Does HCV without cirrhosis cause primary liver cancer?

[dragonslayer]

Hi All, back again!  So, 6 mos ago, my PCP told me to get a cardiac calcium cat scan which is common for  folks my age.. The results werent bad as far as the heart goes, but it picked up a small nodule in each lung.  The recommendation was to  get the chest rescanned 6-12 mos later.. That I did last tuesday.. Results were that the nodules hadnt grown and were stable, but, under the heading of 'if its not one thing its another', it also picked up something else, which was a portion of the liver that wasnt scanned in the 6mo ago scan.. In the left lobe is a small 'lesion'.. 1cm x 1.7cm.  So I was ordered by my PCP to go for an Ultrasound, which I have scheduled tomorrow.

Im freaking out here.. Ive had 2 liver biopsies, both of which showed no liver damage, stage 0 and 0-1.  That was as recently as 4 years ago just  prior to treatment. I got treated and cured in early 2015.

The radiologist report pertaining to this, dated 10/10/18:

"UPPER ABDOMEN: A lobulated hypodense lesion in the inferior left hepatic lobe
measuring 1.0 x 1.7 cm (series 2 image 63/72); portion of the liver
containing this lesion is not imaged on the previous study."

and

"A 1.0 x 1.7 cm hypodense lesion in the left hepatic lobe has Hounsfield units
somewhat greater than expected for a simple cyst. Consider focused ultrasound
correlation."

I thought that without liver damage/cirrhosis, HCV in its own right was not a causative factor for  HCC.  My drinking since treatment has been minimal, averaging  about 3-5 drink equivalents per week which my hepatologist signed off on at end of treatment saying I can carry on as those I never had HCV.

So, then, why this lesion?  I realize it might only be a cyst, but the way the radiologist words his report has me concerned.

Maybe tomorrow's ultrasound will shed some light on the situation in a good way.. Until then, freaking out....

Paul

[Lynn K]

Found a few links including one from hep mag. Apparently while cirrhosis is a higher risk of liver cancer Hep C alone is also a liver cancer risk.

https://www.hepmag.com/basics/hepatitis-c-basics/liver-cancer

Wow this sounds very concerning hoping you have better news soon. Have you had an AFP blood test? AFP although an imperfect diagnostic tool if significantly elevated can give an indication of possible liver cancer.

Please let us know what you find out.

Sending positive energy your way

[lporterrn]

Benign lesions are very common. Some people just make benign growths and the fact that you already have the 2 in the lungs suggests that you may have something benign elsewhere.
That said, who isn't going to be freaked out until this is confirmed? So, we'll freak out with you, albeit in a more supportive way.
Although this is likely to be nothing, if it is serious, its been caught very early, when treatment has a high cure rate.
Let us know.

[dragonslayer]

Thanks you guys; you're the best!  Ill get back with any new info.

[Lynn K]

Thanks Lucinda! I’m so glad to hear there is a good chance of this being benign.

[dogdave]

Hey Dragonslayer,  it is my understanding that they won't do a biopsy on the tumor itself.  The reason is that opening a cancerous lesion could leak cancer cells out to spread.  Also, non-cirrhosis is less of a breeding ground for tumors than one with cirrhosis.

They could take a wait and see approach or they might do some kind of embolization treatment. Both are highly successful.  I know it is stressful, but the professionals will walk you thru this.

Last year at this time I was diagnosed with a 4.5 cm tumor.  I had a chemo-embolization successfully treat it. However because of the state of my liver with cirrhosis, I am now listed on the Transplant list. 

Good luck to you with this!  David

[dragonslayer]

Update:

Got results of the followup Ultrasound.  It's a Complex Cyst and not the Simple Cyst I was hoping for.  So, MRI with and without contrast has been ordered.  That will be the third imaging for this I will have had.. I asked my doctor point blank, 'Doc, do you think its cancer?'.   She replied  'no', but I have my doubts.  Further tests will hopefully clear this up.    I dont think I have symptoms, and liver function tests have been normal.

Although I suppose it's conceivable this cyst arose spontaneously, nothing regarding HCV has been simple for me. As you recall, I was one of the very few who was still detected at EOT and at 8 wks post, not  becoming Undetected until the 12 wk post test.  I have no idea how old this cyst is, and,  this being the first imaging, have no way to determine its growth rate... On the positive side, liver looks otherwise healthy on the ultrasound, and there's no cirrhosis, or abnormalities on other organs.  BTW, radiologists seem to use the most obtuse language sometimes: 'if clinically indicated'.. Hard to find a definition for this phrase that means anything.

"LIVER: There is a complex, septated cyst within the left hepatic lobe
measuring 1.7 x 1.4 x 2.4 cm. There is no associated vascularity. This is
similar when compared to the prior chest CT. Dedicated three-phase hepatic CT
or MR could be considered to help further evaluate if clinically indicated.
The liver demonstrates normal size, contour and echogenicity. No intrahepatic
biliary duct dilatation."

[Lynn K]

My best guess for ‘if clinically indicated' is if the doctor thinks it is a good idea.

Waiting along with you for good news

[dragonslayer]

Ive been trying to find statistics regarding DAA cured HCV patients who went on to develop de novo primary HCC after treatment, and what percentage of them had been diagnosed with cirrhosis.

I came across this interesting (but long!) recent study that published results with a cohort of 819 patients. It also compared HCC rates among those treated with IFN vs DAAs.

Regarding the incidence among those without cirrhosis, it found:

"Results: A total of 819 patients were included in the DAA group. The median follow-up period was 263 days (0–1,001). Twenty-five patients (3.6 HCCs/100 person-years; 3.1%) were diagnosed with de novo HCC within the time of observation. No patient without cirrhosis had developed HCC."

And, countering the concerns that had abounded for some time regarding whether or not DAAs caused HCC, and subsequently debunked, the finding was this:

" Conclusion: The de novo HCC rates did not differ between the DAA-treated patients and those who received IFN. Achievement of SVR is of utmost importance for HCC prevention."

So, it seems to be that the incidence of HCC in non cirrhotic  individuals who have achieved SVR to be extremely low, even though HCV in and of itself is listed as a risk factor.

Interesting study:

https://www.karger.com/Article/FullText/486812


I had to get a blood test today for kidney function, required before radiology will do the MRI with contrast.  Waiting for them to schedule the appt.   In the meantime, every hint of any 'could-be' symptoms of HCC that Im feeling freak me out just a little bit more, naturally.  I really dont understand how with my pristine liver, never having had any measurable liver damage, it could succumb to this.   

[andrew j]

Hi Paul,

I've been thinking about you for a while now - and dammit if this computer in my local library hasn't just disappeared the long post I'd almost finished to you?!!

I haven't got time to re-type it now - so please just know that I am thinking about you - and sending you lots of prayers and good vibes.

These waiting / medical things can be tough, eh?

Best, as they say,

Andrew.

[dragonslayer]

Thanks, Andrew..  Dont you just love when your well crafted thoughts get eaten alive by some ill behaved errant piece of electronics?!  Such is life..

Ive been reading up a lot on these complex, septated liver cysts.   There's no guarantee this is malignant, even if it  grows, it can still be benign.. Hey, I've got to hold on to something, right?    Im still waiting to be scheduled for the MRI with contrast.   I think my hepatologist, instead of giving me a clean bill of health with instructions to carry on as though I never had HCV, should have prescribed Ultrasounds every 6 mos.. This could have been caught a long time ago if he had... I guess he saw 2 clean biopsies as proof that all was well. However, given that the biopsy is taken from the rightmost side of the right lobe, and my lesion is in the left lobe, and since non cirrhotics rarely have an HCC problem, I guess he figured, what the hell..   His mistake, and now I have to deal with the consequences, whatever they are.

I'll keep you all updated, whatever happens... I need some place to 'unload'!

[andrew j]

Doctors are making mistakes all the time.
I've learnt that to my cost.

You have to take a sort-of existential / randomness of the Universe view of it - as I'm sure you realise?!

... And yes ... unloading.

It's  a good thing!!

[spitzbar]

...have a little faith

...."There is no associated vascularity." NOTE: malignant tumors ARE associated with their own extensive individual vascularity to support cell multiplication of the tumor.   (this type of information is a good prognosis rather than poor)

.....Dedicated three-phase hepatic CT MR COULD (not should) be considered to help further evaluate if clinically indicated.  NOTE: if the physician has doubts to the validity of "NO vascularity", he should follow up as indicated.

spitz

[dragonslayer]

Thank you Spitz!!!   Im scheduled for the MRI (with and without contrast) thursday.  Hopefully this will lend clarity.  Since it was my PCP who had me do the original coronary-calcium screen 6 months ago when incidental lung nodules were found which led to the follow up CT recently when the liver lesion was found, shes been the one reading and following up with the radiologist study suggestions, which Im ok with.. Depending on what the MRI shows, I suspect this should be offloaded to a hepatologist at some point, or other specialist   as need be.

BTW, you dont post a lot, but what you do post is always informative and to the point, and Ive always enjoyed reading them.

[dragonslayer]

***UPDATE***
Just heard from my PCP about the MRI with contrast result..  This is good news, yes??      Ultrasound will be ordered in 6 mos to follow up.  Looks like what I have is a true 'incidentaloma' which is so often the product of all the hyper screening thats part of today's 'Standard of Care':

----------------------------------------------------------------

IMPRESSION:
Complex septated cyst in the anterior aspect of segment 3 of the left lobe
liver corresponds with the abnormality seen on CT scan and ultrasound. I do
not appreciate any significant nodularity or solid enhancing component to
this complex cyst. No other suspicious hepatic lesions seen. Follow-up
imaging with ultrasound could be obtained to assure stability of this likely
incidental complex cyst.

[lporterrn]

Great news indeed. Relief for you and all involved!

[dragonslayer]

Great news indeed. Relief for you and all involved!

You're not kidding!  But whats with the radiologists??

" I do not appreciate any significant nodularity or solid enhancing component to
this complex cyst. "


Isnt that a funny way to say it?  I mean I certainly DO appreciate no significant nodularity or solid enhancement!!  Why doesnt he appreciate it too? 

Drs do speak funny sometimes, or else, downright misleading.

[andrew j]

Phew!!

(They do the same thing down here.
Maybe it's so that patients aren't freaking out all the time?!) ...

[dragonslayer]

Phew!!

(They do the same thing down here.
Maybe it's so that patients aren't freaking out all the time?!) ...

Yea, well, Id still rather he DID 'appreciate' that it didnt look like cancer.. Just a weird way of saying it.. How bout just saying, instead,  'I do not NOTE any significant nodularity or solid enhancing component to this complex cyst. "   

Twould  make a lot more sense, even in medical jargon. I see no meaning for the word appreciate that equates to 'note'.

Webster's defines appreciate as:
"To understand the worth or importance of (something or someone) "

So in that sense,  appreciate means to recognize something's worth. Therefore, It could be extrapolated from that that not appreciating cancerous characteristics of a tumor means he didnt note the or didnt find them..  So in that way, i guess it really does make sense..  But it also implies a sense of gratitude.

But, the main thing is,    hallelujah

[Lynn K]

Alright great news so happy for you!

I appreciate reading this!

[dragonslayer]

Alright great news so happy for you!

I appreciate reading this!

And, I appreciate your appreciatin' !

[KimInTheForest]

Congrats on the MRI result, Paul! That is certainly a relief.

kim

[dragonslayer]

Congrats on the MRI result, Paul! That is certainly a relief.

kim

Im telling you! The mind plays weird tricks on you.  I had convinced myself that I had cancer.. After all, this wasnt a simple cyst; the good kind. No. It was a  septated, lobular, complex cyst.  I did my research.. Complex are the kind they suspect, but they can be benign too.. It can even grow in size and stature, and be benign... but sometimes it isnt.. Since this was the third scan they ordered, the first being CT, followed by US, and now this MRI with contrast, they clearly suspected something. And so did  I.. Every ache, Every discomfort lent credence to my supposition.. I had read that cancer causes you to lose weight, so I incessantly began weighing myself, and stuffing my face like a pig just so I can keep from losing a pound or two.. Of course, cancer patients also lose their  appetite, and I certainly did not, but the brain keeps exculpatory evidence out of  your consciousness.   

Nothing with this disease has come easily for me.  EOT: detected.. 8 wks post: detected.  And, of course, as is my wont, I had convinced myself I had failed treatment, but lo and behold, I didnt!  Same thing here. I had entered the bargaining with God phase, thats how far I was gone. So today, when I read the report, which was repeated again for my by my PCP, I could hardly believe it.  All that worry, all that wasted energy, all that extra insomnia... all for naught.  Thank Goodness!

This stuff is rough.   You  keep waiting for the other shoe to drop.. I had the MRI thursday. Today is monday.  Over the weekend, I found myself obsessively opening and signing onto mychartplus to see if my report was there. Every email I received was with lump in my throat and bated breath.   I just wanted to bury my head.

It really does one good to log onto this great forum and just spill..  I Appreciate the opportunity to take advantage of the therapy offered here:   Therapeutic Spilling...  does the soul good..   

Thank you all...

[strangerbynight]

Im telling you! The mind plays weird tricks on you.  I had convinced myself that I had cancer.. After all, this wasnt a simple cyst; the good kind. No. It was a  septated, lobular, complex cyst.  I did my research.. Complex are the kind they suspect, but they can be benign too.. It can even grow in size and stature, and be benign... but sometimes it isnt.. Since this was the third scan they ordered, the first being CT, followed by US, and now this MRI with contrast, they clearly suspected something. And so did  I.. Every ache, Every discomfort lent credence to my supposition.. I had read that cancer causes you to lose weight, so I incessantly began weighing myself, and stuffing my face like a pig just so I can keep from losing a pound or two.. Of course, cancer patients also lose their  appetite, and I certainly did not, but the brain keeps exculpatory evidence out of  your consciousness.   

Nothing with this disease has come easily for me.  EOT: detected.. 8 wks post: detected.  And, of course, as is my wont, I had convinced myself I had failed treatment, but lo and behold, I didnt!  Same thing here. I had entered the bargaining with God phase, thats how far I was gone. So today, when I read the report, which was repeated again for my by my PCP, I could hardly believe it.  All that worry, all that wasted energy, all that extra insomnia... all for naught.  Thank Goodness!

This stuff is rough.   You  keep waiting for the other shoe to drop.. I had the MRI thursday. Today is monday.  Over the weekend, I found myself obsessively opening and signing onto mychartplus to see if my report was there. Every email I received was with lump in my throat and bated breath.   I just wanted to bury my head.

It really does one good to log onto this great forum and just spill..  I Appreciate the opportunity to take advantage of the therapy offered here:   Therapeutic Spilling...  does the soul good..   

Thank you all...

I can totally understand what you have been through, i have been to hell and back a year ago, my ultralsound show 2 lesions on my liver and so they send me for CT with contrast and was ruled out it was hemangioma, at the time i have convinced myselt that i did have a tumor and i am going die from it, one words of advice is stay away from google, webmd ect...google doctor are proven 70% wrong so ever since i never google symptoms anymore, wish you all the best.sorry for me English, its not my native language.

[lporterrn]

I think this is why we need each other - our minds are not reliable, despite the fact that our minds are usually telling us otherwise.

My motto is, "Get the facts first, then panic if the facts warrant." I have never needed to panic, since in all the time I've practiced this, the facts haven't mirrored my imagination.

[Mugwump]

When the strain of words and uncertainty becomes too much I always turn to something pure and real. Stevie Ray had a way to say more than other humans without using too many words.
https://www.youtube.com/watch?v=An4uDegHB8s


Then again if I wanted to listen to something that makes me really scared I would spin this one hit wonder ditty that received far too much air time IMO. I distinctly remember almost spewing chunks on the dance floor to this one.
https://www.youtube.com/watch?v=h1qQ1SKNlgY
Like disco, we may very well need time to adjust to not having hcv. Complex highly evolved retro viruses are real little jerks can do all sorts of things to us that we are just beginning to understand.
Great to see you have good medical people that don't hesitate to do the right tests!

[dragonslayer]

LOL Eric on the disco front..  I had never heard that Stevie Ray version of the Hendricks classic.. Loved it!  I sometimes find Stevie Ray overplays his material to its detriment, however I was very impressed with the restraint he showed in this particular cover.. Might even like it more than the original!

A while ago, I got into listening to some young Bonnie Raitt back when her voice was clear as a bell; sings like an angel.. Here are a couple, and in the runaway cover, dig that harp solo!!

https://www.youtube.com/watch?v=HPzcZNgVfpA

https://www.youtube.com/watch?v=KbqXMQCq59U

And returning to the SRV theme, if youre into it, here's a wonderful display of some soulful blues in a duet with Albert King:

https://www.youtube.com/watch?v=SeLddbrzsHk

I'm on a musical jag today.. Hope folks dont mind. But if they have the time to listen, this  rocks also:

https://www.youtube.com/watch?v=osg_WmeLxQk&t=1

[Docroccin]

Thanks for the music, guys.