Focal Liver Lesion
What is a focal liver lesion?
It is an incidental finding of a lump or swelling or a spot on the liver that is detected on a simple ultrasound of the abdomen during a routine check up.
Is it something to worry about?
Not all incidental lesions are worrisome. However, they need to be investigated in depth before calling them benign (or nothing to worry about)
What are the types of liver lesions?
They are of 2 types- benign (non-cancerous) or malignant (cancer). Benign lesions are the commonest type of lesions.
How do you confirm the type or nature of these lesions?
Ideally, a combination of blood tests, CT scan or an MRI may be needed to determine the exact nature of these lesions. The doctors at this clinic will help you with the necessary tests.
What are the commonest benign lesions?
Some of the commonest benign lesions are described in brief
- The most common benign liver tumour in adults and children.
- They may be congenital and may enlarge under the influence of contraceptives. They can also grow during pregnancy.
- Usually small and asymptomatic.
- Rupture is rare but may occur spontaneously, following trauma or at the time of attempted biopsy. These may then bleed profusely
- Rarely needs any treatment. However, needs an annual follow-up to assess the size
- Surgical resection is the treatment of choice if needed. Minimally invasive therapies include arterial embolization, radiofrequency ablation and hepatic irradiation.
- Hepatic adenomas are rare, benign tumours. Approximately 90% of cases occur in females, mostly aged 15-45 years.
- They are strongly associated with the use of oral contraceptives
- Around 5-13% of adenomas may turn cancerous.
- Patients may need to stop using oral contraceptives.
- Symptomatic and tumours greater than 4 cm may need surgical resection.
- Annual follow up is strongly recommended
Focal nodular hyperplasia
- Focal nodular hyperplasia is the second most common tumour of the liver.
- It is a benign condition of the liver. Commonly seen in women.
- Rarely symptomatic and surgical intervention is almost never required.
- These are seen in 10-15 % of the population
- Commonest types of cysts – Simple/Hydatid/amaebic liver abscess
- Rarely-Malignant cysts such as cystadenocarcinoma
- Simple cysts- which do not need any further evaluation except an annual check up
- Commonly seen in patients who are in close contact with cattle, sheep and dogs.
- Caused due to parasitic infection.
- If large in size- will need surgical excision besides medical treatment
Amoebic liver abscess
- Seen in 40% of patients with intestinal amoebiasis (common disease in the urban population due to outside food)
- Causes fever with chills and severe pain in right upper quadrant of the abomen
- Can cause generalised sepsis if the liver abscess ruptures
- Needs medical line of treatment
- Rarely will need a pigtail drainage of the abscess or a surgical exploration.
Malignant liver lesions
These can be primary (arising from the liver) or secondary liver tumours (cancer that has spread to the liver)
Primary Liver Cancer
These originate from the liver -They are mainly of 2 types - Hepatocellular cancer (common) and cholangiocarcinoma (rare) - Please see separate leaflet
Secondary Liver Cancer
These are cancers that have spread to the liver – the commonest primary sites being the intestine, pancreas, stomach or breast. Some of the secondary liver cancers are amenable to a surgical resection with a view to curing the patient.
These are just some brief guidelines for information. Each liver lesion will have to be assessed in detail and the doctors at the clinic will treat you after a complete detailed assessment.