC is a life changing event. But remember it is a cancer that can be treated and overcome if caught early which appears to be the case with you. Hopefully you do not have HCC and whatever they are seeing are benign lesions that will have no impact of your health status and you can continue to live a normal healthy life now that you have cured your hepatitis C and your liver is no longer being assaulted by the virus.
All the best to you!
If you have any other questions about HCC feel free to send me a private message.
Hang in there and try to be patient. I know it is much easier said than done. Best of luck with your next MRI study!
Hector
Let me make a few assumptions here to save time.
First, I am assuming these MRIs and doctors that are treating you are at a liver transplant center such as Tampa General Hospital or another center? It is only at a transplant center that they have the multidisciplinary team of specialist doctors who can properly diagnose and treat HCC (liver cancer). I assume that a hepatologist, a radiologist and maybe on oncologist are some of the three doctors you say all have the same opinion to wait and see. Gastroenterologist are NOT qualified to diagnose or treat HCC.
The “wait and see” approach is the standard protocol when the lesions are too small to determine exactly what they are. If it is HCC in time the lesion or lesions will grow large enough so the doctors determine the nature of the lesion. If this is the case then they are taking the proper action and you should be reassured that you are getting proper treatment.
“Is there something else that could be done?”
Not knowing all of the particulars of your health situation I can’t say but generally there is nothing to do but wait. Meanwhile I would ask my hepatologist why they are taking the “wait and see” approach. They will explain to you just what I have said. That should relieve some of your anxiety.
Here is the current AASLD (American Association for the Study of Liver Diseases) protocol for detecting small lesions.
“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).”
“My enzymes are normal AST 27, ALT 18, platelets 96, INR 1.1, AFP 2.0.”
HCC can only be detected using Imaging (ultrasound, 4-phase multidetector CT scan and dynamic contrast enhanced MRI and sometimes AFP blood tests. Not all HCC causes elevated AFP levels. Some tumors produce AFP and other don’t. That is why AFP levels alone are not used to diagnose HCC. Imaging studies are how HCC is commonly diagnosed. MRI is the most sensitive imaging method for detecting HCC. So your doctors have used the best tool they have for seeing lesions in your liver. Other blood levels are not used to diagnose HCC. So AST, ALT, Platelets, INR and not relevant to liver cancer.
“I feel great no pains and lead a normal life.”
HCC commonly has no symptoms until it is in its final stage. Like many cancers. That is why surveillance is so important.
“Has anyone been down this road before or have any input to relieve my anxiety or suggestions on what to do now.”
I had HCC tumors for 29 months before having a liver transplant 3 weeks ago so I am very familiar with HCC, its diagnosis, treatments (I had 8 liver cancer treatments) and prognosis.
Unfortunately you may have to wait again for another study for the doctors to determine what the lesions are. HCC is something you want a definitive answer about. Diagnosis of HCC is a life changing event. But remember it is a cancer that can be treated and overcome if caught early which appears to be the case with you. Hopefully you do not have HCC and whatever they are seeing are benign lesions that will have no impact of your health status and you can continue to live a normal healthy life now that you have cured your hepatitis C and your liver is no longer being assaulted by the virus.
All the best to you!
If you have any other questions about HCC feel free to send me a private message.
Hang in there and try to be patient. I know it is much easier said than done. Best of luck with your next MRI study!
Hector
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I noticed your platelets are on the low side. Do you have Cirrhosis? If you have Cirrhosis, this puts you at greater risk for Hepatocellular Carcinoma. You probably already know that.
If it was me, I would make an appointment with (or get a referral to) a Hepatologist at a large university affiliated medical center. Those Hepatologists should be very knowledgeable and competent in diagnosing what type of cysts/nodules/tumors or whatever you have. They would know which tests to order and which would be the best treatment for you if you do need treatment.
Best of luck. I hope Hector sees your post as he can give you much more information than I can.