5mm indeterminate lesion in liver

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Mrc40
Posts: 4
Joined: Sun Aug 19, 2018 3:52 pm

5mm indeterminate lesion in liver

Postby Mrc40 » Sun Aug 19, 2018 4:22 pm

Hi folks -

I am new to the club. I was dx after a colonoscopy on 7/23 at 43. A complete surprise to all of us, as I had been training for a significant athletic event. Still training but differently, and hope to compete next year :D

I feel very uneasy about a finding on an MRI. The report reads that a .5 cm indeterminate lesion was found on my liver, conspicuous as hypointense on post-gadolinium images.

Surgery is scheduled for 9/18 at a major world-renown cancer center with a very well-respected surgeon. I was told I could safely delay the surgery until September as I have no symptoms, feel good, and we have to coordinate 2 surgeons (one for resection and one to conduct partial hysterectomy to remove very large fibroid that may would interfere with the resection). We asked this surgeon and his team about the .5 cm indeterminate finding and he did not seem concerned, but we will continue to monitor.

All my other blood work was excellent, CEA 1.2, good counts, etc. No evidence of ascites, adenopathy, or enlarged nodes.

Our second opinion surgeon who we felt uneasy with wanted to “explore” my liver, which sounded very vague and scary. He wasn’t with a major cancer center (although not a small local hospital), and we got a so-so vibe from him so we went elsewhere.

I hate buyers’ remourse, but I have been over-analyzing this. Any thoughts or similar situations? How did it resolve?

Lee
Posts: 5724
Joined: Sun Apr 16, 2006 4:09 pm

Re: 5mm indeterminate lesion in liver

Postby Lee » Mon Aug 20, 2018 6:59 pm

Hi and welcome, so very sorry for the reason you are here.

What is the world renown cancer center. It's okay to say it here. We are all pretty familiar with all the cancer hospital here in the USA. And abroad. We have member in just about all major countries.

Getting a 2nd or even a 3rd opinion is ALWAYS a good idea. And yes, when dealing with a stage IV diagnoses, you really want a major cancer hospital or cancer treatment center. You want a team of aggressive doctors treating you, especially at your young age.

You will find a lot of information and support here. We really do get what you are going through right now. Feel free to vent. Avoid Dr. Google, some of the information out there is out of date or just plain wrong.

Hope this helps,

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

Lee
Posts: 5724
Joined: Sun Apr 16, 2006 4:09 pm

Re: 5mm indeterminate lesion in liver

Postby Lee » Mon Aug 20, 2018 7:28 pm

Mrc40 wrote:Hi folks -

Our second opinion surgeon who we felt uneasy with wanted to “explore” my liver, which sounded very vague and scary. He wasn’t with a major cancer center (although not a small local hospital), and we got a so-so vibe from him so we went elsewhere.

I hate buyers’ remourse, but I have been over-analyzing this. Any thoughts or similar situations? How did it resolve?


Before some doctor want to "explore "your liver, get a PET scan first.

This is not in stone, butt by the fact your CEA is so low, there is a good chance it is not cancer. Generally liver mets tend to increase the CEA numbers. I am not a doctors, and cancer does not follow a rule book, BUTT generally liver mets tend to have higher CEA numbers.

Also "generally", butt again not is stone, when you have a met, you "tend" to have lymph node involvement. Again cancer does not play by a rule book.

Remember, you are not alone here.

Lee
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

Utwo
Posts: 218
Joined: Mon May 23, 2016 10:14 am
Location: T.O.

Re: 5mm indeterminate lesion in liver

Postby Utwo » Mon Aug 20, 2018 8:36 pm

Mrc40 wrote:... a finding on an MRI. The report reads that a .5 cm indeterminate lesion was found on my liver, conspicuous as hypointense on post-gadolinium images.
What else do you have?
E.g. what is your TNM score?

The more CT scans I had the more I learned about "indeterminate" stuff in my liver, kidney, lungs etc.
However this stuff was not an excuse for a new surgery so far.
58 yo male at diagnosis: T1bN0M0, 0/15 nodes, low grade/moderately differentiated adenocarcinoma
03/2016 colonoscopy #1: 2 small polyps removed in left colon; CEA = 1.3
04/2016 colonoscopy #2: caecum sessile 3.5 cm polyp piecemeal removed with kind of clear margins
05/2016 "prophylactic" laparoscopic right hemicolectomy - bleeding, leak, infection
06/2017 CT scan, colonoscopy OK; CEA = 1.6
A lot of funny stuff discovered by CT scans in liver, kidney, lungs, arteries, gallbladder and a lymph node

boxhill
Posts: 122
Joined: Fri Apr 06, 2018 11:40 am

Re: 5mm indeterminate lesion in liver

Postby boxhill » Tue Aug 21, 2018 4:55 am

It's my understanding that the MRI is the best scan for the liver. I gather you've already had that? What led them to order that additional test? Was there some liver anomaly on a CAT scan?

When I had emergency surgery because of blockage, my surgeon found and removed a similarly-sized met on my liver that did NOT show on the pre-op CAT scan. For that reason, my oncologist and I discussed doing a liver MRI. He said that it is increasingly difficult to get insurers to agree to liver MRIs unless there is something on another scan that indicates a possible abnormality. So we decided to proceed with a full set of CAT scans and see what they revealed. (Which, thankfully, was an absence of any signs of cancer.) Which is why I'm curious that you seem to have had one already.

Some more information about your diagnosis would be helpful: where the tumor is, what scans /tests have you had, what is the pre-op TNM, etc.

FWIW, my surgeon--who is a liver surgeon by specialty--said that he removed what turned out to be the met for biopsy because it was tiny and just subcapsular. And. of course, I clearly had colon cancer with lymph node involvement. The potential benefits would far outweigh the risks. As we know, the liver is *generally* the first place colon cancer likes to go. He said that one normally exercises restraint in removing questionable little masses in the liver, because many of them would never trouble the patient, and being needlessly aggressive can have negative results. But the course of action depends on the circumstances.

Oh, and CEA is not a useful marker for the 30% or so of us whose tumors do not express it. I would try to refrain from putting too much emphasis on it until you know more.
F, 64 at DX CRC Stage IV (or "3 1/2" per Dana Farber consult, LOL)
3/17/18 blockage, emergency surgery, r hemicolectomy
11 of 25 nodes
5 of 5 mesentery nodes, matted
0.5 cm sub-capsular liver met removed
pT3 pN2b pM1
Neg CEA, neg BRAF, KRAS G12D, germline mut ATM
dMMR, MSI-H, Neg for Lynch
5/4/18 FOLFOX started
Added Neulasta 6/28/18
7/9/18 CT scans show no masses or enlarged nodes, 2mm indeterminate lung nodule

Mrc40
Posts: 4
Joined: Sun Aug 19, 2018 3:52 pm

Re: 5mm indeterminate lesion in liver

Postby Mrc40 » Tue Aug 21, 2018 6:35 am

At this point neither the surgeon nor the oncologist have wanted to assess a stage to my cancer yet. They both felt it was too soon and that the staging would occur post-operatively once pathology was in.

The MRI was ordered after the CT came back with 2 indeterminate findings. The 2 indeterminate findings were ruled out as a hemangioma and a benign cyst, but a third .5 cm finding was made on the MRI and that was indeterminate. Upon inquiry to the surgeon and the oncologist, neither one seemed very concerned and said we will monitor. Also said it is too small for a PET to be effective.

The surgeon was most concerned about a very large fibroid that is taking up a large part of my abdominal cavity. I always knew about the fibroid but it never bothered me or caused a problem. I don’t plan on having more kids.

I decided to work with the CRC team at MSK. They spent the most time with me deeply explaining everything, and have seen/can coordinate the two surgeries at once. My husband and I felt most at ease there, and we live in the area.

I keep asking about the .5cm finding, and my brain continues to play games with me, but they keep saying they are not concerned and will monitor. I have a pre-surgical appointment 9/5.

boxhill
Posts: 122
Joined: Fri Apr 06, 2018 11:40 am

Re: 5mm indeterminate lesion in liver

Postby boxhill » Tue Aug 21, 2018 2:51 pm

Well, that makes sense. And yeah, they can't accurately stage it until the pathology is done. Sometimes there's a pre-op estimate, but an estimate is what it is. :) I, personally, didn't have one because it was a matter of hours between the cat scan and surgery.

I have to say that there is something to be said for that. No time for anxiety while still in the you're kidding me, WHAT?!? phase. :)
F, 64 at DX CRC Stage IV (or "3 1/2" per Dana Farber consult, LOL)
3/17/18 blockage, emergency surgery, r hemicolectomy
11 of 25 nodes
5 of 5 mesentery nodes, matted
0.5 cm sub-capsular liver met removed
pT3 pN2b pM1
Neg CEA, neg BRAF, KRAS G12D, germline mut ATM
dMMR, MSI-H, Neg for Lynch
5/4/18 FOLFOX started
Added Neulasta 6/28/18
7/9/18 CT scans show no masses or enlarged nodes, 2mm indeterminate lung nodule

Lee
Posts: 5724
Joined: Sun Apr 16, 2006 4:09 pm

Re: 5mm indeterminate lesion in liver

Postby Lee » Tue Aug 21, 2018 6:50 pm

Mrc40 wrote:. . . . I decided to work with the CRC team at MSK. They spent the most time with me deeply explaining everything, and have seen/can coordinate the two surgeries at once. My husband and I felt most at ease there, and we live in the area.
.


Yes you are in VERY GOOD hands at Memorial Sloan Kettering. That would be my recommendation if you are indeed diagnosed a stage IV. There are many people here who are NED today thanks to the wonderful people at MSK. Many of the people here have traveled great distance for treatment at that hospital. You are very fortunate to be close to it.

And try not to worry about that .5 cm thing! Many years ago, when I was on maintenance care, per a CAT scan, couple of nodes were swollen in my stomach area. Onc stressed not to worry, as she pointed out, I have 2 young kids, one of them probably brought something home and my nodes were doing there job. 6 month later, all was fine. Generally they know when to get concerned.

Good luck with you 9/5 visit, keep us posted.

Lee

P.S. Sorry responding to you while being a family Mom. Anyway, one of the biggest reason my Onc was not worried about the 2 nodes, she was looking at the "whole picture". My blood work was good, I was slooooowly gaining weight. As she put it, you are not a patient fighting cancer. I decided to take her advice.
rectal cancer - April 2004
46 yrs old at diagnoses
stage III C - 6/13 lymph positive
radiation - 6 weeks
surgery - August 2004/hernia repair 2014
permanent colostomy
chemo - FOLFOX
NED - 10 years and counting!

Mrc40
Posts: 4
Joined: Sun Aug 19, 2018 3:52 pm

Re: 5mm indeterminate lesion in liver

Postby Mrc40 » Wed Aug 22, 2018 12:11 am

Thank you all for your insightful answers and feedback! I’m going to sit tight and hug my family and dog!! While I have a pretty clear picture now, I hope to know more by 9/5.

Mrc40
Posts: 4
Joined: Sun Aug 19, 2018 3:52 pm

Re: 5mm indeterminate lesion in liver

Postby Mrc40 » Wed Sep 05, 2018 7:29 pm

Hi Folks -

Just following up. A good visit with Drs. Garcia-Aguilar and Broach at MSK (who is handling the partial hysterectomy to take out what appear to be a softball-sized fibroid). The doctors and their respective staffs were incredible, upbeat, and methodical.

I feel fine. My event/strongman training has been toned down, and I’ve converted my training to more off-season/powerlifting splits with overhead work and conditioning. Even still hitting PRs! The only exception is that my pesky fibroid which seems to be acting up more now I realize what’s been poking my ribs for so long - I compared it to the heel of a baby’s foot basically slowly kicking and driving his heel into my ribs (he now is 5 and those little feet are running around).

No word on staging as we need to see pathology and also a very broad genetic panel. Dr. Garcia-Aguilar is also involved in what appears to be an extremely aggressive study on CRCs in younger patients. It gave me a sense of strength and community - to think that previous generations have helped me, and now perhaps I may help the future

Still nervous and worried, but I feel like I am in good hands.


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