Wednesday, December 19, 2012

Livers and Liver Biopsies

Tuesday, I had a biopsy of my liver.  When I finally got to see my oncologist and find out what "it's complicated" meant, it turned out that there was radioactive tracer uptake in three lesions in my liver which showed on my P.E.T. scan.

You see, when you have a P.E.T. (Positron Emission Tomography), you are injected with radioactive isotopes of glucose (called a radiotracer).  To prepare for the test, you must refrain from physical activity (even walking the dog) the day before and fast prior to showing up.  I think drinking lots of water the day before helps, at least it helps with your blood vessels being plump and easily accessed.  You receive the shot of the radiotracer, then rest for an hour.  Areas which metabolize, or consumer the sugar, more quickly than others will take up more of the radioactive material.  When you are put through a cyclotron, the clyclotron is able to make a 3-D computerized image of what is in your body and the areas which are metabolizing the radioactivity will show up hotter.  Since cancer cells are usually sucking up as much energy (sugar) as possible, those spots are hotter--they are metabolizing at a different rate so the diagnostic imaging specialists can see what is going on.  P.E.T. scans are used for other diseases such as Alzheimer's, Epilepsy and heart disease.

P.E.T. scans are great for showing early signs of cancer in the brain, lungs, bone, as well as indicating whether or not chemotherapy is effective.  Usually, it is used along with other tests such as MRIs to get a better idea of what is going on.

I had a P.E.T. scan a week and a half ago.  My oncologist called and said that the results were "complicated."  When I went to see him, he said that there was uptake in my liver, but that he didn't trust it.  Why? The P.E.T. indicated that there was no further uptake in my bone mets which had been diagnosed earlier--they were stable.  My tumor markers were still moving down which indicated that there wasn't growth in the tumor but that the cancer was being killed and my liver function was normal.

It was possible that it was cancer and that the tumor markers we were following were no longer effective in predicting my status because the cancer may have changed its characteristics and was producing different proteins that we weren't following.  The only way to know for sure what was going on was to have a liver biopsy .  In a liver biopsy, you are given an i.v. with saline solution which also contained some pain killers and light sedatives.  You would then be given a C.T. with contrast while a needle would go in and take tissue from the suspected areas. For two weeks prior to the biopsy, you should refrain from taking Ibuprofen as it has blood thinning capabilities which can cause  you to bleed when the biopsy is done.  Novocaine or another numbing agent was injected at a couple of  levels, the muscle on the exterior, and the "sack" which is on the outside of the liver which has nerve endings.  The liver itself doesn't have any nerve endings, so once you get past those other areas, you won't feel pain.

In my case, two of the lesions were at the back and one was in the center front, just below the sternum and to one side.  Since the easier one to get to was in front, a needle was inserted, I felt some pricks--the shot of the numbing agent...much like it used to feel when you got Novocaine prior to filling a cavity when I was a kid (they seem to numb the surface now before you get the shot so it doesn't hurt so much).  While it isn't pleasant, it isn't horrific either and the pricks are over quickly.  I was correct in thinking it would be as uncomfortable as when they have to dig to find my veins, but bearable.  Then, hollow needles are inserted and tissue cores of the area are taken to be analyzed.

Before doing the needle biopsy, the Radiologist took a look at the CT scan to make sure that it was clear and that he could see where he was going.   I was talking to the nurse and the technician....the nurse said "Boy, they're taking a long time.  What are they doing back there."  The technician looked back "hmm....they're hovered over the computer looking at the image."  I laughed...and told them it was because they couldn't find anything.

You see, the liver metabolizes glucose...and a P.E.T. is often a poor diagnostic tool for livers as it has a lot of  background "noise" --in other words, uptake of the radiation where there isn't any cancer.  When the radiologist returned, he had a perplexed look on his face.  I said, "You couldn't find it, could you?"  He said no, and I laughed and told him I thought that was going to be the case.  He said I could either go home, or he could take a sample from the area as indicated on the P.E.T. scan, but that he would be going blind.  I told him to go ahead because if there were areas of cancer in that area, then we had better do as best we could to determine whether or not it was or wasn't there....He said he would take the samples and analyze them quickly to see if he could see cancer cells...that it would tell us if we needed to look more.  This isn't the final say as a more thorough check would be made of the liver samples.  He only saw liver cells in the quick analysis.

After the procedure, I was to lay quietly, not moving or getting up in order to prevent the biopsy sites from bleeding for two hours. The nurse said that if I had had it on my side, that I should be laying on my side to add pressure, but since it was right in the middle and my port was accessed (thus being on my stomach would prevent the flow of the saline into my port in my chest), I just stayed on my back.

When I came home, I was pretty tired, primarily because I had accidentally read longer than I intended when I went to bed, and I had to be up before 5:00 a. m. to make it to the appointment.  In addition, I don't clear pain killers and sedatives from my system very well.  I wasn't to lift, do anything strenuous, avoid taking Ibuprofen for about a week.  I wasn't to drive the day I had the procedure either.  So...I slept for a couple of hours at  home, went to a quilting gathering with some friends picking me up...came home and went to bed.

There really isn't much to it....however, it does sound scary and most of my friends cringed when I told them I had to have a liver biopsy.  Of course, when you think liver biopsy, you think surgery where you actually have to open the chest wall. In reality, this was much less to worry about than you would think.  I arrived at the hospital at 6:00 a.m, had the procedure and left the hospital at about 12:30 p.m.'re wondering why the lilies at top? Well, it was the only photo I could think of that I had which might illustrate this without grossing anyone out....and of course...I'm sure you are not too lily-livered to have a biopsy should you need one.


  1. Thanks for the humourous twist at the end. Hope the results will be positive-in a GOOD way!

  2. I'm sure they will be, Thandi. At any rate, even if they aren't we'll know more about it. I haven't had a biopsy since 1998 and cancer can change into a different type fairly easily.

    I mainly wanted to write this so that people who are facing a liver biopsy can know what to expect and maybe understand the process a bit better! Here's to healthy livers! (Healthy Live-ers?)

  3. dear lisa,

    what a great job you did describing the liver biopsy and PET scan process! i am a nurse (for 30 years), diagnosed with st IV metastatic breast ca a year ago (now NED). it's so true - knowledge is power. i am sure anyone facing what you went through with the biopsy of your liver will be much less nervous and frightened after reading this post. please know i am sending you positive waves of hope that the results are good, along with thanks for all the time and effort you spent explaining the procedure.

    love, XOXO,

    karen, TC

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