Liver Cancer

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Early Detection, Diagnosis, and Staging TOPICS

Can liver cancer be found early?

It is often hard to find liver cancer early because signs and symptoms often do not appear until it is in its later stages. Small liver tumors are hard to detect on a physical exam because most of the liver is covered by the right rib cage. By the time a tumor can be felt, it might already be quite large.

There are no widely recommended screening tests for liver cancer in people who are not at increased risk. (Screening is testing for cancer in people without any symptoms.) But testing may be recommended for some people at higher risk.

Many patients who develop liver cancer have long-standing cirrhosis (scar tissue formation from liver cell damage). Doctors may do tests to look for liver cancer if a patient with cirrhosis gets worse for no apparent reason.

For people at higher risk of liver cancer due to cirrhosis (from any cause) or other conditions, most doctors recommend liver cancer screening every 6 to 12 months with alpha-fetoprotein (AFP) blood tests and ultrasound exams. But it's not yet clear if screening results in more effective treatment of liver cancer.

Alpha-fetoprotein (AFP) blood test

AFP is a protein that is normally present at high levels in the blood of fetuses but goes away shortly after birth. When it is found in the blood of adults, it suggests they may have liver cancer or a germ cell tumor of the testicle (in men) or ovary (in women).

AFP blood tests may be used to look for early tumors in people at high risk for liver cancer. This test is often done every 6 to 12 months along with an ultrasound. But these tests usually are not used to screen people at average risk for liver cancer because they are not always accurate:

  • Some liver tumors do not make a lot of this protein.
  • Often by the time the AFP level is elevated, the tumor is too large to be removed or it has already spread outside the liver.
  • Some non-cancerous liver diseases can also raise AFP levels.

In areas of the world where liver cancer is very common, using the AFP blood test for screening has detected many tumors at an earlier stage. Still, many experts feel that it isn't an accurate enough test by itself for people living in the United States and Europe. They recommend ultrasound as the main test, often along with the AFP test.

Ultrasound

Ultrasound uses sound waves and their echoes to produce a picture of internal organs or masses. A small instrument called a transducer gives off sound waves and picks up the echoes as they bounce off the organs. The echoes are converted by a computer into a black-and-white image. This test can show masses (tumors) growing in the liver, which can then be tested for cancer, if needed.

This is a very easy test to have, and it uses no radiation. For most ultrasound exams, you simply lie on a table while the transducer (which is shaped like a wand) is moved around on the skin over the part of your body being looked at. Usually, the skin is first lubricated with gel.

This test is used in people with certain liver cancer risk factors to help find cancers earlier. Many experts recommend that the test be done every 6 to 12 months. But no one knows for certain how often is really best.

Who should be screened?

Screening for liver cancer is not recommended for people who are not at increased risk. At this time there are no screening tests thought to be helpful for screening in the general population.

People at higher risk for liver cancer may be helped by screening. Many doctors recommend testing people with cirrhosis (from any cause), especially if the cirrhosis is so severe that the patient is on the waiting list to receive a liver transplant. Without screening, a cancer may develop while the person is waiting for a transplant. Finding cancer early usually makes it more likely that the patient will survive longer. Early cancer will also move the person up on the transplant waiting list.

Most doctors also recommend that certain people with chronic hepatitis B virus (HBV) infections be screened, especially those with a family history of liver cancer, African Americans, and Asian Americans.

In other groups at increased risk, the benefits of screening may not be as clear. If you think you are at increased risk for liver cancer, ask your doctor if screening is a good option for you.


Last Medical Review: 09/25/2013
Last Revised: 02/10/2014