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Suggest Treatment For Metastasis To The Liver
Question: Hi Dr, my dad had been diagnosed with Jaundice almost a month back, and a month before that he was not doing that great with eating food, so after getting him diagnosed we had found out that he has Multiple Metastasis in liver (Report says: Liver is enlarged in size 15cm, Multiple hypo-iso echoic masses in liver largest measuring 2.8cm in seg VIII, No evidence of intra or extra heptic billary tree dilatation). The other area of concern is the report on his Prostate, it is mentioned in the report that there is a grade IV Prostatomegaley (Report Says: Prostate is enlarged in size 70ml. coarse echotecture. Visualized seminal vesicles are normal). He is a diabetic patient as well and eats diabetic medicines as well. Please Dr. could you suggest us what treatment should we follow.
Brief Answer:
further workup necessary
Detailed Answer:
your father requires further workup. It is clear from the ultrasound that he has metastasis to the liver. We now now need to confirm the diagnosis of cancer. This can be done by biopsy or FNAC from liver lesion. he also requires further work up to locate the primary. Possible sites of primary are stomach, colon, lung, pancreatobiliary which are most common. others are not so common. He needs CECT or PET CT, upper GI scopy and colonoscopy and imaging of chest as part of workup.
Once the workup is complete, treatment is planned depending on the site of primary.
I am sorry to say that if the diagnosis of malignancy is confirmed it is in advanced stage. but still good quality of life can be offered to him with proper therapy.
further workup necessary
Detailed Answer:
your father requires further workup. It is clear from the ultrasound that he has metastasis to the liver. We now now need to confirm the diagnosis of cancer. This can be done by biopsy or FNAC from liver lesion. he also requires further work up to locate the primary. Possible sites of primary are stomach, colon, lung, pancreatobiliary which are most common. others are not so common. He needs CECT or PET CT, upper GI scopy and colonoscopy and imaging of chest as part of workup.
Once the workup is complete, treatment is planned depending on the site of primary.
I am sorry to say that if the diagnosis of malignancy is confirmed it is in advanced stage. but still good quality of life can be offered to him with proper therapy.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks doctor for the insight on my dads USG report. As consulted by you as well as our Physician, we had conducted the PET CT scan test given below are the details of his report.
Protocol: 18F-FDG (13.11mCi) was injected after overnight fasting. PET-CT scan was performed 45-60 mins after the injection on GE Discovery 600 PET-CT scanner. Extent of the scan: From base of skull to mid-thigh.
Indications: Case of hepatic SOL's (?metastatic) under evaluation.
Findings: Increased FDG uptake is noted in the circumferential thickening involving sigmoid colon (Max thickness: 1.2cm, length 3.8 cm, XXXXXXX SUV: 10.83). Perilensional fat stranding is noted. Few FDG avid perilesional nodes are noted (largest 1.3cm, XXXXXXX SUV:2.23)
Multiple FDG avid hypodense lesions are noted involving both lobes of liver (largest measuring 7.8 x 6cm, XXXXXXX SUV: 8.96)
The englarged prostate measuring 6,5x5x5 cm does not show any enhancing lesion or focal FDG uptake. The adrenals and other abdominal viscera appear unremarkable. No ascites noted.
A non FDG avid 1.1 cm sized nodule is noted in lower lobe of right lung.
No significant mediastinal adenopathy or pleural effusion noted.
Degenerative changes are noted in L5 & S1 vertebrae. The other visualized bones appear unremarkable. Rest of the whole body scan is unremarkable and represents physiological tracer distribution.
Impression: Case of hepatic SOL's (?metastatic) under evaluation.
Scan findings reveal:
The hypermetabolic thickening in sigmoid colon most likely represents the site of possible primary malignancy.
The perilesional nodes and extensive bilobar, hepatic lesions appear metastatic.
The 1.1 cm sized nodule in lower lobe of right lung appears metastatic.
The bulky prostate does not show any enhancing lesion or hypermetablic focus.
Suggest corelation with Sr. PSA level. No active disease elsewhere in the body.
Please help me with dad's report and let us know what treatment can be given to him.
Protocol: 18F-FDG (13.11mCi) was injected after overnight fasting. PET-CT scan was performed 45-60 mins after the injection on GE Discovery 600 PET-CT scanner. Extent of the scan: From base of skull to mid-thigh.
Indications: Case of hepatic SOL's (?metastatic) under evaluation.
Findings: Increased FDG uptake is noted in the circumferential thickening involving sigmoid colon (Max thickness: 1.2cm, length 3.8 cm, XXXXXXX SUV: 10.83). Perilensional fat stranding is noted. Few FDG avid perilesional nodes are noted (largest 1.3cm, XXXXXXX SUV:2.23)
Multiple FDG avid hypodense lesions are noted involving both lobes of liver (largest measuring 7.8 x 6cm, XXXXXXX SUV: 8.96)
The englarged prostate measuring 6,5x5x5 cm does not show any enhancing lesion or focal FDG uptake. The adrenals and other abdominal viscera appear unremarkable. No ascites noted.
A non FDG avid 1.1 cm sized nodule is noted in lower lobe of right lung.
No significant mediastinal adenopathy or pleural effusion noted.
Degenerative changes are noted in L5 & S1 vertebrae. The other visualized bones appear unremarkable. Rest of the whole body scan is unremarkable and represents physiological tracer distribution.
Impression: Case of hepatic SOL's (?metastatic) under evaluation.
Scan findings reveal:
The hypermetabolic thickening in sigmoid colon most likely represents the site of possible primary malignancy.
The perilesional nodes and extensive bilobar, hepatic lesions appear metastatic.
The 1.1 cm sized nodule in lower lobe of right lung appears metastatic.
The bulky prostate does not show any enhancing lesion or hypermetablic focus.
Suggest corelation with Sr. PSA level. No active disease elsewhere in the body.
Please help me with dad's report and let us know what treatment can be given to him.
Brief Answer:
diagnosis of cancer needs to be confirmed
Detailed Answer:
Your father seems to have spread of disease from sigmoid colon. He needs colonoscopy to locate the primary and biopsy can be done at the same time. Confirmation of cancer has not been done so far and this can be done only with biopsy.
Your father scan shows that the disease is in advanced stage if at all it comes out as malignancy (adenocarcinoma occurs in colon). Fortunately, colon cancer responds very well to chemotherapy and patients even in advanced stage live long. So without worrying over the disease, it would be best if diagnosis is confirmed and treatment is started at the earliest.
diagnosis of cancer needs to be confirmed
Detailed Answer:
Your father seems to have spread of disease from sigmoid colon. He needs colonoscopy to locate the primary and biopsy can be done at the same time. Confirmation of cancer has not been done so far and this can be done only with biopsy.
Your father scan shows that the disease is in advanced stage if at all it comes out as malignancy (adenocarcinoma occurs in colon). Fortunately, colon cancer responds very well to chemotherapy and patients even in advanced stage live long. So without worrying over the disease, it would be best if diagnosis is confirmed and treatment is started at the earliest.
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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