Liver Scan in relation to breast cancer.

[smokey 234]

I have a general question about a liver scan I received because my alkaline phosphatates were mildly elevated before and after surgery for breast cancer. About the liver the report said: Two tiny, subcentimeter, low attenuation lesions are noted in the right hepatic lobe, which are too-small-to-charaterize.  These measure 7 mm and 2 mm respectively.  No other hepatic lesions are seen.,  There is no intrhepatic bile duct dilation.  The hepatic and portal veins are patenet.  The spleen, gallbladder, pancreas and adrenal glands are unremarkable. The kidneys appear unremarkable. There is no hydronephrosis.  Inpression:  Tiny subcentimeter low-attenuation lesions in the right hepatic lobe, which are too small to characterize. No other focal liver lesions.
My question   What does this mean in terms of the cancer spreading? My onc told me not to worry. Also what does this mean in terms of the liver enzymes and is it something to worry about? Also what does low attenuation mean?
Thank you so much for all the help and information that you share here.

[smokey 234]

Thank you for your compassionate reply,  My oncologist, as well as Dr. from SLoan Kettering looked at this report and mine told me I was still stage IIA.  Because of the 12- 15 point raise in alkaline phosphatates, and because of having to go through this I opted for an agressive chemo   AC + T, which was not recommended by my oncologist though she said she felt comfortable doing it.  I am trying to think positive, this was only 2.3 cm. HER-  ESPR90% positive, and I was told the pathology at Cornell cuts up those sentinel nodes really really really small.  So I am going to just do the treatment, hopefully the chemo will take care of any stray cells radiation, arimidex, ext. and assume I will be fine.  Just hope I'm right.

[surgeon]

It's possible to spread through the bloodstream to the liver without ever getting into lymphatics. And not seeing invasion on the slides that were looked at doesn't mean it might not have occurred. Likewise, since metastases begin as a single cell in a location, they start small. So the answers to your questions, unfortunately, aren't specifically reassuring. However, the fact that your tumor sounds very likely to have been cured, that the lesions in the liver are only two in number and are low density all suggest that it's fine. The truly hellacious thing about having had cancer is that no matter what the stage, it's not possible to be absolutely certain that things will be ok forever; everyone with cancer lives with that, at least for a few years. There's every reason to be optimistic in your case, and to assume the liver spots are not significant. As time passes, hopefully you'll get more comfortable with that idea; it takes time for anyone. But as each day arrives and leaves with you feeling fine, it'll get easier. And, for good measure, you'll be getting appropriate followup as well.

[smokey 234]

Thank you. Would it be possible for the cancer to have spread to the liver if there was no lymph involvement, (on two stains) and angiolymphatic involvement was not noted.  Also, wouldn't it be larger if it was cancer.  Also had bone pelvic chest scans ect. all clear except for degenenerative disease and/or trauma.

[surgeon]

In saying you are IIA, your oncologist is assuming the "dots" in your liver are not cancer. It's a pretty safe assumption: cysts, which are fluid collections, and which would be described as being of "low attenuation," are quite common in the liver. Lots of people have them and they are of no significance. The problem is that the smaller they are, the harder it is to be absolutely certain about them, because the images on something that small are just not as reliable. Getting an ultrasound might help: it can tell if it's fluid, and if it is then it's a cyst and not cancer, end of story. But when they're that small, even the ultrasound might not be clear-cut.  Likewise, getting a biopsy needle accurately into a small area is difficult. So for now, it's reasonable to assume you have insignificant cysts; but it would be wise to follow the blood tests and probably to repeat the scan in some reasonable interval.

[smokey 234]

My question is:  since the oncologist said the cancer is stage IIA. There is no lymphnode involvement, and angiolymph involvement noted, and it is lobular, what else could these dots be? Are dots like these common findings?

[CCF-RN,MSN-JS]

Dear SMOKEY 234, A concern would be that these lesions might be metastasis, however they are too small to really get a good idea about them, to say anything as to whether they look more like a benign or malignant finding.  Being so small they are also likely to be too small to biopsy.  So this finding is taken into context of everything else going on with your situation and the breast cancer.  An alkaline phosphatase elevation could be due to a number of things, and these small lesions wouldn't necessarily explain the elevation.  

Low attenuation is a description of the lesion in comparison to the rest of the liver tissue.  If an increased amount air or water becomes present in a body structure this can produce a low attenuation finding.  Again, because these lesions seen on your ct scan are so small they are difficult to characterize what they are ie. a cyst (fluid-filled structure) or something else.