Liver scan

Posted By
Mk517
10/10/2018 9:05am
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Replies: 2

Sorry this is a little long... I have never posted before but have found this group very helpful since my diagnosis.

I was diagnosed in January with stage 3 melanoma with unknown primary. I had a large lump under my arm which was biopsied. I then had an axillary lymph node dissection. My initial pet scan had, what my doctor called, "some minor areas" that lit up but nothing was enlarged so it could just be physiological activity and that they would be treating me as NED - adjuvant treatment of taf/mek, but I couldn't tolerate the mekinist so now I'm just on tafinlar.

Fast forward now to my 6 month scan... CT is ok but shows an "indeterminate lesson" on my liver so they recommended an MRI. Had my MRI with contrast which now shows 2 lessons on my liver - 1 "most likely a hemangioma" and the second "indeterminate". And also an indeterminate lesson on my spleen. So they are recommending PET.

In addition to the obvious reasons of worried, I'm concerned that the PET will lead to a false positive. There's nothing concerning in any of my abd/pelvis lymph nodes, so would they melanoma really skip that and go to my liver? I'm 35 years old with 2 young kids, and while I know that the worry will never completely go away, I was hoping that I could "move on" after my year of treatment.

Any similar experiences or encouraging words are welcome! Thank you all for reading.

JuTMSY4 - (10/10/2018 - 10:50am)

I have an experience to offer, but no real advice:

I allegedly have liver mets when I was first DXed stage 4.  That is now somewhat inconclusive.  What originally showed up on that PET (and later CTs) were 3-4 small lesions along with a slew of bone mets (making my treatment decision much easier).

After treatment, the bone mets responded nearly instantly, but the liver mets remained and changed a little. After years of treatment, off treatment, recurrence elsewhere, etc., the liver mets remained.  We're now shifting to determining whether it's actually focal fatty sparing.  None of my liver panel has ever come back poorly. 

So, it's really hard to say.  Keep in mind, a PET scan will be read in combination with a CT and MRI to give them the best views possible.  Ask to see them too!  It's really neat and the first time a doctor offered it was incredibly informative. 

If you're asking if it's possible for the melanoma to go from your lymph nodes to liver - yes.  Stage 4 melanoma often progresses to the trunk in some fashion.  If you're asking whether this is cancer, I certainly don't know and your doctors are likely working hard to figure that out too.  Give them a chance to get as much info as possible.

doragsda - (10/10/2018 - 11:12am)

To answer your last question first:   yes, melanoma can skip over the lymph nodes and spread to other organs.   My wife's went from her left calf to her brain in 6 months with no other involvement of lymph nodes or other organs.   Her primary was quite deep (over 4mm), so it probably hit the bloodstream and bypassed the lymph system when it spread.

That being said, internal organs can often show litte defects on scans.   This seems especially true of the liver.  Hemangiomas, cysts, fatty deposits and other "things" seem to pop up quite frequently.   If you didn't have a history of melanoma, they would likely not raise any concern with your doctors, but the melanoma diagnosis elsewhere is, rightfully, causing them to investigate further.    It seems that the PET is the correct next step in your situation.   If the PET does show anything suspicious, there are likely other techniques they can use to refine the diagnosis even better (my wife had a MRI with spectroscopy when they thought she had a brain recurrence, but it turned out to be radiation necrosis from the MRI/spectroscopy).     Hopefully your PET will show them exactly what they need, and that will be "these are not metastases."    Good luck to you.