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Burning in abdomen, enlarged liver, homogeneous mass lesion. Treatment ?

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Answered by

Gastroenterologist, Surgical
Practicing since : 1991
Answered : 52 Questions
Dear Doctor,
Good Morning, I , XXXXXXX writing this note from Silchar, the District town of Assam.
My mother named as XXXXXXX Deb , age 70 yrs had a burning sensation in the abdomen in the second week of July, thereafter consulted with a Medicine specialist at Silchar on 18.07.11. He prescribed some medicine like 1. Raxim 250mg, Tab Pan40,Decolic and adviced for USG for whole abdomen, Amylase and Lipase Serum test.
After the consumption of medicine , pain were relieved and never happened after that.
Test were conducted and the result are as follows:
Amylase, Serum: Result 47
Lipase , Serum Result: 211
Both the test are under limit.
USG test describes as: Liver is mildly enlarged in size. There is a hypoechoic mass lesion of size 4.7cmX4.2Cm X 3.9Cm in the segment 4b. The lesion shows areas of XXXXXXX vascularity. IHBR are not dilated. Portal vein is normal.
Advice for Hepatic tumor marker profile test.
Thereafter, AFP(ALPHA FETOPROTEIN ) , TUMOR MARKER (CMIA) was conducted on 01.08.11 under Dr. Lal Path Labs , New Delhi and result found 3.89 ng/ml.
After this test, Doctor advised for CT SCAN and that conducted on 08.08.11 at Silchar Medical College, Silchar. The observation of which is given below:
Liver: Liver is mildly enlarged (19mm greatest axial dimension). There is well defined relatively homogeneous mass lesion of size 60 X 51X42 mm seen involving segment 4b showing moderate heterogeneous contrast enhancement. Portal vein is normal.
Now, the medicine my mother is taking as prescribed by Doctor are : Ursodox 150mg, PAN 40.And advice to go outside for Further treatment.
Please advice what to do .
XXXXXXX E mail ID YYYY@YYYY . Mobile No: 0000.
Posted Wed, 2 May 2012 in Liver and Gall Bladder
Answered by Dr. Nitin Rao 9 hours later

Thanks for the query.

Hopefully the scan done is a triphasic CT scan.

You have provided with some good information. But some more details like
1. The complete CT scan report and what is the radiologists opinion about it, in terms of diagnosis.
You can scan the complete CT scan report and sent it to my attention at YYYY@YYYY
2. Also send me the CT films which will be useful to think of a diagnosis.

Based on this diagnosis, further treatment can be suggested.

There are several possibilities. I will be able to answer better by looking at the CT films and report.

Awaiting your reply.


Dr Nitin Rao
Above answer was peer-reviewed by
Follow-up: Burning in abdomen, enlarged liver, homogeneous mass lesion. Treatment ? 46 hours later
I have sent the report as desired. Reply is awaited.
Answered by Dr. Nitin Rao 13 hours later

I have gone through the CT films and reports.

It is a complex question to answer without knowing the exact nature of the lesion. We need to investigate the case one by one as per the protocols laid.

Tumor marker like AFP is in normal range though CEA is raised over the reference values. This does not rule out a possibility of malignant or benign tumor in the liver. At the outset, given her age even a tumor is a good possibility. A metastatic disease of the liver, Hepatocellular carcinoma and Focal Nodular Hyperplasia (rare at this age) are thought about by experts. They would wish to rule them out as soon as possible.

If she were my patient the next step I would order is to have an OGD (upper GI endoscopy), Colonoscopy. This is to find out any changes in the digestive tract. The chances of Colon cancer is high if it a metastatic disease is thought. If both of them are normal then we would need to further investigate from the liver lesion. It is important to find out the primary lesion in case of metastasis.

An approach by Fine Needle aspiration of the liver mass is also suggested. However, a number of controversial issues surround the role of FNA in this setting. First, it is commonly nondiagnostic when used to evaluate some types of liver lesions such as hepatic adenomas and focal nodular hyperplasia. Second, it is associated with some degree of risk, including bleeding and seeding of neoplastic cells.

If all else is negative and patient is fit then the best course of treatment would be surgery given the general condition of your mother is good.

Let me know if I can be of any help to you to pursue her. I have no idea about the facilities available at places like Silchar to detect the real cause. We would be happy to take care of your mother for treatment.

Take care,

Dr Nitin Rao
Surgical Gastroenterologist,
Above answer was peer-reviewed by
Follow-up: Burning in abdomen, enlarged liver, homogeneous mass lesion. Treatment ? 7 hours later

Thanks for your kind note.
As far as the treatment facilities are concerned at Silchar, there is no such treatment available.Moreover, no specialised doctors are also available. As a result I am totally out of any idea what to do.
Will you please let me know where to go for further treatment in India. It is heard that Chennai , Delhi , Hyderabad and many places there lies the good avenues for liver treatment.
Will you please let me know where to go and whom to XXXXXXX for further treatment. And by this time , What type of food and medicine my mother should take.

Thanking you and awaiting for your kind reply.

Answered by Dr. Nitin Rao 53 minutes later

I appreciate your concern and understand the willingness to help your mother.
She needs a tertiary centre to investigate and treat.
You need to get to a centre where Oncology, Surgical Gastroenterologist and Medical Gastroenterologist are available under one roof.
You can choose to consult at prestigious institute like AIIMS or CMC Vellor. Else you can come to Bangalore, M S Ramaiah Memorial Hospital. If you wish to go to Chennai, Apollo is the best place.

I wish her speedy recovery.

Thank you.
Above answer was peer-reviewed by
Follow-up: Burning in abdomen, enlarged liver, homogeneous mass lesion. Treatment ? 25 hours later

Thanking You for your valued advice. I want to know from you that the tertiary treatment facilitiy which you have suggested for my mother would be available at Asian Institute of Gastroenterology , Hyderabad.

With regards.

Answered by Dr. Nitin Rao 20 hours later

Yes it is also a good tertiary centre available as an option for you. The team of doctors and health care professionals there have good experience and skills to take care of your mother’s condition.

You may go ahead.

Above answer was peer-reviewed by
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