Hemangioma or not - Help needed

[Jon Olis]

Hello Everyone,

Just got the results back of my 4 year post chemo CT scan. Was totally expecting a clean report but the Oncologist says the radiologist sees two 1.1-1.2 cm spots on the liver. They are only seen with contrast and nothing is seen without. He says they appear to have a vein structure to them which is not consistent with a cancer tumor and is more consistant with an hemangioma. The only problem with that theory is they were not there in any previous scans. Last scan was 1 year ago and multiple scans were done prior to that. So he tells me not to worry but to be thorough they want to do a PET scan. I agree. If they light up then they'll want to do a biopsy. I'm concerned about that because I've read about trace cells being spread from the biopsy procedure making treatment more difficult.

Of course being the analytical person that I am, I asked him if it was cancer then what. He said in his opinion it is operable. He would recommend 3 months of chemo, surgery, and 3 more months to follow. I know I'm getting a little ahead of myself but I like to be prepared. He also said if it was not operable that he would recommend RFA to get rid of the tumors. RFA to me seems like kind of a last resort as it clouds the area for scans and makes it dificult to see what's going on with scans and is not curative but more a way to buy time.

Brief history. Stage III CC 6/2004. 7 of 16 nodes positive. Folfox 6 months. Clean since then.

Any info anyone can give me would be much appreciated. Some questions that come to mind are...

Do hemangioma's just pop up like this?
Do they visualize normally only with contrast and do cancerous tumors behave differently?
What's the latest thinking as far as biopsy or not and leaving traces of cancer cells?

So not the news I wanted to hear. I'm really trying hard not to freak out too much. I guess I am hoping for the best but planning for the worst. I like to be prepared. And mentally I am totally ready to stomp this thing out if it means chemo, surgery and chemo. I'd prefer not to however.

Thanks everyone,

[NWgirl]

I'm afraid I have nothing to offer - other than CANCER JUST SUCKS!!!!!! I hope it turns out to be nothing. I would be freaking out too. I'm curious to see what people say - as I'm always concerned about these things popping up on my CT scans as well.

[jane]

Hi Jon,
I know how scared you are feeling - been there. At my 2 yr post treatment scan 2" cysts" appeared in my spleen that weren't there before. This was in July 2007. I had a petscan which did not glow at all. All films were reviewed by expert radiologists in Sydney, I also had an ultrasound. They concluded they were PROBABLY benign and in anyone else who hadn't had rectal cancer would not have been investigated further. 2 months later, I had a repeat CT, and ultrasound. No Change. They were put down to being an anomaly and I was discharged back to my own oncologist. CT scan last July showed they had shrunk???? Don't suppose we'll ever know what they were.
Hang in there, yes a petscan is definitely the way to go. I would be doing that asap, hopefully it's nothing - as you say they do not appear as tumours, then you can get back to your "normal" life.
Best wishes,
Jane

[Jon Olis]

I'm afraid I have nothing to offer - other than CANCER JUST SUCKS!!!!!! I hope it turns out to be nothing. I would be freaking out too. I'm curious to see what people say - as I'm always concerned about these things popping up on my CT scans as well.

Thanks Belle.

[Jon Olis]

Hi Jon,
I know how scared you are feeling - been there. At my 2 yr post treatment scan 2" cysts" appeared in my spleen that weren't there before. This was in July 2007. I had a petscan which did not glow at all. All films were reviewed by expert radiologists in Sydney, I also had an ultrasound. They concluded they were PROBABLY benign and in anyone else who hadn't had rectal cancer would not have been investigated further. 2 months later, I had a repeat CT, and ultrasound. No Change. They were put down to being an anomaly and I was discharged back to my own oncologist. CT scan last July showed they had shrunk???? Don't suppose we'll ever know what they were.
Hang in there, yes a petscan is definitely the way to go. I would be doing that asap, hopefully it's nothing - as you say they do not appear as tumours, then you can get back to your "normal" life.
Best wishes,
Jane

Thanks Jane. I certainly hope and pray its nothing. My Onc's office is ordering up the Pet now so I expect it to be very soon. No time like the present right?

[weisssoccermom]

Jon,

My hubby had a CT scan done (not related to cancer at all) and had a liver hemangioma. He had had a CT scan about 18 months before and nothing was there. Yep, I got really nervous in the beginning also - I mean who wouldn't? His dad had had pancreatic cancer that had spread to his liver so naturally I was freaking out. His gastro (he was having digestive problems), GI and the radiologist were just not concerned about it. I have no idea how they can tell the difference between this benign tumor (hemangioma) and a malignant one but they all seemed pretty confident that it was not presenting itself as anything malignant. At my insistence, they did a liver ultrasound and were more confident than before that it was nothing.

I remember someone telling me that one of the reasons we get contrast with our CT scans is to help outline the vascular system. If I am remembering correctly, that would also help to enhance the vascular makeup of this hemangioma. The PET scan sounds like a reasonable next step. Maybe ask if a liver ultrasound would also be warranted but I wouldn't worry too much about it. Yes, there is always a chance of having a recurrence but the odds (at this time - 4 1/2 years from diagnosis) are pretty slim. Hemangiomas are not rare and do occur in people all the time.

As for the biopsy, dont worry about it unless you have to. I really wouldn't be too worried about cells escaping. Here is something I found about that topic and the stats show that the odds of this happening are less than 1/100 of a percent! Yes, a biopsy COULD cause the cancer to escape and travel to other parts of our body, however, I refuse to be that paranoid and think that doctors all over this country who encourage countless number of patients (both with and without cancer) to have biopsies would do so if the risk of peril was really that high.

Q. Is it true that needle biopsies leak lung cancer cells into the bloodstream, spreading cancer throughout the body?

A. ''With any biopsy of any organ, you do loosen some cells, and some do get into the bloodstream, but very rarely do they stick and implant,'' said Dr. David F. Yankelevitz, professor of radiology at NewYork-Presbyterian/Weill Cornell hospital in New York. There is a very low incidence of tumors forming along the track of the needle, he said.

The rates differ among organs, Dr. Yankelevitz said, but for lung cancer, a study was done last year, based on several thousand cases followed over several years in a large cancer database, comparing cases of early-stage lung cancer in which there was a biopsy and cases with no biopsy.

''If you were causing Stage 1 tumors to spread by putting in a needle, you would expect the long-term survival rate would be lower,'' he said, ''but in fact we found no difference at all.''

He added: ''The reason you do a biopsy in the first place is that you don't want to do surgery, sometimes big surgery, for a benign condition. A biopsy can reduce the chance of an operation for someone who doesn't need one, which is a much greater risk.''

Another large 1998 study, by researchers at the University of Alabama, Birmingham, found that in approximately 68,000 needle biopsies, there were eight metastases along the needle track. The review concluded, ''This small risk is random and unavoidable.'' C. CLAIBORNE RAY

[Jon Olis]

Wow, great stuff weisssoccermom . Now that's the type of info I need. I feel much better with this and less scared about a needle biopsy if that ends up being the plan.

Thanks so much

[Gaelen]

Jon, you'll know more after the PET, and I'd actually weigh that test heavier than the results of a liver ultrasound--but the docs used a liver ultrasound to dx me, so there's value in that test, too. I just think a PET is a better imaging system, based on results over time.

And I agree about the needle biopsy...if it *is* cancer, and it's in the liver, bloodstream spread is more likely from the tumor itself than from the needle biopsy.

[garbovatwin]

A hemangioma is a benign tumor that involves blood vessels.

Sounds like you have a sharp eye looking at things with a plan for making sure.

Keep us posted.

jamiana

[Ivona]

When I first diagnosed, I had an abdominal CT scan done. They found 4 'spots' on my liver. Naturally I was freaking out. After the surgery, my surgeon told me they were hemangiomas, and he even took a picture of one during the laparoscopic procedure (he showed it to me). Hemangiomas are basically blood blisters, and he told me they are quite common. Now that I am under the care of an onc, he wants to see these spots more clearly just to make sure (more freaking out on my part). I am having an MRI of my liver next week. Unfortunately we can't get PET's in my province...for some some reason Ontario doesn't cover them.

Good luck and let us know what happens.

[Polarprincess]

did your doctor mention any possibility of it being fatty liver? It can show up as cyst like lesions on the liver. I just mention it because i work in a hospital and cannot count the times people have ended up with this as a dx when "something' suspicious showed up on their scans. My doctor and i just discussed it on monday and how chemo drugs can cause it. My fingers are crossed for you that it turns out to be nothing.. You are already so far out from dx...

[Dori]

Good question about whether hemangiomas can just pop up. I wish I knew the answer.

I was told I had what looked like a hemangioma about halfway through chemo. They did another CT with a special liver protocol (I'm not sure what it's called) and a liver ultrasound, neither of which showed additional cause for concern. I've also had a clear PET/CT scan since then, so I guess what they saw on the scan really wasn't cancer. I don't know if it is related to the hemangioma (or whatever it is), but my liver enzymes are still elevated and now we're trying to figure out the cause.

According to my doc, hemangiomas are not rare, so I think there's an excellent chance that you are okay. I'm really glad you and your doctors are being cautious though.

Good luck,
Dori

[Jon Olis]

did your doctor mention any possibility of it being fatty liver? It can show up as cyst like lesions on the liver. I just mention it because i work in a hospital and cannot count the times people have ended up with this as a dx when "something' suspicious showed up on their scans. My doctor and i just discussed it on monday and how chemo drugs can cause it. My fingers are crossed for you that it turns out to be nothing.. You are already so far out from dx...

Thanks

[Jon Olis]

Good question about whether hemangiomas can just pop up. I wish I knew the answer.

I was told I had what looked like a hemangioma about halfway through chemo. They did another CT with a special liver protocol (I'm not sure what it's called) and a liver ultrasound, neither of which showed additional cause for concern. I've also had a clear PET/CT scan since then, so I guess what they saw on the scan really wasn't cancer. I don't know if it is related to the hemangioma (or whatever it is), but my liver enzymes are still elevated and now we're trying to figure out the cause.

According to my doc, hemangiomas are not rare, so I think there's an excellent chance that you are okay. I'm really glad you and your doctors are being cautious though.

Good luck,
Dori

I'll let them be thorough for sure. Thanks,

[vancouver eve]

My thoughts are with you. I hope the best for you. Keep us posted.