Liver Health: Fatty Liver, Tumors, and Cancer Concerns - Gastroenterology and Hepatology

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Liver problems


Hello doctor, I am asking on behalf of my mother.
My mother is 60 years old and has moderate fatty liver disease.
She has been undergoing regular ultrasound examinations every three months for the past few years.
The doctor mentioned that there is a shadow on her liver, which is benign and identified as a lipoma.
However, during today's ultrasound, the doctor noted that the lipoma appeared more pronounced and suddenly asked my mother if she had lost weight.
My mother replied that she had only gained weight.
The doctor then asked if she wanted to undergo a CT scan for a more detailed examination and provided a referral with the note "suspected liver cancer."
I would like to ask:
1.
Can an ultrasound determine if it is a lipoma? How can it be directly identified as a lipoma and deemed benign?
2.
Why did the doctor suddenly order a CT scan with the note "suspected liver cancer" after initially stating it was a lipoma? Why not express the suspicion directly instead of issuing a referral for further examination?
3.
During the ultrasound, I was unclear about the conversation between the doctor and my mother, but I felt confused.
If a CT scan referral is issued with the note "suspected liver cancer," does this imply a strong suspicion of liver cancer, but the doctor prefers not to inform the patient directly?
4.
Is a referral necessary for a CT scan, or can it only be ordered for this specific type of examination?
5.
My mother is scheduled for eye surgery on December 30 to remove a cataract.
Will undergoing a CT scan one week later have any impact?
Thank you for your assistance, doctor.

A, 60~69 year old female. Ask Date: 2022/12/23

Dr. Chen Shidian reply Gastroenterology and Hepatology


The preliminary diagnosis on the examination report is not accurate and will depend on the results of the CT scan.
The examination is unrelated to ophthalmic surgery.

Reply Date: 2022/12/23

More Info


Understanding liver health is crucial, especially when it comes to conditions like fatty liver disease, liver tumors, and the potential for liver cancer. Your concerns regarding your mother's recent ultrasound findings and the subsequent recommendation for a CT scan are valid and warrant a thorough explanation.

1. Ultrasound and Fatty Tumors: Ultrasound is a common imaging technique used to evaluate liver conditions. It can help identify the presence of masses or lesions in the liver. In many cases, a fatty tumor (also known as a lipoma) can appear as a well-defined, hyperechoic (bright) area on an ultrasound. However, while ultrasound can suggest that a mass is likely benign based on its characteristics, it cannot definitively diagnose it. The term "benign" in this context usually means that the mass does not exhibit features typically associated with malignancy, such as irregular borders or internal vascularity. Nevertheless, further imaging, such as a CT scan or MRI, is often recommended to obtain a clearer picture and to rule out any potential malignancy.

2. Suspicion of Liver Cancer: The sudden shift in your mother's diagnosis from a fatty tumor to a suspicion of liver cancer is understandably concerning. Doctors often approach such situations with caution. They may initially describe a mass in benign terms based on ultrasound findings, but if there are changes in size, shape, or other concerning features, they may recommend further imaging to gather more information. The phrase "suspected liver cancer" on the CT scan order does not mean that the doctor is certain of a cancer diagnosis; rather, it indicates that they have identified characteristics that warrant closer examination. This cautious approach allows for a more accurate diagnosis while minimizing unnecessary alarm for the patient.

3. Communication and Diagnosis: It is not uncommon for doctors to withhold definitive statements about a diagnosis until all necessary tests are completed. This is often done to avoid causing undue anxiety or distress to the patient and their family. The healthcare provider may want to ensure that they have all the relevant information before discussing potential outcomes. If the ultrasound findings raised concerns, it is standard practice to follow up with additional imaging to clarify the situation.

4. CT Scan Necessity: A CT scan is a more advanced imaging technique that provides detailed cross-sectional images of the body. It is particularly useful for characterizing liver lesions and can help differentiate between benign and malignant masses. The decision to order a CT scan typically depends on the findings from the ultrasound and the clinical judgment of the physician. If there is any uncertainty regarding the nature of a liver mass, a CT scan is often the next step.

5. Timing of the CT Scan: Regarding your mother's upcoming eye surgery, it is generally safe to undergo a CT scan shortly after another procedure, provided that the healthcare team is aware of her recent surgery. However, it is essential to inform both the ophthalmologist and the physician ordering the CT scan about the timing of these procedures. They can provide guidance on whether any specific precautions or considerations are necessary.

In conclusion, while the prospect of liver cancer is understandably alarming, it is essential to approach the situation with a clear understanding of the diagnostic process. The ultrasound findings, followed by a recommendation for a CT scan, are standard protocols to ensure accurate diagnosis and appropriate management. It is advisable to maintain open communication with your mother's healthcare providers, asking questions and expressing any concerns you may have. This will help ensure that you and your mother are well-informed and can make the best decisions regarding her health moving forward.

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