Liver Resection: Is surgery the only option?

Hi @tearose, welcome to Mayo Clinic Connect. I can understand your reluctance to undergo a major surgery such as a liver resection, given your experience with sepsis from gallbladder removal. You may be interested in reviewing this discussion where members @phillrachel @marybethfly4u @sheikham1 @islandmomma talk about their experience with liver resection related to hemangioma.

- Liver hemangioma/liver resection https://connect.mayoclinic.org/discussion/liver-hemangiomaliver-resection/

I'd also like to bring @tressa and @pkindron into this discussion.

Tearose, have the workups shown whether the lesion is benign or malignant? Have you talked to your health care team about possible localized treatment options? Is the lesion small enough that you could do minimally invasive (laparoscopic) liver surgery?

Hi Colleen. Thank you so much for the reply and reference. I have had many workups; blood tests, MRI, MRCI, liver biopsy, endoscopy/colonoscopy. All in the past two months! I spoke with my doctor again yesterday after I read the posts and asked about other options. The skinny is that they don't know whether this is malignant and couldn't determine from the biopsy what it is. They were thinking that it might be sarcoidosis but the bloodwork didn't support that theory. Given that it's the liver, they want to try and get ahead of whatever it is since the lesion is small enough to be removed (they think) with robotic surgery. I've had a number of false starts with this team, so I reached out to Mayo Clinic to see if they would take my case and they did. I have an appointment with Mayo on Monday and am hoping that they can give me more context around my situation. The good thing is that most of my bloodwork for cancer markers and the liver biopsy results were processed through Mayo Clinic, so they have all of those records.

Funny thing is when I read the liver biopsy report, it said negative for malignancy. That's the piece I don't understand and need another set of eyes on.

Hello @tearose

I am glad to hear that you have an upcoming appointment at Mayo. I can understand your confusion and concern. You certainly have been getting a lot of mixed messages and that does contribute to doubt and confusion.

If you are comfortable sharing more, what symptoms were you having that led the doctors to do these tests?

Thanks, Teresa. So...no symptoms of note. After the sepsis in late 2017, I started to follow up with a gastroenterologist to ensure that the liver enzymes came back into normal range. I also had a ver small cyst on my pancreas. It was very small so no action taken except to monitor. I did start having achiness in my upper mid abdomen but I realized that was happening when I ate lots of white rice and noodles, which I eat often because I love them! Since stepping back from those foods, I am not having that achiness anymore. That was the only thing that resembles a symptom; no weight loss, jaundice, or anything else. I do struggle with fatigue from time to time, but I have a grueling schedule and I am anemic. Since starting telework full time, the fatigue is resolved and I have lots of energy. Nothing else. We found this lesion when I went for the MRI to see if the cyst had grown in March 2020. The cyst was fine, but the lesion has popped up. Another concern is that the lesion wasn’t there in December 2017, so it appears to be growing rather fast. It’s about 4cm by 3 cm currently.

Thanks again.

Hello @tearose,

I am glad to hear that you are relatively symptom-free. I also have pancreatic cysts (many of them) and we watch and wait with those. For several years, MRIs and CT scans also showed what was considered an "Indolent lesion" on the liver. My anxiety goes high with reports like this because I have had three surgeries for a rare form of cancer (carcinoids) in the upper digestive tract. Curious thing is, the indolent liver lesion disappeared when I had the MRI last year. Strange, huh?

I note that you mention that you are anemic. Do your doctors know why you are anemic? I have a friend who was very anemic. All of the iron supplements did nothing for the anemia. She had an upper endoscopy and was found to have celiac disease. Have you been checked for celiac? It might be worth talking with the Mayo doctors regarding that. Here is a link to information about celiac disease from Mayo's website, https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220.

I can see your concern about the growth of the lesion, however. Once again, I'm really glad that you are being seen at Mayo tomorrow. I do hope you will report back and let me know how you are doing.

What Mayo department(s) are your appointments tomorrow?

Hi! Could you describe your symptoms for carcinoid cancer in your upper GI tract?

My appointment is with the gastroenteritis and Hepatology clinic.

@angiev18 There are generally no symptoms for carcinoid cancer in the early stages (as mine were). Carcinoid cancer is usually found when doctors are looking for something else. Mine was discovered through an upper endoscopy.

If you are interested in learning more about carcinoid cancer, here is the Carcinoid Cancer Foundation website where you can learn more, https://www.carcinoid.org/.

I look forward to hearing about your experience at Mayo.

Hi all. Update from @tearose - I had my appointment with two awesome doctors this morning. They were patient and (in my opinion) very thorough. Long story short, they advised against the liver resection surgery because they believed that additional test analysis of the MRCI and biopsy could be conducted to come up with a diagnoses. They did not rule out the surgery, but the thought was, given the size of the lesion and it being only one, the safer thing would be to do some more analysis before going to surgery. I have a follow-up in two weeks (could be less if they get the additional information from the pathologist) to discuss treatment plan forward.