3035. What to do with a large liver cyst?

Feb 21, 2017

Routine blood test. Liver enzymes slightly elevated.
Ultrasound & MRI. One large liver cyst of around 12 cm across and smaller ones.

3 Gastro-enterologists in private practice.

SPECIALIST 1.
Liver cysts are common. Computer screen shows graphic of liver.
Liver cysts are mostly benign. 3 options.
1. No treatment.  MRI 6 months later to say whether enlarged.
2. Keyhole surgery for histopathology. Not advised as not 100% of cyst wall can be sampled.
    If benign, does not mean no malignancy.
3. Surgery.
3.1 Usual risk of anaesthesia, bleeding, infection. Also pneumonia as painful to breathe post-op, phelgm accumulates. Exercise before surgery. Breathing tools. Patient may regret surgery done if cyst is benign 100% and be able to accept this possibility.
3.2  Will not take out the smaller liver cyst
3.3 Needs 2 surgeons and an anaesthesist for liver surgery.
3.4 I should have sufficient liver tissues to lead a normal life. The liver "regenerates" by enlargement, not really growing new liver cells!

4. Cost $30,000 - $40,000.
5. Need more cancer marker tests and ECG.

SPECIALIST 2.
1. Classmate of Dr Chua Seng Chew, my GP who referred me to him. He does not perform surgery. 
2. Reviewed ultrasound and MRI. 
3. Reviewed colonscopy and gastro-duodenal scopy done by Dr Eu Kong Weng. Advised
stools pre-scope to flush out residual stools affecting scope. 2-yearly scope will do. 
4. Physical exam of right upper abdomen. No pain. Took weight.
5. Refers to Specialist 3 who is a surgeon for another opinion.

SPECIALIST 3.
1. Specialist 3 who is a surgeon.
2. Only 2% of liver cysts become cancerous as most are benign.
The largest liver cyst he operated had filled up the rib cage and causing breathing distress in a patient.   
3. Inserted ultrasound CD into computer and and showed me the "echogenic" materials floating inside the
large cyst. This material and walled cyst could develop into cancerous cells. I was surprised as he had seen the MRI. "Ultrasound provides more information than MRI," he explained patiently.
4. Not Echinococcal cyst as there will be many daughter cysts. As a vet, I might have been exposed
to Echinococcal parasites.  
5. Surgery takes 2-3 hours.
6. Usual risk of anaesthesia, bleeding, infection. Also bile leakage despite closing all major bile ducts during surgery. Need to insert a "drain." I did not ask how this drain will resolve bile leakage. Enquired whether I had hepatitis vaccination or hepatitis in addition to health issues.
7. Will take out the other liver cyst too although I did not ask him.
8. Cost $30,000 - $40,000

CONCLUSION
I requested a routine blood test to screen my cholesterol levels and end up with discovery of
liver cysts from increased liver enzymes. What is the next step?