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Dr. Andrew Rynne

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How to rule out liver cancer?

Answered by
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Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1476 Questions

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Posted on Fri, 23 Oct 2015 in Cancer
Question: I am 49 female. 3 weeks ago I was told I have liver lessons. I have had a colonoscopy which was clear. PET scan was clear. Liver biopsy was negative. Today I had a RBC scan because hemangioma was suspected. The scan was negative for hemangioma. The radiologist said he does not know what it is. Now he is saying maybe he didn't get deep enough in the liver to get a good tumor sample. It was CT guided. I thought PET scans would determine if the lessions are cancer. My only blood lab out of wack was an ALP of 216. Is an AFP marker test for liver cancer? I don't know if that was done or not if it is but I would have thought they did one. I was on the pill for years and before a hysterectomy was given extra to stop bleeding. Do you have any thoughts or a direction. Thank you.
doctor
Answered by Dr. Indranil Ghosh 3 hours later
Brief Answer:
Probability of cancer very low

Detailed Answer:
Hi
Thanks for your query.

Considering that PET and biopsy are both negative, probability of cancer is very low.

I still feel that these are benign lesions, may be cysts. AFP is a marker for liver cancer and if it is low then further reassuring.

if you can upload the PET report then I can guide you better.

Hope this helps.
regards
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Indranil Ghosh 22 minutes later
I don't have the PET report however I was shown by the radiologist and no hot spots existed and I was told it was clear. But I also have been told that a PET may not show up primary liver malignancies. Is that the case? Concerning the biopsy the radiologist said since hemangiola was ruled out that he wants to do another biopsy because he is afraid he missed the lesion and only healthy liver tissue was tested by the pathologist.
doctor
Answered by Dr. Indranil Ghosh 43 minutes later
Brief Answer:
repeat may be done for peace of mind

Detailed Answer:
PET also has CT with it so very unlikely that liver cancer will not show up on both CT and PET.

Repeat biopsy may be done if the docs are unsure. But I don't think it is going to show anything.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Indranil Ghosh 1 hour later
So you think it sounds like the three lesions are benign?
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
my guess

Detailed Answer:
As I said earlier, I need at least the PET-CT report to give further opinion but this is my intelligent guess based on what info you have provided.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Indranil Ghosh 5 hours later
I will try to get those reports. This all started with a CT hat a small hospital. I was told after that I had cancer in liver and it started in my colon. The colon oscopy clear. But then they did the PET, biopsy and RBC. Now they say they are not sure. Could the original CT be right and the PET missed malignant liver lesions?
doctor
Answered by Dr. Indranil Ghosh 3 hours later
Brief Answer:
very unlikely

Detailed Answer:
As I said, PET includes CT. So CT at small hospital picking up something which PET-CT will miss is very unlikely.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Indranil Ghosh 3 hours later
The PET scan that was ordered by the gerontologist and oncologist saw the 3 tumors but they did not light up. That is what has me scared because they said some cancers don't always light up in a PET. They do show up in CT but say they didn't light up in PET because it could be a cancer that does not show up in PET. Back to the needle biopsy. I had it 2 weeks ago and was told neg for cancer. Then after my RBC to verify hemangioma I was told by the same radiologist that maybe he didn't get enough tissue. He said he wants to go deeper. He is afraid he missed the tumor. If he was using CT guided biopsy how could he miss it?
doctor
Answered by Dr. Indranil Ghosh 6 hours later
Brief Answer:
ct guided is not 100% accurate

Detailed Answer:
Though we rely a lot on CT guided biopsies and they are mostly accurate, in say 5% cases they may be falsely negative. So even if a biopsy comes back as negative, if clinical suspicion remains we order another biopsy.

So here you will have to rely on the gut feeling of your doc. But I feel probability is low.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 2 days later
Hello, Since we last spoke we heard back from Mayo clinic on a biopsy sample sent to them. They found hepatic adenoma. My question is this. She has three the largest being 2.5 to 3 inches. Can these turn to cancer and what should be the treatment.
Thank you.
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
Need to verify the size

Detailed Answer:
Are you sure the size is in inches and not cm? If it is really inch, then it is like 7.5 cm, quite large. If contraceptive pills were stopped recently then we can wait. Otherwise we should go for elective surgery. Because in large tumours there is risk of bleeding or even cancerous transformation.

But if size 3 cm then we can wait. Risk of any event is low.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 17 minutes later
it is 5.7 cm
doctor
Answered by Dr. Indranil Ghosh 11 minutes later
Brief Answer:
may be observed for some time

Detailed Answer:
If it increases further then should be operated
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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