Even Large Hemangiomas Are Not Cancerous

Q:  What causes liver hemangiomas?

I'm 56 years old and was diagnosed with a hemangioma of my liver on an ultrasound. My doctor confirmed this further with an MRI of my liver. The hemangioma is 5 cm and seems to be causing pain with bending and other movements.

Do I need any further follow up of this or any other treatment?

A:  Hemangiomas are noncancerous tumors consisting of a collection of blood vessels. They can be found throughout the body - on the skin, in the lungs, and commonly in the liver. They often occur as single lesions, but can also be numerous.

Typically, liver hemangiomas do not cause symptoms and are found incidentally when imaging of the abdomen is completed. Hemangiomas larger than 5 cm, like yours, can cause symptoms that you are describing, although even they are usually asymptomatic.

Once confirmed, these tumors usually do not require follow-up. Liver function tests are normal in patients even with large hemangiomas, so there is no need to repeatedly check them. Patients with large tumors like yours may be followed for worsening of symptoms and for any change in size on imaging.

There is no treatment for hemangiomas except for surgery in very rare cases. Surgical intervention is often avoided if possible. Dr. Kia Saeian, hepatologist at the Medical College of Wisconsin, states that "most patients with liver hemangiomas do not require surgical intervention unless the lesion is clearly the cause of otherwise uncontrollable symptoms." All other causes for abdominal pain should be evaluated before concluding that the pain is coming from the hemangioma.

The cause of hemangiomas is unknown; however, estrogen may play a role. Hemangiomas are more common in women and seem to grow with hormone replacement and even pregnancy. Women with large hemangiomas may want to avoid hormone replacement because of the potential association with estrogen.

In your case, I would recommend that you have a repeat imaging study and follow up with your doctor to ensure that the hemangioma has not grown. Other causes for your abdominal pain should be ruled out. If other causes have been ruled out and your symptoms persist or if your hemangioma grows significantly, I would encourage follow up with an experienced liver surgeon.

If a repeat scan in 6 to 12 months shows no growth and your symptoms do not progress, further routine imaging is not warranted.

Deidre L. Faust, MD, is a Staff Physician (Internal Medicine) at the Medical College of Wisconsin's Plank Road Clinic. Her column appears in the Milwaukee Journal-Sentinel.