Could my liver hemangioma actually be liver cancer?

Question

Hello doctor,

I started having right sided pain in the rib area around one year and three months ago. It got really bad last week and I went to a doctor. They did an ultrasound and found several hyperechoic nodular foci on the liver. He said this could simply represent hemangiomas but could be mucinous metastases. I started panicking as I have always had bad health anxiety. I went to get a CT scan and could not do a contrast so found well defined "mildly hypodense mass" measuring 44.6x32.9 mm. I started to get really bad - not sleeping, not eating, losing weight, bad headaches, ringing in ears, muscle twitches, shaking, etc. They scheduled me for biopsy and when I got there the surgeon said they pulled up my old CT from six years ago and the mass had not changed. So, it was most likely hemangioma and not going to do a biopsy.

I still kept on the downward spiral as I did not believe them. I was told an MRI with contrast was the best test for liver lesions so I paid and had that done. Also had a brain MRI done because I thought I definitely had stage 4 cancer. All of this was one year back. MRI showed multiple liver lesions with largest 30.5x23.9 mm. T2 hyperintense and several others. All identified as behaving as hemangiomas and simple cysts. Not being satisfied with that I had a colonoscopy and upper endoscopy done. Both alright. Decided to go to liver specialist and they did another MRI with 9 cc Multihance. Findings were all clear except liver with "multiple lobulated T2 hyperintense hepatic lesions" largest being 3.1x2.5 mm. All consitent with hemangiomas. "No suspicious hepatic lesions".

The specialist also told me if I had stage 4 I would be in very bad shape with no treatment. I started back working out and put all my weight back on up to 200 lbs and feeling better except same pain in right side rib area every day. Got another six month follow up MRI last month and nothing had changed. Last week, I started having pain again in right rib area and started internet searching again and finding most hemangiomas are single not multiple and most metastases are multiple, which mine are. Also that hemangiomas are mostly in women not men. So now I am back to not sleeping, not eating, and feeling like I have some type of stage 4 cancer. Never had any cancer diagnosis though and none in my family. Eat good, worked out twice a day, only drink water, maintain a healthy weight. Even though I know in almost a year and a half with no treatment and stage 4 I would be bad shape or actually dead as the average lifespan of stage 4 metastases without treatment is 8.7 years, but I do not really believe that because they are not oncologists. I looked up and saw that NET's could be slow-growing cancers and maybe I have that. I just need an independent second opinion on what could cause right side pain besides what is showing up in all the tests I have had done. Also if having three MRI's with contrast saying the same thing is specific enough to rule out liver metastases. Online it shows MRI with contrast has a 97 % specificity when done one time so is three times even better to rule it out? Why would a male in great shape otherwise develop hemangiomas throughout the liver? Would a PET scan be better than MRI at this point? Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

Do not worry and do not panic. All your reports (attachment removed to protect patient identity) are pointing towards hemangiomas. It is easy to differentiate between cancer and hemagioma by a radiologist on CT scan, MRI, or ultrasound. Your reports are clearly indicating cystic lesions (hemangiomas).

If these liver lesions were cancerous, usually they will be symptomatic - progressive weight loss, poor appetite, jaundice and deranged liver function tests, sometimes dark urine, etc.

Any cancerous liver lesion will progressively increase in size. Even slow-growing metastatic neuroendocrine in liver is usually stage 4 neuroendocrine tumor.

Your blood report is showing normal liver parameters, CT scan/MRI showing cystic/hemangiomas in liver. Any radiologist can easily differentiate between hemangioma and metastasis. So, your radiologist has mentioned clearly benign cystic lesions.

Also, you have no weight loss, poor appetite, and your liver parameters in blood test are normal. Also, colonoscopy and gastroscopies are normal (there was no need to go for endoscopy).

So, relax and do not worry at all. But keep following up with the hepatologist for these hemangiomas.

Internet search information will confuse you. If any questions, contact me for free for one more time in the next few days.

For further queries consult a medical oncologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-oncologist

Answer 2

Hello,

Welcome back to icliniq.com.

Multiple hemangiomas or large hemangioma can cause abdominal pain and discomfort.

Hemangiomas are more in females that does not mean that they are not in males.

Poor appetite can be due to many reasons even anxiety is one of the causes.

For more information consult a medical oncologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-oncologist

Answer 3

Hemangiomas can some times present with large sized liver. Which can cause pain , fullness and discomfort on the right side of upper abdomen . Even sometimes hemangiomas can increase in size ( yearly 0.1 to 0.3 cm approximately ) , mostly in young people who are less than 30 years of age . For Liver - MRI study is better Diagnostic tool as compared to ultrasound and CT scan . Your reports are showing that there is no suspicious lesion in the liver and the lesions are unchanged hemangiomas when compared to previous reports . Your liver is functioning well as Liver FUnction test is normal . If there would have been any suspected cancerous lesion . It would interfere with liver function and will destroy the Liver in months . Usually suspected Liver lesions ( cancer) can not stay same sized even for few months and they usually produce signs and symptoms eg progressive weight loss , nausea , loss of appetite , jaundice , fatigue even can cause bleeding . Your liver enzymes ALT , AST , alkaline phosphate and all other liver parameters are normal . Your pain can be related to stomach upset , musculoskeletal disorder , anxiety or even due to liver hemangiomas So Don't worry just keep regular follow up with your Hepatologist . He will monitor your Liver regularly Hemangiomas are the most common benign ( non Cancerous ) tumours of liver . Most the of people live with them life long without any kind of intervention

Answer 4

Don't worry about this hepatomegaly ( little large sized liver ) . it is due to burden of hemangioma on liver . Also your liver function test is normal so don't worry Now your liver will be monitored every every 3 to 6 months for any change in size of hemangioma size , liver size . change in the lesions . They will compare always old and new scans . Also your liver function tests will be monitored

Answer 5

Usually small bowel tumours are rare , Anatomically the lumen of small bowel is small as compared to large bowels So these these tumors present with early symptoms and signs . The most common symptoms and signs of small bowel tumors are bowel obstruction , central abdominal pain , abdominal distention , weight loss , recurrent vomiting and constipation There are number of different type of small bowel tumors e.g adenocarcinoma , carcinoid ,GIST , lymphoma ,neuroendocrine tumors . But all of them are rare in clinical practice .Small bowel tumors produce early signs and symptoms as mentioned above Your previous scans have not picked up any small bowel pathology .Usually It is difficult to pick up small bowel tumor or lesion on imaging scans eg CT Scan abdomen or MRI unless its size is large . The tests which can pick up small bowel tumours easily are capsule endoscopy , balloon assisted enteroscopy and C.T enterography Just SIBO positive alone does not justify to go for these tests Usually if small bowel tumors will be left untreated for 3 or 4 months , They will definitely cause obstruction in most of the cases and there is no recommended screening for these tumors in most of the countries SIBO is a common bowel infection , so it needs antibiotics for eradication . Nothing to worry about anything serous

Answer 6

Malignant small bowel tumour if left untreated for long time. It will definitely metastasize to other organs and cause infiltration to near by organs . Even it can will cause bowel obstruction just in few months of appearance So nothing to worry about and don't link your SIBO with small bowel tumour . Cancers have specific presentations and features Your signs and symptoms and radiological findings don't raise suspicious about malignancies Continue treatment for SIBO as prescribed by your doctor .

Could my liver hemangioma actually be liver cancer?

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