Liver lesion on CT scan
I finished chemo-surgery-rads-1yr herceptin this week and had a CT scan (insurance denied PET scan because of no known disease!). The CT scan showed a few things, such as lung changes (attributable to radiation), small kidney nodules (possibly cortical cysts), and "a small hypervascular area of nodularity within the dome of the liver." None of these showed on my pre-treatment PET. I had complete pathologic response to chemo, and this CT scan reports "No evidence of local recurrence or metastatic disease."
My MO said the liver lesion could be a benign hemangioma, but to check it, ordered a PET scan. Well, it has been denied again. I can't have an MRI with a tissue expander still in, and I'm scheduled for DIEP flap recon next month in NOLA -- with this liver issue unknown. I'll try to reach MO on Monday about what to do next, but meanwhile...
How can the report say no metastatic disease when there is an indeterminate liver lesion? I have searched, and find it can be any of several benign or malignant lesions. Does anyone know what what a hypervascular lesion on the liver would represent?
Comments
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My insurance denied my oncologist intial request for me to have a PET scan at the beginning of treatment for staging puposes. It is up to your oncologist to get this through. I don't know what my doctor told my insurance company but they then changed their minds. I would say the CT scan warrants a PET to be sure! And I am sooo very sorry that you are having this scare! Are you really a stage IIIC? Your shown stats are really a IIA. I hope you get good news soon!
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Kathleen - stage IIIC is due to skin involvement, and presumably many positive nodes. One positive node with extracapsular extension was biopsied before neoadjuvant chemo, but imaging had shown so many very enlarged axillary nodes that my BS decided that the tumor was T4N3M0. Can't know for sure because chemo cleaned them out before bmx!
I don't know if my MO will fight for the PET scan. She must have thought it was warranted -- even the CT scan report recommends follow-up with PET or MRI. I wondered if it could be chemo damage, but nothing I read suggests that for a hypervascular lesion. Anyone have a liver lesion? How do mets appear?
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I have a hemangioma in my liver. The first CT showed it and a follow-up CT 3 months later confirmed what my MO was sure of, that it was benign. My initial report also indicated that there should be a followed-up, although I was declared NED. Another doctor who looked at the report said these follow-ups are often cases of CYA.
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Yorkiemom - that's encouranging to know! I'll keep thinking about this if my MO decides to wait 3 months for another CT scan.
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Ho big is the liver lesion? If it is big enough and in an accesible area, you could have a biopsy done. If that is not possible, I would fight my ins for a pet.
I had a liver lesion, had a ct and then had a biopsy to confirm mets. Because you have an agressive cancer, same as I do, I would not take "the wait and see aproach".
I had a diep down at NOLa when I was early stage, and I can't believe that they will do this major surgery (and I wouldn't want to have it), if there is any possibility this is a liver met.
Laurie
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Laurie -- The size is given only as "small" and tells the location on the scan where to find it, only a single lesion. Would a PET help rule out malignancy (if it looks like a common hemangioma), or is it absolutely necessary to do a biopsy? What will the PET scan tell us that the CT scan did not?
Can you (or someone) tell me how involved a liver biopsy would be - needle or scalpel, anesthesia, pain, recovery from biopsy itself? I am scheduled for DIEP in 3 weeks, and don't know if there is time for PET approval, then biopsy if warranted, to hopefully be cleared as benign. (Delays will make me lose the summer timeframe when my DH can be my helper in NOLA and a few weeks of recovery. Of course, mets would change it all.)
I'll be trying to contact my MO first thing Mon AM.
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A pet scan scan is not conclusive. It measures how active the lesion is. The higher the number, the more likely it is cancer. So, if you had one and the number was low, it would be unlikely the lesion is cancer.It does matter how small it is because very small lesions will not show up on the pet.
I didn't have a pet. I went straight to a biopsy because the ct said "consistent with metastatic disease".
Women's experiences with liver biopsies varies. Mine was very easy, similar to a breast biopsy. Some women say they have some pain and the dr makes them lay stil for an hour or so afterward. The recovery was to take it easy that day.
Did your dr say it looks like a common hemangioma? Does he think it is necessary for more testing?
Laurie -
Laurie -- I do wish they had specified the size of it, but the impression section suggested a PET so maybe it is thought to be big enough. My MO went by the report, I think, where the first "guess" was hemangioma...she didn't use the word "common" but downplayed its significance as "like a mole."
Quoting findings: "There is a small hypervascular area of nodularity in the dome of the liver (series 2 image 184 and series 302B image 53). This has an indeterminate appearance and could represent a small hemangioma among other things. This appears to connect with a vessel and could even represent a vascular malformation. No additional hypervascular areas are seen."
And in the impression section: "There is a small hypervasuclar lesion within the dome of the liver as described in the body of the report. MRI of the liver could be performed to further evaluate. Alternatively, nuclear medicine PET scan could be performed to assess for matabolic viability of the nodule."
The impressions also have me NED: "No evidence of local recurrence or metastatic disease." Does that make sense with this indeterminate liver lesion?
My MO considered a liver MRI until I reminded her that my TE has a metal port and I had been told by my PS that I can't have any MRIs with it in. Thanks for info on liver biopsy. I may find out tomorrow if I should get one.
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Update: my MO is still trying to get PET scan approved with Aetna. But she said through her nurse that I am fine for surgery (DIEP) with what she sees on the CT scan. She expects from the liver lesion's characteristics that it is benign. (And the report said no evidence of metastatic disease, which is why insurance wants to deny the PET scan.) I would still be more content having the PET scan.
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What's better a ultra sound or a ct scan? Do ultra sounds show up cancer?
The last few months, I've had a burning ache on my right and left side. I think it could be a Herceptin side effect, but that I had this pain for a month, my oncologist ordered a ultrasound Friday morning. My oncologist wanted me to report anything unusual. I think once I complete Herceptin it will be easier to know if something is really out of the ordinary. I wonder once dx with idc if we'll be scanned the rest of our life for unusual pain. I wonder if after awhile negative scans will give us a feeling we're ok and we'll begin to ignore possible signs of cancer. One thing I like about having infusions is they are always checking our liver, and blood for whatever. I feel in someway that's a safety net in catching cancer early. I just wonder after the infusions how you would know if your blood levels were off, and if ever after the infusion they check you like they do now. I asked my oncologist how would you know if you have cancer like in the liver or lungs. She did say that it would be early for me to be dx with mets. I'm not really concerned now, but now that I know it could be a year later or so, I'm a little concerned how you would know especially then it will be after the infusions and I' won't be seeing my oncologist anymore.
It would be nice to move on after infusions, which I plan to do...but in what my oncologist said today, I wonder if you can forget about cancer. Part of the reason for my mastectomy was to get rid of the problem once and for all. One good thing the oncologist said today is that it's rare those who have Herceptin to have a recurrence. That's the good news, but not a 100% guarantee.
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Eve - My MO said she will follow me based on symptoms. My next appointment after conclusion of treatment (with year of Herceptin) is at 3 months, with labs. Because my end-of-treatment CT scan (should have been PET, denied by Aetna) showed a liver lesion, I don't know if I will be followed in a different way (more scans) or if it will be ruled out as benign in one more scan, hopefully PET this week if approved, and then go to symptom-only scans. Ultasound does show some cancers -- it showed my IDC and cancerous nodes, but biopsy was required to diagnose.
My MO said the opposite of yours about Herceptin, that HER2+ (especially grade 3) is a sneaky cancer and tends to go to the liver and brain. So it got my attention when the CT scan showed a liver lesion, even though it is thought to be a benign hemangioma, and the report was inconsistent saying no evidence of recurrence or metastasis. I would like to get DIEP and move on with life, but MO says I will be followed closely for a while.
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I got word that Aetna denied the PET scan again, even after my MO had peer-to-peer with the reviewing doctor. Something about not having a biopsy or other imaging that indicates disease. My MO was about to order an abdominal (liver) MRI when I reminded the nurse on the phone that I can't have an MRI due to tissue expander, so either the MRI waits several weeks until the TE is removed, or something else will be ordered (I have no idea what).
Meanwhile, yesterday's pre-op EKG came back with something that may be abnormal, so MO wants me to see a cardiologist (a first for me). Oh my. I asked them to try to get me in this week, because I'm leaving to visit family next week, and home only a few days after that before going to NOLA. Does this happen often, something on the EKG that turns out to be OK?
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ann - sorry to read of your struggles with this liver lesion, hopefully benign, and now an anomaly on your pre-op EKG. I know that several ladies on the TCH and Triple Pos threads have had these things show up on scans, and they have proven to be cysts or other harmless growths or vascularization. The difficulty seems to lie in how to check it with certainty, especially if your insurance company is non-cooperative. Just wanted you to know I was thinking about you and hoping this all works out and you have a successful recon surgery.
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Good to see you SpecialK -- I checked the TE trouble thread a couple of days ago, and see you are still giving helpful advice there!
The latest with my liver lesion dilemma is that my MO has decided to have me get an MRI after I have the TE out at my DIEP flap surgery (in less than 3 weeks, but MRI might be a month after that). She considers it benign, and I think that's likely. I'll report back the MRI results.
To check out the pre-op EKG potential abnormality, I'll see a cardiologist this Fri.
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Hello Ann,
I just wanted to let you know that I had something show up in my liver on a CT scan which my onc thought was probably a cyst, based on the radiog's report. We decided to wait and watch and it was unchanged on my next CT 3 months later and was not noted at all on my latest scan another 3 months on.
I really hope that your liver lesion turns out to be nothing to worry about, too. Take care xx -
Angelfalls -- good to know. There will be 2 months between the CT scan and the upcoming MRI, so I'm hopeful that there will be no news.
I just saw a cardiologist this morning -- nothing wrong with EKG and heart, cleared for DIEP surgery in a couple of weeks!
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It sounds to me like they don't think there is cancer growing in your liver. Trust me, if they thought there was they would word it in such a way. Radiologists are rarely as definitive as yours is so I think what he's saying is he sees something but it ain't cancer.
I have mets to the liver, by the way. I had half my liver removed and a spot in the right lobe ablated. Two PET/CTs later they are not sure if the spot they see on the liver is cancer growing back or scars from the ablation. The uptake on the PET doesn't match what they see on the CT. PETs are not always definitive by any means.
A biopsy is definitive but it doesn't seem that you warrant one. If it is a hemangioma, that could be a bleeding risk too. Biopsies are painful, the only painful test I ever had!
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CoolBreeze -- I was puzzled by the report of no metastasis, which seemed inconsistent with an indeterminate liver lesion, and wondered how the radiologist could know if it was benign. I guess experience with the characteristics of liver nodules makes a difference. I hope he's right.
Wow, I didn't know a person could lose half a liver. Sorry you have this suspense about what's happening with a spot now. I was concerned I could end up with a liver biopsy (when the PET was denied and MRI impossible at the moment). I read about the procedure, and it seems like no fun, but neither was your drama of liver surgery & ablation!
Keep on, CoolBreeze. Oh, I see you are Ann too. -
Now that I had DIEP recon in NOLA, which also removed my remaining tissue expander (with metal port, not allowed in MRI), I had an abdominal MRI this morning. I hope to get results later this week, or Labor Day weekend will cause a litte more delay.
Still hoping it's a benign liver hemangioma. I hope this MRI is definitive, to avoid further tests. Anyone else have experience with this?
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Good luck with your scan. I think it sounds hopeful.
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About my MRI: I found out today that the liver lesion was diagnosed as an atypical hemangioma, a BENIGN hypervascular tumor. The report recommends comparison for changes on future imaging, but there is no specific follow-up right now. I don't know if it is common for it to make trouble later, or whether it is more likely to stay as it is. But I have enough other things to worry about that I can set this aside. Trying to get my necrotic abdominal wound from DIEP to heal.
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Dear Ann- good news. I'm so happy for you.
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Hi....I don't know how I came across this but earlier this week and added it to my favorites to watch. I'm so thankful it turned out like it did.
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Great news and congrats. I'm so relieved for you:)
Have a good weekend.
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I had a scan before chemo which showed 'something' on my liver (which could have been secondaries) and also 'something' on my adrenal gland.
It was decided to scan me again after 3 months and a couple of chemo sessions, to see whether it had shrunk/grown or stayed the same.
To say I was in bits is an understatement. After 3 months it was exactly the same. Benign was the report. Relief!!!
That was over 4 years ago and nothing since. No evidence at all of anything sinister.
These days the technology is wonderful but the scans are super-sensitive and show lumps and bumps that people have ordinarily through life. Nothing sinister, just from life.
But after a BC dx it's difficult to see what's sinister and what isn't. We're super-sensitive, and until we're actually told it's benign we think the worst (sometimes it's difficult to believe even when we're given the 'all clear').
I think that's normal.
My thoughts are with you as I know just how worrying it is, but 'what a relief when it's benign'!!!!!!!!!!!!!!!
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Thanks, ladies. I'm thankful too.
Maltomlin -- I don't know when I'll be scanned again, but I'm not going to worry about it now that I have heard from so many that it is common to have benign hemangiomas or cysts in the liver. The scans also showed cysts on my kidneys, but my MO didn't seem concerned about that. She had told me before that HER2+ cancer tends to metastasize to the liver or brain, so I guess anything seen in those organs gets attention.
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I finally had another MRI last week to check the liver lesion. It is still there but stable and the impression is either a "benign hemagioma" or "benign focal vascular shunting." There are no new liver lesions. So that was a year of some concern about how it would turn out, but I'm relieved. No follow-up scan scheduled for the liver, but I have a PET scan in 6 months if it isn't denied by insurance like it was last week!
I wonder if chemo could have caused this liver lesion -- it didn't show on my diagnostic PET scan 2 years ago.
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Yay Ann! So glad it's benign and nothing new! Followed your story before....take care and prayers to you for living well!
Karen -
Just saw new oncologist, as wanted a 2nd opinion and closer to home. Had bone scan as well as CT scans of chest, abd, pelvis. The New oncologist DR 2 we will call him, said small cyst on liver, and small area on lung size of pen tip that we will watch, he wasn't concerned about liver spot and said it was a cyst. He was very laid back and telling mental positivity and emotional well being are all part of being treated and healed. Which I agree...well I had Stage 1 idc in right breast that was .7mm and had bilateral mastectomy with negative lymph nodes. I am er and pr positive, her negative so my cancer grew on hormones. I have expanders in and getting them exchanged tomorrow for implants as one has seroma...anyhow barely got home from that oncologist number 2 and the oncologist I saw last week number 1 called to tell me that he thought the radiology report was inconclusive and showed a cyst on my liver that he would like to see clearer. He viewed the films also and said he couldn't tell either as radiologist report said, so not sure a cyst..he recommends an MRI...cant' have that til after expanders out. I told him I had gotten 2nd opinion and closer to home, etc. I told him the other Dr thought it was a cyst per the radiology report and no worries. He disagreed and thinks I should get MRI. Then if that inconclusive a biopsy of liver.
What should I do?????? I could see a 3rd oncologist and get a 3rd opinion it seems... -
Audra
I don't have a spot on my liver but I do have a nodule on my lung and one on my thyroid that they did a biopsy on today. What you are going through is to me one of the worst things about having BC. The uncertainty of any incidental findings of these scans.I spoke to the dr that did my thyroid biopsy today and she told me that the most common things they find on Ct's are nodules on lungs and thyroid and cysts in the liver. They are almost always benign.
In my case the lung nodule was rescanned after chemo and is the same as it was on the first scan so it is presumed to be benign. Still waiting on the thyroid nodule.
You could get a 3rd opinion but I would have the MRI and get the results so you don't have to worry about it anymore.
Good luck, I am sure it will all be fine. Hugs
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