Liver Hemangiomas: Should You Seek a Second Opinion?

Hepatic hemangioma

Hello Doctor: In February, I visited the emergency room due to discomfort and unexpectedly discovered a 4 cm hepatic hemangioma.
Since I was unfamiliar with this condition and did not know any doctors, I randomly consulted a hepatobiliary specialist at a large hospital.
My liver function tests (GOT, GPT) and alpha-fetoprotein levels were normal, and I tested negative for hepatitis A, B, and C.
Recently, a CT scan showed that the tumor has not increased in size, but two additional 1 cm tumors were found.
The doctor indicated that these are likely hemangiomas, with a higher probability of being benign than malignant.
However, given my family's history of various cancers, including my father's passing from cancer, I am quite concerned.
Should I seek a second opinion or further evaluation? Thank you.

Isa, 30~39 year old female. Ask Date: 2012/09/10

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello Isa, please rest assured.
The CT scan is quite accurate, but it is essential to follow up on time.
If you are still concerned, a fine needle aspiration biopsy can be performed for pathological examination.
However, this is generally not necessary.
Changhua Hospital cares about your health.
Dr.
Chen Shidian.

Reply Date: 2012/09/10

More Info

When it comes to liver hemangiomas, understanding their nature and the appropriate steps for management is crucial, especially given your family history of cancer and your understandable concerns. Based on the information you provided, it appears that you have been diagnosed with a 4 cm liver hemangioma, along with two additional smaller lesions measuring 1 cm each. Your recent CT scan indicated that these lesions have not changed in size, which is a positive sign.

Liver hemangiomas are the most common benign tumors of the liver and are typically asymptomatic. They are composed of a mass of blood vessels and are usually discovered incidentally during imaging studies for other reasons. The majority of hemangiomas do not require treatment unless they cause symptoms or complications, which is rare. The fact that your liver function tests (GOT, GPT) and tumor markers (such as alpha-fetoprotein) are normal is reassuring, as these tests can help rule out liver dysfunction or malignancy.

Your physician's assessment that the hemangiomas are likely benign and that the probability of malignancy is low is consistent with standard medical practice. In most cases, if the hemangiomas are stable and asymptomatic, they can be monitored with periodic imaging rather than undergoing invasive procedures. The recommendation to follow up with imaging studies, such as ultrasound or CT scans, at regular intervals (often annually) is a common approach.

However, given your family history of cancer, it is entirely reasonable to seek a second opinion, especially if you feel uncertain or anxious about your diagnosis. A second opinion can provide you with additional reassurance or alternative perspectives on your condition. It may also help you understand the rationale behind the management plan proposed by your current physician. When seeking a second opinion, consider consulting with a hepatologist or an oncologist who specializes in liver diseases. They can review your imaging studies, lab results, and medical history to provide a comprehensive assessment.

In addition, if you have any new symptoms, such as abdominal pain, unexplained weight loss, or changes in appetite, it is essential to report these to your healthcare provider, as they may warrant further investigation.
In summary, while the current assessment of your liver hemangiomas suggests a benign nature, your concerns are valid, especially with a family history of cancer. Seeking a second opinion can provide peace of mind and ensure that you are receiving the best possible care. Remember to discuss your concerns openly with your healthcare provider, as they can help guide you through the decision-making process regarding further evaluations or referrals.

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