[MOL] Secondary Liver Cancer [01701] Medicine On Line


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[MOL] Secondary Liver Cancer



Question on liver metastases:  Please help...I have been trying to access a Liver Disease Forum, but have been unable to.
 
My Dad was diagnosed with liver mets. 2 weeks ago.  This was found 'by accident'.  He had been having fevers, mild jaundice, chills, nausea, loss of appetite etc.  He went for an US and it showed gallstones, but also a 'liver shadow'.  He was admitted to hospital, where a gastroenterology surgeon suspected a liver abscess.  There were no markers in his blood, or any clinical/physical indications that my dad had cancer.  He responded well to antibiotics, his nausea, *very* mild jaundice etc disappeared and he is now very well (just a little tired).  Initially he had a raised bilirubin level which is now normal.  The docs said he had a gallbladder infection (due to stones in the gallbladder) but were worried about the possibility of a liver abscess.
 
Dad had a full CT scan, which indicated their suspicions about the infection were correct (gallbladder wall was slightly thickened and he had multiple stones) but surprisingly it also showed what the surgeon said was 'inoperable liver metastases'.  Apparently the surgeons were as shocked as we were...they feel that the discovery of liver mets. wouldn't have happened if Dad had not had the infection and therefore the CT.  What I would like to know is:
 
a) Dad's LFTs/bloods are normal and he is now asymptomatic.  The surgeon seemed to indicate that the mets. were fairly small but didn't say how many he had.  Surely there is a chance of resection?  There can't be that many mets. if his liver is working perfectly?
 
b) How accurate is CT in distinguishing between benign growths (e.g.. hepatocellular adenomas, hemangiomas, focal nodular hyperplasia etc) and liver mets?  Given the fact that Dad has no other cancer symptoms or blood 'markers' to indicate cancer (plus the primary source is not clear) could benign growths be a possibility?  The surgeon, when I questioned him about this, said that he thought CT was 99% accurate...but he didn't give me any concrete answers and when I raised the questions he said he felt that the radiographers were usually pretty accurate with their diagnosis, but he would check it out again.  I seemed to raise some doubt in his mind but he has not come back with anything else.  Would an MRI be more accurate?  Should Dad have a liver biopsy?
 
c) How can one tell the difference between a metastases and primary liver cancer *just* from a CT? (remember blood tests have indicated nothing).
 
They are referring him to an oncologist, but I want to be able to have accurate info so that I can ask the right questions when he sees him.  We live in the UK, where I'm afraid, as we have a 'National Health Service' money is always a big issue as far as tests and treatments are concerned.  I asked the surgeon if they planned on doing any more tests on Dad (i.e.. to find the primary cancer).  He said 'no' at first, as he said it did not matter.  When I questioned him further about this he agreed with some of my suggestions - i.e.. surely the source *does* matter as far as treatment is concerned?  If he had, for example, colorectal cancer, then I've read that liver mets. are often resectable.  If he had prostate cancer, then a hormone based chemo would help?  If the primary was a germ cell cancer, then isn't a 'cure' a vague possibility? etc.  I may be cynical, but as Dad is 69 years old, (but a very fit and well 69 year old), then he will not be at the top of the list as far as UK National Health Service treatments are concerned.  Surely he should have a biopsy/more investigations?  I fear that they will just leave things as they are, but I'm unhappy with this.  He is my dad and I am prepared to sell my home to help him if it takes money to get better treatment.  Are USA treatments more advanced than in the UK?
 
I know that this is very long and I really apologise for this.  I just want the best for my Dad.  The more info I read on the Net, then the more frustrated I get at the surgeon's lack of concrete answers.  The surgeon seemed pretty grim about the whole thing.  I know liver mets. show advanced disease, but as Dad is very well, then surely there are treatments out there for him?  Maybe the oncologist will be able to help, but until Dad sees him, I am very worried that not enough is being done for him.  Thank you so much for your time.  Ms C King.