I can do without the excitement...

[LoneNutTheorist]

Howdy all.

I passed my 1 year exam -- but my CAT scan showed a few spots on my liver (looked unchanged or mostly unchanged since last year -- about 4/10 of an inch), so my urologist didn't want to take any chances and he sent me for an MRI.

The MRI results appear to show that one of these is a cyst and that the other is unclear -- it looks like it took on more contrast that a cyst typically would, so I'm off to a gastroenterologist on Monday with my MRI films in hand (picking them up tomorrow) to figure out what this is.

Are there any cases of seminoma bypassing lymph nodes and heading straight for the liver? I'm told that there are a lot of benign liver growths and this could be one. My doctor told me not to be too concerned but that I should definitely follow up based on the history of TC. I've read that TC can spread to the liver but I always thought it tended to move thru the lymph nodes first.

Anyway, hope all is well with everyone.

LoneNut

[LoneNutTheorist]

Here's what my MRI is saying:

two lesions are confirmed in the right lobe of the liver. they are unchanged in size compared to the previous ct scan (taken in july). the inferior lesion demonstrates minimal to no initial enhancement and on a delayed sequence demonstrates some peripheral enhancement, this is not the typical appearance of a hepatic hemangioma.

the superior right lobe lesion does not enhance ad is consistent with a cyst.

the kidneys, adrenal glands and spleen are normal. the gallbladder is identified. there is no retroperitoneal adenopathy.

impression:
1) two lesions within the right lobe of the liver are unchanged in size compared to the previous study
2) the superior lesion is a cyst
3) the inferior lesion demonstrates enhancement not typical of a hepatic hemangioma. distinction between benign and neoplastic etiologies cannot be made, stability and size suggests benign lesion, however, recommend clinical correlation and follow-up.

[MRM]

I can't offer any expert opinion but spread to the liver without involving the lymph nodes or chest would be rare, at least.

You might want to join and post this to question to TC-Net at http://tcrc.acor.org/tc-net.html. It's an e-mail support list operated by the Testicular Cancer Resource Center and has a lot of expert advice from TC survivors.

Let us know what happens.

[LoneNutTheorist]

I'm just waiting for the consultation with a gastroenterologist on Monday. Not much else I can do until then. The more I read about it the more I don't know what to think. Hopefully it will just turn out to be some kind of benign mass.

[Scott]

I hope this turns out to be something completely unrelated to your cancer, but if it comes to it, I'm told Sloan is especially good with liver metastases.

[dadmo]

LoneNutTheorist:
Scott is right about Sloan and since you live in Butler NJ you can be there in less then an hour. If you need it I can take you.

[LoneNutTheorist]

Thanks for the info and the offer.

I'm gonna hang tight until my appointment. I do know the mass is small (4/10 of an inch according to my doctor) and stable in size since June (i should have them compare to my cat scans from last year, no?? -- i think i will call the imaging center tomorrow -- they are open saturdays).

I posted on the email list, and so far the responses are that liver mets without any spread to nodes or lungs would be pretty rare.

Part of my liver was within my radiated field, so it would be interesting to see if the mass was on my pre-radiation/mapping cat scans. I called my radio-oncologist and left a message and now I know another question to ask him.

I had complete bloodwork done for work not too long ago, and nothing came up weird there either.

So I'm hoping it will be something relatively minor. But as you can see I'm up and not sleeping. I'll let you know what the dr. says.

Thanks!

LoneNut/Jason

[Karen]

Jason,
Waiting is torture . All previous scans should be re-examined. With clean bloodwork and no change in size, my money is on something benign and unrelated. I hope you can sleep so you'll be alert enough to ask lots of questions Monday. Good luck!!!

[LoneNutTheorist]

Today was kind of a waste. The gastroenterologist told me he couldn't read MRIs and also that TC was beyond his expertise.

He asked me to make an appointment with the oncologist I consulted with before choosing radiation. So I made an appointment for Wednesday.

He did tell me that MRIs sometimes are not of sufficient resolution to 100% identify a hemangioma. I will probably end up with a PET scan, or possibly a red blood cell scan to determine if that's all it is.

[Karen]

Sorry you have to wait another 2 days for answers. I hate that. The PET sounds like a darn good idea to me....maybe you should insist on one? What onc did you consult with? Hang in there, LNT!

[LoneNutTheorist]

Sorry you have to wait another 2 days for answers. I hate that. The PET sounds like a darn good idea to me....maybe you should insist on one? What onc did you consult with? Hang in there, LNT!

Just an update on my situation:

I went to the oncologist yesterday (dr. martin frank). They took blood and he said that while a met to the liver would be exceedingly rare, it would be foolish to not look more closely. He referred my MRI results to a team of radiologists.

I will find out what they say tomorrow. I may need a PET scan or red blood cell scan to determine what this mass on my liver is.

It looks like the mass is the same size or only very slightly larger than it was 15 months ago. (all of the prior cat scan results said it was a hemangioma).

Question: if this was cancer, wouldn't it have grown by more than a miniscule amount in 15 months?

[IowaBrian]

Just my .02 I read a lot of medical records in my line of work and the first Rad report doesn't seem to really alarm me that much. If they can't tell they always put clinical visit needed to determine. Don't be too worried but also if they don't know after the team takes a look at it then maybe a call to Sloan is in order. They may also want a new scan like you have stated to see if what they are seeing is anything to worry about or just normal (well as normal can be in all of our cases). Also I bet Sloan will want you scanned on their machine if you go even if you just had a scan I see a lot of that doctors love certain machines over others. Good luck
Brian

[Karen]

LNT,
I would certianly think something that stable would not be cancer. Agree with Brian that if they're still scratching their heads a Sloan field trip may be a darn good idea. Hope tomorrow gives you good news!!!

[LoneNutTheorist]

Doc says he and the head radiologist both reviewed my MRIs and that they were left "unimpressed" (his odd choice of words) that it was malignant. He said that my bloodwork came back normal (even before the i/o it was normal), but still recommended I go for a PET scan on Wednesday to get a better look at it. If it looks suspicious, they would consider doing a biopsy. If it exhibits characteristics of a benign mass I'd be on my merry way until the next checkup.

Do you think I should stay the course with this Dr. until I get the PET results, or do you think I should start calling sloan already? It sounds like he's leaning in the benign direction (and says that he's not really heard of TC bypassing every lymph node, lungs and other organs and just appearing on the liver) but wants to do the PET scan to cover his butt.

[mk6439]

I think I would call Sloan if I were you. Maybe they'll be willing to do a phone consult with you to give you some assurance that your onc is heading in the right direction.