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Trust Ultrasound Diagnosis of Simple Cyst Rather Than Cancer

Dear Dr. Roach: In order to detect the existence of a hernia, I had a CAT scan. It revealed something mysterious on my liver. The doctor then ordered an ultrasound, and pronounced a simple cyst, not cancer. Others tell me that an ultrasound cannot be conclusive; only a biopsy can do that. Thus, what I have on my liver either may indeed be cancer or become cancer. I know that at age 84 I cannot or should not undergo the very aggressive treatment for liver cancer, so could it be that my doctor is not saying more, knowing that if it is cancer, nothing can be done anyway? — D.B.

Answer: The increasing use of very detailed imaging studies, including CT, MRI and ultrasound, has led to a whole new category of disease — incidental findings. We are learning more about these, but still don’t understand with 100 percent certainty which of these incidental findings are destined to be benign, and which are worrisome.

Although a few people have been cured of serendipitously found cancers, most of these incidental findings are ultimately proved, after much time, money and worry, to be nothing to worry about.

About 1 percent of people have simple liver cysts. If the ultrasound shows it to be a simple liver cyst, it is very, very unlikely to be cancer. If the ultrasound were suspicious, then you and your doctor should have had a discussion about how you want to proceed. The days are, or at least should be, long gone when the doctor made these kinds of decisions without talking to you.

Some liver cancers are completely curable.

Dear Dr. Roach: About two years ago, I had terrible pain on the top part of the left side of my head. It also felt very warm. I went to my doctor, who diagnosed it as shingles and treated me with gabapentin. I can’t recall how long I took the pills, but eventually he told me to wean myself off of them.

My question is: Did I really have shingles? I had the pain, but no sores or blisters on top of my head. — T.K.

Answer: There is a condition called zoster sine herpete, which means “zoster without the blisters.” I have seen cases where the pain precedes the blisters by months — once by 18 months — but I haven’t personally seen a case where the blisters never show. Still, given your history, I think there’s a very good chance that your doctor was right.

Dear Dr. Roach: I am 78 and have had urinary tract infections continually for the past eight or nine months. My urologist prescribed methenamine for six months, then a month of cephalexin, then back to the first prescription. Why is it so hard to get rid of UTIs? What would you recommend? — A.C.S.

Answer: Frequent urine infections are common. However, it is important to find out if this is the same infection that hasn’t ever gone away, or a series of new infections. An infection that doesn’t go away needs an evaluation for something abnormal in the urinary tract, such as a kidney stone. Your urologist is treating you with medication to prevent new infections. Methanamine is a urinary antiseptic, and cephalexin is a broad-spectrum antibiotic.

You didn’t tell me if you are a man or a woman. Men with recurrent infections should be evaluated for prostate issues. Women with recurrent UTIs frequently are affected by atrophic vaginitis. There are many other causes. It’s worth discussing further with your urologist.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853- 6475.