A liver specialist says it’s best to remove the growing cyst.

Dr. Keith Roach
| For your health

Dear Dr. Roach: Over 15 years ago I was diagnosed with several liver cysts. My doctor and I are monitoring the growth of the cysts using ultrasound, and one of them is increasing in size. We did an MRI with and without contrast to look at the cyst. The radiologist said the cyst looked “complex” and, for lack of a better word, unusual.

A consultation with a liver specialist indicated that we could remove it if we wanted. The doctor stated that he just had a patient who had a cyst and it was a cancerous cyst. He felt that it might be better to remove it, but it was not urgent.

I would be grateful for your opinion on this situation.

— LS

Dear PM: Simple liver cysts are common, and even if they are large, they do not need to be removed unless they cause symptoms. However, any cyst other than a simple cyst should be carefully evaluated as there are many possibilities, including various types of cancer, especially mucinous cystic neoplasm, which may be associated with invasive cancer.

I looked at the ultrasound and MRI reports you sent, and although it seemed like the radiologists thought it was most likely a simple cyst with some bleeding, they couldn’t be sure. In addition, the increase in cyst size is a concern.

In some cases, it is wise to wait and repeat the scan after 6–12 months, when the risk of a cancerous cyst is low. However, since the liver specialist (who has much more experience than me) is so concerned that he recommends surgery, I don’t understand why you would want to wait. I suspect surgery will confirm it was a benign cyst, but you’ll probably sleep better at night once you know for sure.

The surgery is usually performed laparoscopically, and although it is usually a very safe and effective procedure, there is always a small risk of complications. You should talk to your surgeon.

Dear Dr. Roach: Do you have any comments regarding the use of metformin for weight loss and prediabetes? I am a 57 year old woman.

— BS

Dear BS: This is the only question I can answer based on very good data. The National Diabetes Prevention Program addressed this very issue. The study subjects, who had a mean age of 51 years, were overweight and prediabetic, were receiving metformin; an intensive lifestyle program focusing on a low-fat diet and 150 minutes of exercise per week; or placebo.

The diet and exercise group performed better, reducing the rate of new cases of diabetes by 58% compared to the placebo group. However, the metformin group also had an advantage: the number of new diabetes diagnoses decreased by 31%.

Personally, I recommend both. Metformin does help with weight loss a little, but taking it along with some diet changes and exercise will likely have a much better effect than metformin alone. We no longer recommend a low-fat diet, emphasizing whole fruits and vegetables, whole grains and very few processed foods. A registered dietitian will be a valuable partner in helping you create a diet that fits your regimen. You don’t have to train for the full 150 minutes, but it’s a goal you can work towards.

New research shows that drugs such as semaglutide are even more effective at preventing diabetes, but they are very expensive and often not covered by insurance.

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