Liver spot seen on CT...Should I be concerned??

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Bina
Posts: 16
Joined: Mon Oct 09, 2017 3:31 pm

Re: Liver spot seen on CT...Should I be concerned??

Postby Bina » Wed Oct 11, 2017 1:25 pm

This whole thing about liver lesions is really confusing to me. My previous liver MRI said the following:

MRI done on 1/16:
Hepatic segment 5 simple cyst measuring 0.5
cm. Hepatic segment 8 cyst measuring 0.4 cm. No suspicious hepatic lesions
identified. No biliary ductal dilatation.

If they identified them as cysts, that means that they were pretty sure right?

and then my CT scan from 9/16:
HEPATOBILIARY: Now apparent mild hepatic steatosis. Unchanged
too small to characterize subcentimeter hypodense liver lesion, probably
cyst.

and the most recent CT scan from 10/17:
HEPATOBILIARY: Fatty liver. Tiny low-density too small to characterize in segment 8 is unchanged. A tiny low density in segment 7 is not visible on prior cross sectional imaging.

How come the other spots were deemed cysts, but they didn't write anything about this new one? I guess they have to watch it over a few months to be able to say it's a cyst (if in fact it is a cyst)?
1/16- DX w/ Stage 3A CC @ 26 F; surgery & treatment@MSK
2/16- Colon resection; 2/19 positive LN
3/16-8/16- FOLFOX/FLOX
8/16- Dad diagnosed w/ Stage 2A (surgery only); Shock & confusion; genetics testing: negative for Lynch & no genetic connection found
9/16- Clear CT/colonoscopy
10/17- New spot on liver seen on CT scan; 1.0 CEA
11/17- Follow up MRI; 2 subcentimeter spots; too small to characterize; "suggestive of cysts"; plan is to wait & scan again in Feb

mpbser
Posts: 312
Joined: Wed Apr 19, 2017 11:52 am

Re: Liver spot seen on CT...Should I be concerned??

Postby mpbser » Wed Oct 11, 2017 3:16 pm

Because we know one of the two masses are definitely cancerous, the plan is for resection after 4 rounds of chemo. The surgeon says that they could shrink enough to be candidates for ablation but husband and I actually just spoke about that today as may not be a great idea if we want to know the histopathology of the tumor #2.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm width T1 N0
CEA: 1.4 Pre-op; 2.1 2 days Post-op
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal expression of MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53

mpbser
Posts: 312
Joined: Wed Apr 19, 2017 11:52 am

Re: Liver spot seen on CT...Should I be concerned??

Postby mpbser » Wed Oct 11, 2017 3:39 pm

Bina,

I think that whether a mass is cyst compared to a tumor, etc., depends on different properties that they show on the images. It gets pretty technical, from what I have read, and whether the "impression" of the radiologist is accurate or not depends on their level of skill and experience. I encourage anyone who has questions about their scan results to get a second opinion from Mass General Hospital. You don't have to go to Boston for this. see http://www.massgeneral.org/imaging/serv ... inion.aspx
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm width T1 N0
CEA: 1.4 Pre-op; 2.1 2 days Post-op
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal expression of MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53

User avatar
CRguy
Posts: 9323
Joined: Sun Feb 10, 2008 6:00 pm

Re: Liver spot seen on CT...Should I be concerned??

Postby CRguy » Wed Oct 11, 2017 7:38 pm

mpbser wrote:Bina,
I think that whether a mass is cyst compared to a tumor, etc., depends on different properties that they show on the images. It gets pretty technical, from what I have read, and whether the "impression" of the radiologist is accurate or not depends on their level of skill and experience. I encourage anyone who has questions about their scan results to get a second opinion from Mass General Hospital. You don't have to go to Boston for this. see http://www.massgeneral.org/imaging/serv ... inion.aspx

AND just to add on here :
It also has 100% to do with the RIGHT folks, choosing the RIGHT imaging modality ...
in order to get the RIGHT results for your individual situation !!!!!

experience and pro-activity are REQUIRED
BUTT ...... getting the RIGHT information, upon which the Docs base their decisions is = ABSOLUTE !

More imaging and more "eyes on my SitRep" = why I am here now !

WORD... !!!!! :mrgreen:
Best wishes
CRguy

(( addendum :
I have been taking and reviewing xrays, ultrasounds, CTs, PET scans and MRIs for my patients for the past 36 years ....
AS well as being a patient having all of those ...done on ME :shock: for the past 10+ years
EVERY imaging modality has its strengths and weaknesses
the RIGHT Docs will choose the best imaging and then proceed. IF there are inconsistencies or irregularities, they need to get more info.
IF they do NOT ..... get another Doc. ))
Caregiver x 3
Stage IV A rectal cancer/lung met
10 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Bina
Posts: 16
Joined: Mon Oct 09, 2017 3:31 pm

Re: Liver spot seen on CT...Should I be concerned??

Postby Bina » Wed Nov 01, 2017 3:55 pm

Just did an MRI yesterday.. results tomorrow... so nervous and having scanxiety to the max!
1/16- DX w/ Stage 3A CC @ 26 F; surgery & treatment@MSK
2/16- Colon resection; 2/19 positive LN
3/16-8/16- FOLFOX/FLOX
8/16- Dad diagnosed w/ Stage 2A (surgery only); Shock & confusion; genetics testing: negative for Lynch & no genetic connection found
9/16- Clear CT/colonoscopy
10/17- New spot on liver seen on CT scan; 1.0 CEA
11/17- Follow up MRI; 2 subcentimeter spots; too small to characterize; "suggestive of cysts"; plan is to wait & scan again in Feb

User avatar
susie0915
Posts: 544
Joined: Wed Aug 02, 2017 8:17 am
Facebook Username: Susan DeGrazia Hostetter
Location: Michigan

Re: Liver spot seen on CT...Should I be concerned??

Postby susie0915 » Wed Nov 01, 2017 6:13 pm

Good luck. I will pray everything is fine
58 yr old mother of 3 Dx @ 55
5/15 DX T3N0MO/ 2A
6/15 5 wks of chemo/rad
7/15 sigmoidoscopy/scar tissue left
8/15 Pet scan NED
9/15 LAR
0/24 nodes
10/15 Bowel blockage. 3 1/2 weeks in hospital,early ileo rev, c-diff inf :(
12/15 6 rds of xelox
5/16 Clear CT lung scarring/inflammation
9/16 clear colonoscopy
4/17 CT 4mm lung nod onc thinks scar tissue
monitored for autoimmune disorder/interstitial lung disease
7/17 no change lung nodule
10/17 Clear CT
11/17 CEA<.5

menreeq
Posts: 41
Joined: Fri Jun 30, 2017 10:26 am

Re: Liver spot seen on CT...Should I be concerned??

Postby menreeq » Wed Nov 01, 2017 7:27 pm

Don't want to get too technical but CT and MRI are different modalities with different strengths and weaknesses. MRI sequences can characterize soft tissue in ways that CT cannot. Things that are "low density" on CT can be confirmed to be cysts on MRI (with some exceptions). Smaller than 1 cm, it can still be "nonspecific." CT imaging can be acquired at sub millimeter thickness and MRI usually cannot (in practical terms). Anything less than 10 mm on a CT is technically too small to characterize, but statistically they are usually cysts. PET scan usually needs something to be 8 mm or larger (there are exceptions).

Some things have to be watched over time. I don't like it either. I wish I could know everything now.

When it comes to imaging, each modality has a role to play. One is not better than another at everything. And sometimes you need all of them put together to make sense of it all. And then other times you have all that and you still have to just follow up over time.

Hoping they are simple benign cysts and will be nothing to worry about!
Stage IIA rectosigmoid CC (T3N0M0)
Dx 6/5/17 @age 41, mom to 5 & 2yo girls
Workup: c-scope, EUS, rectal MRI, CT C/A/P
AdenoCA 5.5cm, WHO Grade 2, 0/22 LN, no distant mets
CEA 1.9 (6/5/17)
No lymphovasc/perineural invasion, clear margins
MSI intact, OncotypeDx RS 7
Lap sig colectomy 6/23/17, no ileo/colostomy
Genetics counseling negative for mutations, 4 VUS
Started Xeloda monotherapy 8/13/17

Bina
Posts: 16
Joined: Mon Oct 09, 2017 3:31 pm

Re: Liver spot seen on CT...Should I be concerned??

Postby Bina » Fri Nov 03, 2017 8:54 am

OKAY, results are in!

"Punctate 2 mm hyperintense T2 foci are seen within hepatic segment 7 and 8 corresponding to low density lesions on prior CT exam. Lesions are much too small to characterize, however are suggestive of small cysts. Continued follow up can be obtained. No enhancing hepatic mass."

Doctor didn't say much except "just go enjoy your day" and when I asked him if he would recommend a follow up he said just because I'm young he would do a CT scan in 6 months.

I feel a lot better about this MRI report.. any thoughts??
1/16- DX w/ Stage 3A CC @ 26 F; surgery & treatment@MSK
2/16- Colon resection; 2/19 positive LN
3/16-8/16- FOLFOX/FLOX
8/16- Dad diagnosed w/ Stage 2A (surgery only); Shock & confusion; genetics testing: negative for Lynch & no genetic connection found
9/16- Clear CT/colonoscopy
10/17- New spot on liver seen on CT scan; 1.0 CEA
11/17- Follow up MRI; 2 subcentimeter spots; too small to characterize; "suggestive of cysts"; plan is to wait & scan again in Feb

mpbser
Posts: 312
Joined: Wed Apr 19, 2017 11:52 am

Re: Liver spot seen on CT...Should I be concerned??

Postby mpbser » Fri Nov 03, 2017 9:32 am

Just to chime in again.... Every liver surgeon my husband and I have spoken to prefers MRIs. I've done some reading on the topic and it appears to be the gold standard for liver examination.

On another thread, (or here... I can't recall) none of my husband's CT scans picked up anything on his liver but he has two liver masses (one cancerous and the other likely a cyst) so we will be monitoring via MRI.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm width T1 N0
CEA: 1.4 Pre-op; 2.1 2 days Post-op
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal expression of MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53

menreeq
Posts: 41
Joined: Fri Jun 30, 2017 10:26 am

Re: Liver spot seen on CT...Should I be concerned??

Postby menreeq » Sun Nov 05, 2017 5:48 pm

Liver protocol CT and MRI have different strengths and weaknesses. Feel reassured that a CT in 6 months will have higher spatial resolution than MRI and can thus evaluate change in size a bit better.

If you ever have questions, you could discuss it with the radiologist. I defer surgical decisions to the surgeons, chemo decisions to the oncologist, radiation decisions to the radiation oncologist and imaging decisions to the radiologist. Although the radiologist is a bit less accessible, they do still practice direct patient care.

I think your MRI report is reassuring and it's time for a glass of wine!
Stage IIA rectosigmoid CC (T3N0M0)
Dx 6/5/17 @age 41, mom to 5 & 2yo girls
Workup: c-scope, EUS, rectal MRI, CT C/A/P
AdenoCA 5.5cm, WHO Grade 2, 0/22 LN, no distant mets
CEA 1.9 (6/5/17)
No lymphovasc/perineural invasion, clear margins
MSI intact, OncotypeDx RS 7
Lap sig colectomy 6/23/17, no ileo/colostomy
Genetics counseling negative for mutations, 4 VUS
Started Xeloda monotherapy 8/13/17

menreeq
Posts: 41
Joined: Fri Jun 30, 2017 10:26 am

Re: Liver spot seen on CT...Should I be concerned??

Postby menreeq » Sun Nov 05, 2017 6:00 pm

CRguy wrote:
(( addendum :
I have been taking and reviewing xrays, ultrasounds, CTs, PET scans and MRIs for my patients for the past 36 years ....
AS well as being a patient having all of those ...done on ME :shock: for the past 10+ years
EVERY imaging modality has its strengths and weaknesses
the RIGHT Docs will choose the best imaging and then proceed. IF there are inconsistencies or irregularities, they need to get more info.
IF they do NOT ..... get another Doc. ))


CRguy, what is your background that you have been reviewing all these modalities for decades? I am curious!
Stage IIA rectosigmoid CC (T3N0M0)
Dx 6/5/17 @age 41, mom to 5 & 2yo girls
Workup: c-scope, EUS, rectal MRI, CT C/A/P
AdenoCA 5.5cm, WHO Grade 2, 0/22 LN, no distant mets
CEA 1.9 (6/5/17)
No lymphovasc/perineural invasion, clear margins
MSI intact, OncotypeDx RS 7
Lap sig colectomy 6/23/17, no ileo/colostomy
Genetics counseling negative for mutations, 4 VUS
Started Xeloda monotherapy 8/13/17

User avatar
CRguy
Posts: 9323
Joined: Sun Feb 10, 2008 6:00 pm

Re: Liver spot seen on CT...Should I be concerned??

Postby CRguy » Sun Nov 05, 2017 8:19 pm

I am a veterinarian ( canine/feline only ), certified acupuncturist, TCM herbal medicine training, science geek/nerd :shock:
and professional CRC patient :twisted:

Cheers :mrgreen:
CR
Caregiver x 3
Stage IV A rectal cancer/lung met
10 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

menreeq
Posts: 41
Joined: Fri Jun 30, 2017 10:26 am

Re: Liver spot seen on CT...Should I be concerned??

Postby menreeq » Sun Nov 05, 2017 9:03 pm

CRguy, I recall you said you were a vet in reply to one of my posts. What an interesting background in addition! I love reading your posts. When I get scared, I come on the forum to not feel alone.
Stage IIA rectosigmoid CC (T3N0M0)
Dx 6/5/17 @age 41, mom to 5 & 2yo girls
Workup: c-scope, EUS, rectal MRI, CT C/A/P
AdenoCA 5.5cm, WHO Grade 2, 0/22 LN, no distant mets
CEA 1.9 (6/5/17)
No lymphovasc/perineural invasion, clear margins
MSI intact, OncotypeDx RS 7
Lap sig colectomy 6/23/17, no ileo/colostomy
Genetics counseling negative for mutations, 4 VUS
Started Xeloda monotherapy 8/13/17

Bina
Posts: 16
Joined: Mon Oct 09, 2017 3:31 pm

Re: Liver spot seen on CT...Should I be concerned??

Postby Bina » Wed Nov 08, 2017 7:18 pm

This might sound silly, but if on my CT scan report it says "resolution of right ovarian cyst," does that mean that the cyst is no longer there?
1/16- DX w/ Stage 3A CC @ 26 F; surgery & treatment@MSK
2/16- Colon resection; 2/19 positive LN
3/16-8/16- FOLFOX/FLOX
8/16- Dad diagnosed w/ Stage 2A (surgery only); Shock & confusion; genetics testing: negative for Lynch & no genetic connection found
9/16- Clear CT/colonoscopy
10/17- New spot on liver seen on CT scan; 1.0 CEA
11/17- Follow up MRI; 2 subcentimeter spots; too small to characterize; "suggestive of cysts"; plan is to wait & scan again in Feb

User avatar
Robino1
Posts: 220
Joined: Fri Aug 11, 2017 12:09 pm
Facebook Username: Robin.lawthers
Location: Florida

Re: Liver spot seen on CT...Should I be concerned??

Postby Robino1 » Wed Nov 08, 2017 8:17 pm

Bina wrote:This might sound silly, but if on my CT scan report it says "resolution of right ovarian cyst," does that mean that the cyst is no longer there?

From the web: Complete Response (CR): The complete resolution or disappearance of targeted cancerous lesions, through treatment.

Sounds like it went away. If I'm wrong, someone will come along and correct me :)
At 54 2014 1st colonoscopy colon cancer detected.
Colon resect right ascending
margins clear. No chemo Stage II
2017
Distended abd, pain in intestines.
CT scan shows seeding
Ascites
Lap diag - cancer on the omentum
CEA 217
CEA 219
PET cancer on the omentum, susp activ right abdomen
FOLFOX started 6/17
CEA 202
Not genetic
8/29/17 CT scan showed excellent melting of the tumor. Chemo is working!
Ascites is gone
CEA: 9/30/17 -109; 10/12/17 - 99.1; 11/4/17 - 90.7; 11/30/17 - 70.7
BRAF V600e mutation :(


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