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.
