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Liver Mets

Posts: 1170
Joined: Sep 2012

For people who have have had liver metastasis, I'm wondering how it was diagnosed. Obviously lesions or abnormalities would show up on a ct or pet scan. Do oncologists usually assume it's cancer based on the history or do they do a biopsy before starting chemo? Lesions showed up on my husbands ct. The onc ordered an MRI and testing of the CEA. (pet scans are difficult to get in Ontario). She didn't mention a possible biopsy. Is this normal?


maglets's picture
Posts: 2585
Joined: Jun 2006

my liver lesions showed up both times on ct scans.....oncologist and liver surgeons went with the radiologist....never have had biopsy....radiologist was the man

you are right about pet...it is difficult to get one but my surgeon said it really would not add anything .....he just wanted the ct images

when I was entering my second liver resection the surgeon asked if i would do a pet....I had to pay for it....it was a study to see if pet actually was beneficial to outcome for liver patients....


Posts: 1170
Joined: Sep 2012

Thanks for the info. We paid for a pet scan before Steve's hipec surgery. $2500.00 here in Ontario. OHIP does not recognize the need for pet scan with regards to colon cancer. Feel ct is sufficient.


herdizziness's picture
Posts: 3642
Joined: Apr 2010

They did a biopsy of my liver the first time, when I was diagnosed with colon cancer. I would NOT have done it if I had known about the possibility of seeding (cancer cells getting loose from the biopsy,apparently the liver is known to occasionally do that, I must admit it is controversial as to whether it does "seeding" or not, but I rather err on the safe side in my future, especially when they "SEE" it with the ct scan or MRI), they basically know it's cancer from the CT scan. This time I'm having surgery on the right side of my liver based on my CEA rise and the CT scan which shows the tumor, no biopsy necessary. This is based on the history now for me, had it on left side and it was removed and now one has showed on the right side. So I would say, yes that is normal and prudent NOT to get the biopsy.
Winter Marie

Posts: 1170
Joined: Sep 2012

Holy crap! Thanks for the seeding info. Sounds like a biopsy might not be worth the risk.


Momof2plusteentwins's picture
Posts: 507
Joined: May 2012

I had a CT which showed lesion and surgeon was pretty confident it was cancer. I also had a pet which liver lesion lit up. Surgeon didn't need any more evidence. Had surgery for colon tumor, liver tumor, and gallbladder on June 17, 2012. Getting my first CT tomorrow since surgery.
Sandy :)

Posts: 1170
Joined: Sep 2012

Good luck regarding tomorrows scan. I'm sure it will be a stressful few days (until you get the results).

Take care,

Posts: 753
Joined: Apr 2011

Based on what i have read, no biopsy required. I consulted with 3 oncs.
The second one from a top hospital (?) wanted to do a biopsy. I had 15 tumors at least in the liver. Doing a biopsy would have been ridiculous due to seeding and loss of valuable time. The doctor had a PHD, too. Clearly she didnt know much even with all that education. Gotta watch everyone these days
Good luck. Keep us posted.

Posts: 1428
Joined: Feb 2011

Strange rules in Ontario for PET scans, seems they'll do them for some cancers covered by OHIP but not others. There is a private scanning place somewhere in Toronto and I thought the fee was $1,500.00, if you had some private insurance through work it would be covered apparently. My onc. seemed against PET, carried on about the radioactive die and such not being good. Mags if your PET was helping for a study ...sheesh...you'd think they would have picked up the fee Huh??

jjaj133's picture
Posts: 863
Joined: Mar 2011

Hi Chelsea,
A routine colonoscopy showed polyps and i had 1/3 of my colon removed. no follow up chemo. ct scans every 3 mths, 6 mths, yrly. then 5 years later a blood test showed my cea had risen. I had a ct scan, the liver lit up and I had a biopsy. no one told me about seeding. Now i get chemo, then a liver resection, followed by chemo for 9 months. The surgeon told my family, there is a spot i am concerned about but i can't do anymore right now. A year later after a ct the spot lit up and I was scheduled for a 2nd liver resection and 9 more months of chemo/ This time it was "just Xeloda". A bit easier to handle. I moved to Florida and go to a different cancer center. There was no biopsy the second time. Most likely because of my history. I am now 19 month NED and doing well.
I wish you and your husband the best of luck and will add you both to my prayers .

Posts: 1170
Joined: Sep 2012

Thanks for the info. Judy. I really appreciate the comments and support I'm receiving from such nice people, such as yourself. I wish I would have joined the discussion group a year and a half ago when my husband was first diagnosed. Thanks and best wishes to you.


Posts: 172
Joined: Jul 2012

My liver mets were first discovered on a pre-op CT scan however the results of the scan arrived the day after my emergency surgery and there was no liver surgeon available at the time of my operation so I missed out on a liver resection which very well might have me in a different position now.

My oncologist has had several patients from earlier years who ended up with seedling metastasis in the abdomen after liver biopsies so lucky for me he didn't order one. Instead, he sent me for an ultra sound to determine density of the lesions on my liver. If the spots are cysts then there is no density/depth of the lesion.

I've personally met 2 people in the chemo room who now have abdominal mets as a result of liver biopsies. It shocks me that there are oncologists who still order this when there's plenty of information to show the risks. If your husband hasn't already had surgery for his cancer and the ct scan shows that those liver mets could be removed surgically, go to a hospital where those surgeons are available. Several procedures done in one operation is better and he could very well be cancer free at the end of it all.

I've had several Pet scans and I'm surprised that you have to pay in Ontario. I'm in BC and ours are covered. Seriously, we live in the same country. Why should you have to pay and I don't? This is the one thing about our health care system that really bugs me. It should be the same for everyone, coast to coast.

Wishing you all the best :)

Posts: 1170
Joined: Sep 2012

Yes, it does seem crazy. My husbands Quebec surgeon said that Ontario is the only province that won't pay for the pet scan. It seemed so justified to do one before the hipec surgery. Obviously it makes sense to rule out distant metastasis or another disease before going to the trouble (and the risk) of cutting open the abdomen and administering hot chemo. I guess I won't be voting Liberal at our next provincial election. Thanks for the info and best of luck.

Take care,

Maxiecat's picture
Posts: 544
Joined: Jul 2012

Thank you so much for the info on the seeding with a biopsy. I go in tomorrow morning for an ultrasound on my liver...if they find something next step is probably a CT scan.


westie66's picture
Posts: 642
Joined: Jun 2010

Hi all: I'm from Ontario too. In my case, the radiologists could not determine if a growth on my liver (from gallbladder cancer) was cancerous or not. A CT or MRI can't really determine this for sure except for monitoring growth. I ended up having a nuclear scan (not PET scan) whereby blood is withdrawn and injected with radioactive material. Then this is re-injected into the body. If the growth in question is an hemangioma (like a blood blister), then it will light up. If it doesn't, well it is likely a tumour. Mine didn't light up unfortunately. I was offered a PET scan under someone's research agenda but didn't get it in the end. I did have to pay for my chemo though - almost $4000/month! My chemo treatment is standard for pancreatic and colon cancer (at least for some stages) but I have gallbladder cancer so ...

Posts: 1170
Joined: Sep 2012

Very interesting. I've never heard of this test. I have heard lots about cancer treatment in the London, ON. I work with a woman who's father was treated for cc in London. It sounds like they offer some cutting edge treatment options. They seem to have a good reputation.

Best of luck.

Posts: 74
Joined: Sep 2012

My daughter had a ct scan and ultrasound both said suspicious. mri confirmed it 2 weeks ago.She is also in Ontario.

Posts: 271
Joined: Nov 2011

When I had a liver met my onc wanted to do a biopsy, but a good friend who is a big shot onc told me to refuse the needle biopsy because of possible seeding to the peritoneal cavity, etc. He got his opinion backed up by his friends who are heads of oncology at 4 major cancer centers and they called my onc.

A PET showed uptake in the very center of my spot on my liver and I had surgery very quickly after that.

Good luck!

Posts: 92
Joined: Sep 2012

I am also in Ontario. I had a liver met which showed on a ct. It was initially thought that it was a cyst, however after an ultra sound and a MRI, the MRI showed that it was a met. My understanding is that it will show a blood source on the scan. Also, it is monitored to see if it changes in size. Mine was initially found at .8 cm, when it was checked again by ct scan it had grown to 1.6cm, which indicates it is a met. A biopsy was not required and should be avoided due to possible seeding.

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