Could my liver hemangioma actually be liver cancer?

Hello doctor,

I started having right sided pain in the rib area around one year and three months ago. It got really bad last week and I went to a doctor. They did an ultrasound and found several hyperechoic nodular foci on the liver. He said this could simply represent hemangiomas but could be mucinous metastases. I started panicking as I have always had bad health anxiety. I went to get a CT scan and could not do a contrast so found well defined "mildly hypodense mass" measuring 44.6x32.9 mm. I started to get really bad - not sleeping, not eating, losing weight, bad headaches, ringing in ears, muscle twitches, shaking, etc. They scheduled me for biopsy and when I got there the surgeon said they pulled up my old CT from six years ago and the mass had not changed. So, it was most likely hemangioma and not going to do a biopsy.

I still kept on the downward spiral as I did not believe them. I was told an MRI with contrast was the best test for liver lesions so I paid and had that done. Also had a brain MRI done because I thought I definitely had stage 4 cancer. All of this was one year back. MRI showed multiple liver lesions with largest 30.5x23.9 mm. T2 hyperintense and several others. All identified as behaving as hemangiomas and simple cysts. Not being satisfied with that I had a colonoscopy and upper endoscopy done. Both alright. Decided to go to liver specialist and they did another MRI with 9 cc Multihance. Findings were all clear except liver with "multiple lobulated T2 hyperintense hepatic lesions" largest being 3.1x2.5 mm. All consistent with hemangiomas. "No suspicious hepatic lesions".

The specialist also told me if I had stage 4 I would be in very bad shape with no treatment. I started back working out and put all my weight back on up to 200 pounds and feeling better except same pain in right side rib area every day. Got another six month follow up MRI last month and nothing had changed. Last week, I started having pain again in right rib area and started internet searching again and finding most hemangiomas are single not multiple and most metastases are multiple, which mine are. Also that hemangiomas are mostly in women not men. So now I am back to not sleeping, not eating, and feeling like I have some type of stage 4 cancer. Never had any cancer diagnosis though and none in my family. Eat good, worked out twice a day, only drink water, maintain a healthy weight. Even though I know in almost a year and a half with no treatment and stage 4 I would be bad shape or actually dead as the average lifespan of stage 4 metastases without treatment is 8.7 years, but I do not really believe that because they are not oncologists. I looked up and saw that NET's could be slow-growing cancers and maybe I have that. I just need an independent second opinion on what could cause right side pain besides what is showing up in all the tests I have had done. Also if having three MRI's with contrast saying the same thing is specific enough to rule out liver metastases. Online it shows MRI with contrast has a 97 % specificity when done one time so is three times even better to rule it out? Why would a male in great shape otherwise develop hemangiomas throughout the liver? Would a PET scan be better than MRI at this point? Thanks.

Hi doctor,

Thank you for the reply.

I have a poor appetite when I start worrying about metastases but other than that my weight has been the same, actually increased since last year. My serotonin levels were also fine. I just stay worried because I am a male and hemangiomas normally are for females so having so many of them is just really worrisome that they are missing something and why do I have them, but as time goes by it gets easier. I do see where up to 20 percent of the population can have them but do not get screened. So, they never know. I still get the intermittent right side pain some days so it is a constant reminder. I had never contacted an oncologist though and so to hear that is refreshing as I just hear from my regular doctor and liver doctor that the average total life span of stage 4 metastatic cancer is about 8.7 months untreated, (not years like I said above sorry) and I am going on 15 months now. So, I would be dead or in bad condition, but I am still working out and working every day. Also, my complete blood workups would surely show at least one enzyme or tumor marker off or blood cell counts off I would think. Just the anxiety wears me down.

Hi doctor,

Thank you for the reply.

I have a few more questions for you and would like you to look at the last two reports I had done comparing all of my MRIs. All of them indicate that nothing has changed over a year, even the largest one from as far back as 2012, and that there are no suspicious lesions. However, I still have pain in the right and left rib areas, which, based on everything I am looking up, may relate to the liver. The last two reports I had, which were reviewed by second opinions, showed that five months back, my liver size was 17.5 cm, and in previous reports, it was 18 cm, 17.8 cm, and 17.6 cm. What I found suggests this is considered just outside of the normal range. It is concerning that the original reports which I respect for their expertise, only indicated that the 'liver is normal in size.' Only one radiology MRI and CT also showed 'normal size liver.' How do I distinguish between these two different readings, and could the size be considered 'normal' for my larger body cavity? If it is not normal, could that explain my pain in the ribs? Additionally, could the volume of the hemangiomas expand the liver size, considering they are technically tumors? With all my liver blood work and tumor markers normal and no hepatitis or cirrhosis, why would my liver be larger, if it is indeed so?

Hi doctor,

Thank you for the reply.

That is what I thought. I was just wondering why all the reports said the liver size was normal but showed measurements of 17 cm or more, while I read that over 17 cm is considered large. I was thinking that it might be because, given my chest size of 48 inches and waist size of only 32 inches, it might not be considered large relative to my body size, which is why the reports say 'normal size and contour' of the liver. I also looked up a study on liver size in over 2,000 people, which showed an average for males of 15.1 ± 1.5 cm, so mine would be just outside the upper variance range, correct? With several hemangiomas, the largest being almost 4 cm, they would have to increase the liver volume, as you mentioned. All of this is just so confusing, especially when I start searching the internet, which I am trying to do less.

Hi doctor,

Thank you for the reply.

Just a follow-up: I found a radiologist report from the 2012 CT scan, which also showed my liver at 17.5 cm. This indicates that my liver size has been consistent since 2012, which provides some reassurance. The 2012 reading I attached notes, 'Foci of hypodensity are seen in the hepatic parenchyma, consistent with known multiple hepatic hemangiomas,' suggesting these hemangiomas have been present for nearly six years.

The reason for my follow-up is that I received a breath test result today, which was positive for SIBO (small intestine bacterial overgrowth). The doctor prescribed an antibiotic, which I will start. However, my internet research has caused me some concern. While SIBO is listed as being benign in many cases, it also mentions conditions like small bowel tumors or lymphoma, which I have suspected based on my symptoms.

My question is whether any of the tests I have had, including blood tests, colonoscopy, upper endoscopy, CT scans with barium of the abdomen, and multiple contrast MRIs, would have detected a small bowel tumor or swollen lymph nodes in the small bowel. The second opinion reports I attached mention 'No small or large bowel dilation' and 'No evidence of bowel obstruction.' Does this mean the small intestines were visualized? If I had a small bowel tumor that had metastasized to the liver in 2012 or late 2016, would I be experiencing other symptoms? Would the liver lesions be significantly larger? Would an MRE of the small bowel be a useful test to request?

Hi doctor,

Thank you for the reply.

So just to clarify in my mind: if I had a small bowel tumor that had already metastasized to my liver over a year ago, or especially back in 2012, I would be experiencing much worse problems, such as anemia in my blood work, severe bowel obstruction, or even death at this point without treatment? I have had no constipation, just a lot of gas, a sour stomach that makes a lot of noise after I eat, and the right and left upper quadrant pain that I have been experiencing for almost a year and a half now, along with somewhat loose stools but going regularly every morning. I also have some low back pain. There is no blood in my stool, no fatigue, no extreme weight loss, and I am still able to work every day and exercise twice a day.

The bottom line, I guess, is that I just want to find out if this SIBO issue could be related to these liver lesions or hemangiomas in any way that would indicate stage 4 cancer. They did prescribe me Rifaximin, which I will start today.