Liver Hemangiomas: Monitoring, Risks, and Insurance Implications

Hepatic hemangioma

Hello Dr.
Chen, I had an abdominal ultrasound in 2003 that revealed a 1 cm hepatic hemangioma, which increased to 1.5 cm last year.
I would like to ask the following questions:
1.
Besides abdominal ultrasound, should I also have blood tests for Hepatitis B, Hepatitis C, and alpha-fetoprotein (AFP) for monitoring the hepatic hemangioma?
2.
How long should the hepatic hemangioma be monitored? I am interested in purchasing a savings life insurance policy (not a medical insurance), but I was denied coverage after disclosing the 1.5 cm hepatic hemangioma when they requested my medical records from the hospital.
When I switched to accident insurance, the insurance agent asked me to sign a statement on the tumor questionnaire stating that no follow-up treatment is needed and that I am currently cured, and they will send the information to the life insurance association to establish a computer link.
Is there a risk of fatality associated with hepatic hemangiomas?
3.
Can a hepatic hemangioma rupture and bleed on its own without any trauma? Is there a possibility of it transforming into a malignant tumor?
4.
Can an abdominal ultrasound and a colonoscopy be scheduled on the same day?
5.
For the diet two days prior to the colonoscopy, I am advised not to consume tofu or milk.
Can I have soy milk or Yakult instead?
I apologize for the many questions… Thank you!

Nanxi, 40~49 year old female. Ask Date: 2009/07/29

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello,
1.
Hepatic hemangiomas typically present differently on abdominal ultrasound compared to liver cancer.
If there are concerns, testing for hepatitis B and C, as well as alpha-fetoprotein, is reasonable.
Once it is confirmed that there is no hepatitis B or C, it is not necessary to perform blood tests at every follow-up.
2.
Hepatic hemangiomas are mostly congenital benign tumors; generally, they do not grow significantly.
Follow-up every 3 to 6 months is advisable, and if there are no major changes after several evaluations, continuous monitoring of the hemangioma may not be essential.
The increase from 1 cm to 1.5 cm could be due to measurement angle variations.
3.
Small hepatic hemangiomas are unlikely to cause bleeding.
Larger hemangiomas may bleed spontaneously, but this is rare.
Malignant hepatic hemangiomas are extremely uncommon, and the transformation from benign to malignant is even rarer.
4.
An abdominal ultrasound can be scheduled on the same day as a colonoscopy, depending on the hospital's scheduling convenience.
5.
The colonoscopy preparation primarily involves a clear liquid diet; tofu and milk should be avoided, while soy milk and yogurt are generally acceptable.
Wishing you good health,
Dr.
Chi-Feng Chen, Taoyuan Hospital, Department of Health

Reply Date: 2009/07/29

More Info

Liver hemangiomas are the most common benign tumors of the liver, typically asymptomatic and often discovered incidentally during imaging studies. Your concerns regarding monitoring, risks, and implications for insurance are valid and important to address.

1. Monitoring and Blood Tests: For liver hemangiomas, routine monitoring typically involves ultrasound imaging. While additional blood tests for hepatitis B and C, as well as alpha-fetoprotein (AFP), can be useful, they are not always necessary unless there are specific concerns about liver function or the presence of other liver diseases. If your hemangioma is stable and you have no risk factors for liver disease, regular ultrasound follow-ups every 6 to 12 months may suffice. However, if there are changes in size or symptoms, further evaluation may be warranted.

2. Duration of Monitoring: The need for ongoing monitoring of liver hemangiomas largely depends on their size and any associated symptoms. In your case, the increase from 1 cm to 1.5 cm is relatively small and may not necessitate immediate concern. Generally, if a hemangioma is stable over several years, the frequency of monitoring can be reduced. Insurance companies often have strict guidelines regarding pre-existing conditions, which can complicate matters when applying for life insurance. While liver hemangiomas are benign and not typically life-threatening, the insurance company may view them as a risk factor, leading to denial of coverage. It is crucial to communicate with your healthcare provider about your condition and obtain documentation that supports the benign nature of your hemangioma.

3. Risk of Rupture and Malignancy: Small liver hemangiomas, such as yours, rarely rupture or bleed unless they are significantly larger (typically over 4 cm) or subjected to trauma. The risk of a hemangioma transforming into a malignant tumor is exceedingly low. Most hemangiomas remain stable and do not pose a significant health risk. However, if there are any sudden changes in symptoms, such as abdominal pain or swelling, it is essential to seek medical attention promptly.

4. Scheduling Imaging Studies: It is generally possible to schedule an abdominal ultrasound and a colonoscopy on the same day, but this depends on the specific protocols of the healthcare facility. It is advisable to discuss this with your healthcare provider or the scheduling department to ensure that both procedures can be accommodated.

5. Dietary Restrictions Before Colonoscopy: Before a colonoscopy, it is essential to follow dietary restrictions to ensure a clear view of the colon. While tofu and milk are typically restricted due to their potential to leave residue, soy milk (豆漿) and probiotic drinks like Yakult (養樂多) are usually acceptable, but it is best to confirm this with your healthcare provider. They can provide specific dietary guidelines tailored to your preparation for the procedure.

In summary, liver hemangiomas are generally benign and require careful monitoring rather than aggressive treatment. Understanding the implications for insurance and maintaining open communication with your healthcare provider can help you navigate these challenges effectively. Always prioritize regular follow-ups and report any new symptoms to ensure your health remains stable.

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