- Who is at risk for liver cancer?
- How do you screen for liver cancer?
- What happens if a lump is found in my liver?
- THSP: Toronto Hepatoma Screening Program
CT scan of the liver with cancer circled in red.
Large lumps seen in someone with cirrhosis or hepatitis B are always concerning for cancer. Cancers this size have a certain look because of their blood supply. If you inject a dye into your veins, the dye shows up in liver cancers before it shows up in the liver (called "hypervascular"). As you keep on watching, the dye starts going into the liver when it has already left the liver (called "washout"). All this can be seen with "contrast-enhanced studies". These tests all involve an injection before pictures are taken. At TWH Liver Clinics, these tests include:
CT Scan (an x-ray with dye, should not be used if your kidney function is bad)
MRI Scan (pictures obtained using a big magnet with you in a very small tube. This can be hard to do if you have claustrophobia)
Contrast Ultrasound (special form of ultrasound)
A positive result for liver cancer on any one of these three tests means you have liver cancer and a biopsy is not needed.
Lumps this size are still concerning. Cancers of this size are still curable but they may not look like typical liver cancer - they may look like a lump with fat. People with these small lumps should have contrast-enhanced studies. If the lump looks like liver cancer on at least 2 contrast studies, then it should be treated as liver cancer - a biopsy is not needed. However, if it looks like cancer on only 1 study, then a biopsy is needed to confirm that it really is liver cancer. It is very important that lumps of this size be checked out. If it turns out to be cancer, they are treatable. If you let them get bigger, it will be more difficult to treat.
Small lumps can be common if you have cirrhosis. Even when you get a new small lump, it is hard to tell if you have a lump of normal liver cells trying to grow back or if this is early cancer. It is also very difficult to biopsy such a small lump - you may not hit it with the biopsy needle. We are currently keeping a close eye on these close lumps - you may need more frequent ultrasound exams, perhaps every 3-4 months instead of 6 months.