Liver Lesions

What are liver lesions?

Liver lesions are essentially abnormalities in the liver which are seen on a scan. They represent an area where the tissues are different from the rest of the liver. These may be tumours, areas of infection (such as an abscess) or areas where the fat content is different. However, the most common use of this term is in reference to tumours in the liver, both benign and malignant.

Are all liver tumours bad?

No. A tumour simply refers to an abnormal growth. This may be a benign thing, such as a haemangioma or it can be malignant (cancerous) thing such as a liver cancer.

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What are the possible diagnoses of a liver tumour?

Liver tumours can be benign, such as:

  • Haemangiomas – these are like “birthmarks” within the liver – a collection of abnormal blood vessels
  • Focal nodular hyperplasia – these are areas where the liver cells have grown in an abnormal pattern around some abnormal blood vessels.

Or they can be benign but with potential to turn cancerous:

  • Hepatic adenoma – benign tumour with a potential to become cancerous
  • Dysplastic nodules – abnormal growth within a cirrhotic (“hardened and damaged”) liver

Or they can be cancerous:

  • Hepatocellular carcinoma – see section on liver cancer
  • Cholangiocarcinoma – cancer of the bile ducts within the liver
  • Metastases – spread of cancer from other sites

How can one differentiate between the different types of liver tumours?

The most important investigation in determining what a liver lesion represents is to do a special scan of the liver. A CT or an MRI scan can be performed, but the key is the use of a dye which is injected into the vein in the arm. A series of scans is then performed at different time intervals after the injection which allows one to see how the dye is distributed within the lesion as compared to the liver. As each lesion has different amounts of blood vessels supplying it, the way the dye is distributed will give the radiologist and surgeon a clue as to what the diagnosis is. Newer dyes (for MRIs) are absorbed by functioning liver cells, which also allow one to determine whether the tumour/lesion is composed of functional liver cells as well.

Apart from scans, the surgeon may also order blood tests, including liver function tests, hepatitis tests and tumour markers. Gastroscopy and colonoscopy may also be performed to look for associated problems such as bowel cancer. Again, all these tests provide clues as to the nature of the liver lesion.

What is the treatment for liver lesions?

The treatment of a liver lesion depends entirely upon the nature of it and how certain we can be as to what it is. Sometimes, an operation may be necessary; sometimes we can watch and wait. Occasionally, other treatments such as chemotherapy or burning of the lesion may be recommended.

In cases where there is uncertainty as to what the lesion may represent, cases should be discussed at a multidisciplinary meeting where the radiologist, surgeons and other specialists can come together to discuss difficult cases. At CESA, our surgeons are associated with multidisciplinary teams and can draw on such expertise if required.