Is Liver Biopsy absolutely necessary?

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Ronald
Posts: 3
Joined: Sat Nov 21, 2020 6:46 pm

Is Liver Biopsy absolutely necessary?

Postby Ronald » Sat Nov 21, 2020 7:01 pm

Greetings all:
My mother was recently diagnosed with Colon Cancer that has matastized to liver.(by GI and Oncologist) It was primarily based on MRI, CT-Scan, Blood tests that showed positive for Colon Cancer Antigens and symptoms. Colonoscopy discovered a tumor that was determined by Pathology to have Adenoma with High Grade Displasya. Oncologist (and to some degree a Pathologist) explained that malignant cells are likely located deeper in the colon and that being the reason that biopsy did not fully confirm the diagnosis.

Oncologist said that he is 99% sure of the diagnosis but ordered the full PET Scan and the Liver Biopsy to be 100%. Due to potential risks/complications of the Biopsy and no guarantee that it will further confirm anything – is it really necessary? Two other possible options I've read about:
1. when Doctor is positive of the diagnosis – can continue without Biopsy or
2. Repeat Colonoscopy by GI who has special expertise in it.

I plan to schedule with another MD to get a second opinion.
I'd greatly appreciate any input our group members may provide in the meantime.
Last edited by Ronald on Sun Nov 22, 2020 10:40 pm, edited 1 time in total.

stu
Posts: 1396
Joined: Sat Aug 17, 2013 5:46 pm

Re: Is Liver Biopsy absolutely necessary?

Postby stu » Sun Nov 22, 2020 12:52 pm

Hi ,
Are they frightened it’s the wrong chemo for the cell type ?
My mum went straight to chemo without a biopsy but that was a long time ago . They shrank on the CT scan so that kind of confirmed it . She also had lung surgery without a biopsy . The PET scan showed uptake on both so they were happy to proceed.
Take care ,
Stu
Last edited by stu on Tue Nov 24, 2020 12:15 pm, edited 1 time in total.
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

boxhill
Posts: 641
Joined: Fri Apr 06, 2018 11:40 am

Re: Is Liver Biopsy absolutely necessary?

Postby boxhill » Sun Nov 22, 2020 4:46 pm

What is the proposed course of treatment? How big is the suspected liver met, and where in the liver is it? Is there more than one?
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/19 MRI stable/NED
Stop Key
8/20 MRI NED

Rikimaroo
Posts: 324
Joined: Tue Dec 20, 2016 8:48 pm
Location: Florida

Re: Is Liver Biopsy absolutely necessary?

Postby Rikimaroo » Sun Nov 22, 2020 9:39 pm

i had cancer spread to my liver, one solid tumor and never had a biopsy. Went straight to chemo then surgery to remove the tumor from liver.
RC T3N1M0 12/16
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
Port Scheduled for 12/2017, folfox - avastin 12/2017
LAR/Liver Resect 4/2018
Chemo Finish 8/2018
Reversal 10/18
CEA highest 500, lowest .8 throughout process, waiting for latest
Recurrence left vesical/pelvic sidewall - 10/7/2019 resect perm bag,
FolFiri 11/6 - 5 rounds
CEA rise Feb/May 3.7, 8.8, 30, Recurrence in Pelvic
Maintenance Chemo begin 6/3/20 FolFiri

Ronald
Posts: 3
Joined: Sat Nov 21, 2020 6:46 pm

Re: Is Liver Biopsy absolutely necessary?

Postby Ronald » Sun Nov 22, 2020 10:39 pm

Thank you to all who replied. This really helps.

Court: I am not exactly sure on Oncologist exact reasoning. Possibly, there is 1% that it's not cancer(though no other suspicions were announced) and he does not want to start treatment in case it's not..

Rikimaroo: Just to clarify: Did you initially have a Biopsy of the Colon?(show positive for cancer)

boxhill: Oncologist wrote down 8 Choices of Chemo from easiest to toughest. He said it will depend on how aggressive we'd want to go.
1. Capecitabine pills
2. Capecitabine + Avastin
3. Folfox
4. Folfox + Avastin
5. Cape-Ox
6. Cape-Ox +Avastin
7. Folfox1R1

There is more than one liver met. Oncologist said one of them is located on the surface and easy to be accessed by needle biopsy.
Here is what MRI report says:
Multiple peripherally enhancing liver masses with T2 hyperintensity and T1 hypointensity and restricted diffusion, for example:
* Hepatic segment 2/3 measuring 2.8 x 2.3 cm, previously measured 2 x 1.6 cm on prior CT (series 15/34).
* Adjacent hepatic segment 2/3 lesion measuring 1.5 x 0.9 cm, better seen by MRI
* Hepatic segment 4a lesion near the dome measuring 1.2 x 1 cm, previously measured 0.9 x 0.8 cm on prior CT (series 15/19).
* Hepatic segment 7 lesion measuring 1.1 x 0.7 cm, previously measuring 0.7 x 0.6 cm (series 15/29).
* Additional few scattered enhancing lesions with restricted diffusion,

boxhill
Posts: 641
Joined: Fri Apr 06, 2018 11:40 am

Re: Is Liver Biopsy absolutely necessary?

Postby boxhill » Mon Nov 23, 2020 10:40 pm

Well, obviously I'm not a doctor, but...yes, the liver is known to produce non-threatening masses, but from all of the cases I've read about it seems unlikely that her liver would produce that many of that size. Moreover, they appear to be growing. By all means, get a second opinion though. With a needle biopsy there is always the fear of seeding.

How old is your mother? Is she reasonably healthy otherwise? Do you think the onc is hesitating because of her general health?
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/19 MRI stable/NED
Stop Key
8/20 MRI NED

Ronald
Posts: 3
Joined: Sat Nov 21, 2020 6:46 pm

Re: Is Liver Biopsy absolutely necessary?

Postby Ronald » Mon Nov 23, 2020 11:04 pm

boxhill: Thank so much for that input. My mother is 71. She was healthy but got weaker with significant weight loss, edema and GI problems this cancer has brought. It takes her a while to recover from each test/procedure and I am certainly worried of liver biopsy risks. I am guessing doc is just following a standard scheme to have a biopsy to be 100% sure it's cancer. Possibly, also use it for Biomarker testing/Precision Medicine.

Unfortunately, potential Biopsy/it's results and getting 2nd opinion are also further delaying start of the treatment. Hope, our current doc will be open for discussion on this..

stu
Posts: 1396
Joined: Sat Aug 17, 2013 5:46 pm

Re: Is Liver Biopsy absolutely necessary?

Postby stu » Tue Nov 24, 2020 12:14 pm

[quote="stu"]Hi ,
Are they frightened it’s the wrong chemo for the cell type ?
My mum went straight to chemo without a biopsy but that was a long time ago . They shrank on the CT scan so that kind of confirmed it . She also had lung surgery without a biopsy . The PET scan showed uptake on both so they were happy to proceed.
Take care ,
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

stu
Posts: 1396
Joined: Sat Aug 17, 2013 5:46 pm

Re: Is Liver Biopsy absolutely necessary?

Postby stu » Tue Nov 24, 2020 12:20 pm

Hi ,
I also thought it was concern over tumour seeding .
Again no Doctor but we were told it presented as mets given the extent of the spread and the presentation .

All the very best ,
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .


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