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Cancer

Liver Cancer

05/08/2009

Question:

I have been diagnosed with liver cancer. I have been seen by a ARNP and a interventional radiologist. My alpha feta protein test was 529. I had a CT scan which showed NO masses or tumors, followed by a MRI of my liver which showed supposedly 3 masses in segment 2 of my liver and 1 highly vascular tumor in segment 4. The ARNP scheduled a ultrasound of my liver to see if they could do a guided biospy, which showed NO sign of the 4 tumors that showed on the MRI. The technician that did the ultrasound said he had the radiologist on staff take a look at the MRI and he told him that those 4 masses were artifacts. The interventional radiologist stated that I had cancer because the AFP is high and he is convinced that there is 4 masses showing in the MRI. The interventional radiologist wants to treat the supposed tumors with chemoembolization.

I used my own medical insurance and got another MRI of the liver and it doesn`t show any masses. I am scheduled to have the chemoembolization on the tumor in segment 4 next week. Prior to the interventional radiologist injecting the chemo, he is going to peform a angiogram that should highlight the tumor if it is cancerous. How effective is this test? Is it possible to have cancer on the liver just based off the AFP test being so high? Or could it be high because I have hepatitis C? Or could it be high because I could possibly have cirrohsis which has never been confirmed? If you have any recommendations or suggestions of what I should do please let me know. Thank You.

Answer:

Thanks for all this detail. Most patients do not provide the level of information which you have. First, I would highly recommend another scan, such as a biphasic CT. We always use at least 2 different modalities of imaging. I personally prefer CT. A biphasic CT is a different type of CT, not your ordinary one. An AFP of 529 ng/ml would be considered by most, including me, to be HCC, even in the face of HCV. Nonetheless, with HCV, you can run a high AFP. It should be repeated.

If the value is lower, it would be possible, although unlikely, that the elevated AFP could be due to your HCV activity. If the value is higher, I would say that there is little doubt that there is cancer somewhere.

Before any interventional radiologist would do TACE or any other catheter-based treatment to your liver, he/she would obtain a hepatic angiogram. If the tumor(s) are vascular, they will show up as blushes. If the radiologist cannot see blushes, than likely he cannot and will not do TACE, because you need vascular flow to the tumor in order for the technique to work. In theory, the radiologist should look to treat ALL the lesions, especially if they are in the same lobe, at one setting. That is a matter of style.

Your situation is not terribly unique. It seems to me that the right things have been done. Your lesion may be well differentiated, in which case they may be hard to discern from the 'native' liver tissue. Alternatively, you may have a type of HCC that is infiltrative, and in that case, it is very difficult to measure. Best of luck to you.

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Response by:

Steven  M Rudich, MD, PhD, FACS Steven M Rudich, MD, PhD, FACS
Formerly
Professor of Surgery, Director of Liver Transplat and Hepatobiliary Surgery
College of Medicine
University of Cincinnati