Liver mets - how to diagnose?

[Jackie07]

Hi,

I am seeing my oncologist Monday the 22nd. What would be a good way to ask about liver mets? Is there an inexpensive test available? Would the blood test reveal anything if cancer has spread to the liver?

My oncologist has already determined that I am hypochondriac. I'd like to figure out a good way to communiate my concerns over the slight irritation below/inside my right rib. There is a slightly painful spot at the bottom of my left ribs also.

My weight has been steady, but I thought I should have gained another 4,5 lbs.

[Rich66]

Note: I'm just a guy trying to sort this stuff out.
A CT scan seems to be in order. I was able to get a breast MRI for my mom by offering to pay out of pocket..the onc did it and it was Medicare approved. You have symptoms and a recurrence history. It shoudl be arguable that it is "medically necessary".

[chrisy]

Hi Jackie,

Unfortunately, there is no cheap and easy way to diagnose liver mets. Standard LFT blood tests are not usually too helpful for that. You can have a liver chock full o'tumors (as I did) and still show normal liver functions in blood tests. Rich is right, you would rule out liver mets with an ultrasound at minimum and/or a CT scan.

Sometimes other types of cancer markers (ca19.9 for pancreatic cancer) will elevate with liver mets but I wouldn't recommend that without other reasons, as it is not really specific and as you know, tumor markers themselves are not always reliable.

Noting your onc-described hypochondriac-ness, don't get all excited about this...but symptomatically, you may not have any symptoms at all or minimum symptoms with liver mets. But likely symptoms would include pain in upper right quadrant of the abdomen, or radiating up to the right shoulder. Another common symptom could be a general digestive complaint. My diagnosis came after tests looking for an answer to a stomach ache (which had by then resolved).

I think pain under the ribs on both sides would not indicate liver problems - if only on the right side maybe, but not on both sides.

You mentioned weight (an area in which I unfortunately have ABUNDANT experience!). I've had pain under both ribs caused by having the waistline on my clothes being too tight! I hate to admit that, but at least it wasn't cancer!

You know the drill, tho. If the symptoms persist over two weeks, you want to discuss it with your doctor...but the symptoms you describe don't fit with what MY experience was.

Have you had recent abdominal scans? If not, maybe that is a way to have the discussion with your onc, just wanting to make sure everything is clear...

[Rich66]

I've seen others post here that ERs are more likely to scan based on a complaint. That's been my experience with my Dad at an ER.

[BonnieR]

Your doctor needs to remember that even hypocondriacs get sick! It's his job to know the difference. As Rich said earlier, it is not without reason that you have concerns. It is probably true for most of us that things we might have dismissed in the past seem more ominous now even though they might prove to be benign. We still want them investigated.

[jml]

i'm assuming your most recent PET scan on 5/8 was clean & no sign of liver mets?
that's certainly a good start!
elevated liver enzymes could be a good indicator, but as Chrissy mentioned, aren't always accurate,
like chrissy, when my liver mets were characterized as "innumerable, immeasureable" my liver enzymes were totally normal & my tm's were only in the 70's.
My 1st liver met was discovered via CT during my primary dx. the next step was a CT guided biopsy.
NOT FUN, but a necessary step to confirm what was seen on the CT was in fact metastatic disease.
i continued to wrestle with liver mets, multiple times, PET scans q12weeks.
Finally had a liver resection in Dec05.
Liver's been NED ever since :)
Oh, & I never "felt" anything that would indicate the mets has progressed/returned/resolved.
Every time I thought I "felt" something, it was actually just gas.

[Bill]

Jackie, you are in our our thoughts and prayers. In my opinion, a person that has been diagnosed with cancer should be a "hypochondriac". You are the only person that knows all of the subtle workings of your body, the aches and pains, etc. The "somethings just not quite right" feeling.

[Jackie07]

Thank you all so much for the valuable points. I think the 'mets' in my liver already got 'dissolved'. Now how about the irritating spot at the joint of my r. shoulder blade? :)

When the huge tumor resided in my brain since childhood started causing symptoms that I could not bear any more, I had to change my primary (who was ready to refer me to a psychiatrist) and then kept pressing on the 2nd primary doctor. It was not until a retired pathologist who was a volunteer at the library where I worked gave me advice - that my 'dizziness' was a serious matter - that I started get serious about my headaches.

Finally I squeezed out a referral to see a neurologist - after seeing a ear, nose, throat doctor, a skin doctgor, and a gynecologist. My jaw dropped when I saw the 'Headache specialist' sign by his door - why hadn't anybody told me there is a specialist for headaches and his name is 'neurologist'?

Then my insurance company ignored my pleas to allow me to have the surgery done by a neurosurgeon at Scott & White. Dr. Charles S. C. Chang had his training from Johns Hopkins and did his residency at Bethesda Naval Hospital (where Presidents go for their annual check) and happened to be an aquaintant of mine. He did a neurological exam on me without an appointment and then told me that we could wait, though not very long.
It took a maverick boss of mine who had legal office experience to get my special contract done. Then the surgery went on for 25 hours and I had 10-day semicomatose...

My 2nd brain surgery (Gamma-knife radiosurgery) was also delayed because the new neurosurgeon changed my annual check to bi-annual check. And my breast cancer recurrence was delayed, overlooked for 4 full years...

You can see that I am still pretty traumatized by those past experiences.

Thank you again for giving me such strong support and valuable tips. I think I will be able to 'calmly' discuss my concerns with my onco a week from next Monday. Thank you, guys. Y'all are the best!