Ultrasound Shadows: Are They Signs of Liver Cancer?

Ultrasound shadowing

Hello, I would like to ask about a shadow measuring 1.64 cm in size found in the S5/S6 region during an ultrasound examination in May.
The doctor arranged for a CT scan, but nothing was visible.
In September, a follow-up ultrasound showed that the shadow had grown to 2 cm, and blood tests returned normal results.
Could this indicate liver cancer? Thank you!

Lan, 50~59 year old female. Ask Date: 2022/09/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

Further confirmation of the diagnosis should be done in collaboration with a specialized hepatocellular carcinoma physician.

Reply Date: 2022/09/19

More Info

When it comes to the presence of a shadow or lesion in the liver detected by ultrasound, it is essential to approach the situation with caution and a thorough understanding of the potential implications. The fact that you had a 1.64 cm shadow in May that grew to 2 cm by September raises some concerns, but it does not automatically indicate liver cancer.
Ultrasound is a useful tool for initial assessments of liver lesions, but it has limitations. The characteristics of the shadow, such as its size, shape, and echogenicity (how it reflects sound waves), can provide clues about its nature. For instance, benign lesions like hemangiomas or focal nodular hyperplasia often have distinct ultrasound features that can help differentiate them from malignant tumors. However, not all lesions can be definitively characterized by ultrasound alone.

The fact that a CT scan was performed and did not reveal any abnormalities is somewhat reassuring, but it does not rule out the possibility of a malignant process entirely. CT scans are more sensitive than ultrasounds for detecting certain types of liver lesions, but they can still miss small or atypical tumors. It is also important to note that liver cancer can sometimes present as a subtle change in the liver's appearance rather than a distinct mass.

The normal blood tests you mentioned, particularly liver function tests and tumor markers like alpha-fetoprotein (AFP), are also encouraging. Normal results in these tests can suggest that there is no active liver disease or malignancy at this time, but they are not definitive. Some liver cancers may not produce elevated AFP levels, especially in the early stages.

In your case, the increase in size of the lesion is a significant factor that warrants further investigation. While benign lesions can grow, a change in size, especially in a relatively short period, raises the suspicion of malignancy. It is crucial to follow up with your healthcare provider for additional imaging studies or possibly a biopsy if indicated. A biopsy can provide a definitive diagnosis by allowing pathologists to examine the tissue directly.

In summary, while the presence of a shadow in the liver can be concerning, it does not automatically mean liver cancer. The combination of imaging studies, blood tests, and clinical evaluation will guide the diagnosis. It is essential to maintain open communication with your healthcare team, follow their recommendations for further testing, and discuss any concerns you may have. Early detection and diagnosis are key in managing liver lesions effectively, whether they are benign or malignant.

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