Worried - lesion in liver which is not hemangioma

[I_will_fight]

Hi all,

To say I am scared would be an understatement.
After having undergone surgery and 4 cycles of CAPOX I had a CT scan done in mid november 2020, in this scan they found a lesion in the liver which doctors thought was an hemangioma because of the way it showed up in the CT.

When they checked the pre-surgery CT scan done 6 months earlier (in June 2020) they found the lesion was already there, but for some reason the radiologist had not included it in the report. When they compared both CT scans the lesion was "unchanged" (neither larger nor smaller, even after CAPOX)

So the doctor ordered a liver RMI but which comes back with the following:

"In the perifery of segment VIII a focal lesion of 6mm with mildly irregular morphology, which is slightly hyperdense in T2 and isodense in T1 with no evidence of clear restriction to difusion. In the dynamic analysis there is highlighting in arterial phase and homogeneity in the rest of dynamic phases. Nonspecific characteristics, with no typical hemangioma behaviour, given the clinical context metastasis cannot be ruled out. PET-TC is advised."

I am quite concerned, I know the wording is ambiguous and they say the lesion is "non-specific"... they also make it clear it does not look like an hemangioma.

Do you think the fact that the lesion did not change in 6 months is relevant?

Thank you, BR

[stu]

Hi ,
If I am reading this correctly you have been on chemo between the two scans ?
The positive is that has stayed the same , exactly the same and absolutely nothing else has shown up . So I think that is incredibly positive . I take it they are thinking of removing it ?

Keep the positives at the forefront . It’s solitaire and there are options .
Much love ,
Stu

[roadrunner]

I agree with Stu, and would stress that your doctors’ perspective is crucial here.

As you likely are aware, a very low percentage of TSTC liver lesions are mets, and even lesions classed as “suspicious” TSTC lesions are only mets around a quarter of the time (according to one large study I’ve seen). I think that the extended stability of this finding, including through chemo, further suggests that it is not malignant. And radiologists often are very conservative in the language they use — this one just said a met can’t be ruled out, for example. It also appears a hemangioma can’t be fully ruled out. And, of course, there are other liver lesions that it might be.

However, I am not familiar with all of the terminology your radiologist used, so I can’t really say anything useful about how that evaluation changes the above picture. Your doctors will need to give you that perspective. Good luck!

[I_will_fight]

Hi ,
If I am reading this correctly you have been on chemo between the two scans ?
The positive is that has stayed the same , exactly the same and absolutely nothing else has shown up . So I think that is incredibly positive . I take it they are thinking of removing it ?

Keep the positives at the forefront . It’s solitaire and there are options .
Much love ,
Stu

Thanks Stu, you are reading it correctly, the lession has stayed the same through CAPOX.

I had a word with the oncologist, he checked with another radiologist and they think it is not a meta. They are suggesting take another CT scan in 3 months.

Thanks for the warm words.

Javi

[I_will_fight]

I agree with Stu, and would stress that your doctors’ perspective is crucial here.

As you likely are aware, a very low percentage of TSTC liver lesions are mets, and even lesions classed as “suspicious” TSTC lesions are only mets around a quarter of the time (according to one large study I’ve seen). I think that the extended stability of this finding, including through chemo, further suggests that it is not malignant. And radiologists often are very conservative in the language they use — this one just said a met can’t be ruled out, for example. It also appears a hemangioma can’t be fully ruled out. And, of course, there are other liver lesions that it might be.

However, I am not familiar with all of the terminology your radiologist used, so I can’t really say anything useful about how that evaluation changes the above picture. Your doctors will need to give you that perspective. Good luck!

Thanks a lot roadrunner,

I was not aware of this fact (in fact until now I was not even aware of the acronym TSTC meaning "too small to characterize")... I have googled to see that study you are referring to, is this the one? https://radiologyassistant.nl/abdomen/l ... dentalomas

My oncologist (what a great guy he is) had the images checked by the cancer comitee radiologist and this second radiologist said that his colleague had been very defensive in the wording and the lesion does not look like a metastasis.

The are recommending just having another scan in 3 months.

In the meantime I am thinking to get a Signatera liquid biopsy.

[DBF]

Hi,

I hope it is not a met. I agree with others that it’s a good sign that it didn’t change during the CAPOX course.

I had a similar situation. I was told my liver spot wasn’t a met at first. However, in my case it turned out it was. At first I was scared, but it was just one met in a good spot for resection, so they cut it out. That was in 2013. My liver has been clear since then.

I’m really wishing you all the best. I know the waiting is so nerve wracking.

Donna

[roadrunner]

IwF:

I had used this study as a reference for my comments.

https://pubmed.ncbi.nlm.nih.gov/24866542/

It is, as I recall, at least fairly representative of the general literature on this topic (though of course there are lots of variations). The link you included appears to be a seminar deck, but I seem to recall reviewing it in the past, and my vague recollection is that it was helpful.

Because we cancer patients nowadays get direct access to radiologist and pathologist reports, we are put in a bit of a dilemma: If you don’t research extensively, you have no idea what the report means. However, radiologists and pathologists are not writing for the patient, but instead for the surgeons and/or oncologists, insurers, and the file. So even if you do research, some aspects of tone and motivations can be opaque to us patients, which can lead to misunderstandings and unnecessary anxiety. The doctors whom you talk to—usually surgeons or oncologists—have as part of their job the task of interpreting the sometimes cryptic language of radiologists and pathologists for us. So to me, the best courses are either to ignore the precise wording of the report and just listen to your doctors (there’s a lot of trusting there, though) or to “trust but verify,” which suits my personality—research, then ask your doctors the best questions you can, and reach a degree of comfort based on all that info.

Here, your doctor interpreted the result and language for you, and that was reassuring, which seems to align with the studies/literature. The 3-month scan should also be reassuring—they aren’t worried, but they are being careful. But ultimately, while I think you can be reassured here, your comfort level is up to you.