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7 Things You Should Know About Diagnosing a Liver Mass

The liver is one of the body’s most important organs.

It breaks down food, processes nutrients from the digestive system, and helps rid the blood of harmful substances.

Sometimes, abnormal cells or tissues - referred to as a liver mass or liver lesion - develop on the liver. They can either be benign (noncancerous) or malignant (cancerous). But accurately diagnosing a liver mass can be complicated.

Here are 7 things you should know about identifying a liver mass to help ensure an accurate diagnosis.

1. Most liver lesions are detected during an imaging test for an unrelated issue.

The majority of patients living with a benign liver mass do not experience any symptoms. Even malignant liver lesions are often asymptomatic. As a result, they’re are often detected during imaging tests for an unrelated condition.

Unfortunately, this makes it difficult to catch a cancerous liver mass at an early stage. With no routine screening in place to monitor the liver, it’s advised high-risk patients get a liver scan annually, or as advised by a doctor.

2. Determining the type of a liver mass requires an expert subspecialty radiologist.

There are many types of liver lesions. Some tumors originate in the liver, while others develop when cancer from another part of the body spreads to the liver - known as liver metastases, or secondary liver cancer.

Even with advanced imaging, it can be very difficult to differentiate one type of liver mass from another. The risk of mistaking a benign liver mass for a malignant tumor (or vice versa) is extremely high and can drastically impact patient outcome.

In order to ensure an accurate diagnosis, it’s important to seek out a radiologist who specializes in abdominal imaging. In addition, a second opinion from a subspecialist can help confirm a diagnosis, offer peace of mind that a liver mass is benign, or potentially save a life by catching and preventing a misdiagnosis.

3. Since 1980, the incidence of liver cancer has nearly tripled in the US.

In 2019, an estimated 42,030 adults (29,480 men and 12,550 women) are expected to be diagnosed with primary liver cancer. While obesity and chronic alcohol consumption have both been linked to the rise in incidence, the advancements in radiographic imaging have also contributed to an overall increase in detection. The occurrence of fatty liver disease is also on the rise, putting more people at risk of developing cirrhosis - scarring of the liver that often leads to hepatocellular carcinoma.

But liver cancer is not only becoming more prevalent in the US. According to a study published in JAMA Oncology, the incidence of liver cancer increased by 75 percent worldwide between 1990 and 2015.

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4. Over 20% of the general population has a benign liver lesion.

Despite the climbing rate of liver cancer, being diagnosed with a liver mass doesn’t always have to mean bad news. The majority of liver lesions are noncancerous, harmless, and can be left untreated.

Liver hemangiomas are the most common type of benign liver mass, occurring in an estimated 5% of adults in the US. Other common noncancerous liver lesions include focal nodular hyperplasias and hepatic adenomas.

While a benign liver mass is non threatening, they can be a challenge to accurately diagnose. With similar characteristics to malignant hyper vascular liver lesions, they can easily be mistaken for hepatoma (hepatocellular carcinoma) or fibrolamellar carcinoma.

In order to ensure accuracy, image interpretation by a subspecialty radiologist with extensive expertise in identifying masses of the abdomen is crucial. A second opinion is also highly recommended before pursuing treatment.

5. An alarming 23% of patients diagnosed with liver cancer don’t actually have cancer.

A researcher at the University of New Mexico’s School of Medicine estimated that 23% of liver cancer patients are actually misdiagnosed.

With similar characteristics to hepatoma, a hemangioma liver mass is the most common lesion mistaken for cancer. Hemangiomas have a high prevalence rate but do not require treatment. A misdiagnosis can have major consequences, including unnecessary invasive procedures and harmful treatments. A second opinion from a subspecialty radiologist with experience interpreting liver scans can help ensure an accurate diagnosis.

6. MRI with gadolinium is the most powerful tool for examining a liver mass.

Different types of liver lesions often share similar characteristics with one another. This makes the diagnostic process especially challenging. Focal nodular hyperplasia lesions, for instance, share imaging features with the fibrolamellar variant of hepatoma. They also display similar characteristics found in hepatic adenomas.

One study found that in 70% of cases, MRI with gadolinium was able to differentiate between focal nodular hyperplasia and hepatic adenomas.

“MRI with dynamic gadolinium imaging is the most powerful tool to evaluate the liver, but it also has the greatest requirement for skilled interpretation of the studies. A radiologist needs a lot of training and experience in order to accurately and fully interpret all the findings in an MRI.” says Dr Richard Semelka. “It’s imperative a subspecialist handles these types of cases.”

7. Birth control has been linked to the development of some liver lesions.

Some research supports that the development of focal nodular hyperplasia liver lesions and hepatic adenomas is often linked to the prolonged use of oral contraception pills.

While the claim is somewhat controversial regular use of contraceptive pills, estrogen therapy medications, and anabolic steroids are considered risk factors. Most doctors advise patients diagnosed with these liver mass types to discontinue use of such medications.


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An easy 3-step process - instantly upload your scans, select an expert subspecialty radiologist (or have DocPanel assign your case to the appropriate subspecialist), and submit your request. Upon uploading your scans, you’ll also have the opportunity to ask any questions you might have about your case. Not sure what a subspecialist is? Learn more with our in-depth article on the importance of getting a second opinion from a subspecialty radiologist.

In this article...

1. Most liver lesions are detected during an imaging test for an unrelated issue. 2. Determining the type of a liver mass requires an expert subspecialty radiologist. 3. Since 1980, the incidence of liver cancer has nearly tripled in the US. 4. Over 20% of the general population has a benign liver lesion. 5. An alarming 23% of patients diagnosed with liver cancer don’t actually have cancer. 6. MRI with gadolinium is the most powerful tool for examining a liver mass. 7. Birth control has been linked to the development of some liver lesions.

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