Liver Cancer Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is liver cancer found?

Liver cancer often does not cause symptoms until it is in its later stages, so it is seldom found early. Small tumors are hard to find by physical exams.

Many patients who develop liver cancer have had cirrhosis for a long time. If you have cirrhosis it gets worse for no known reason, your doctor may need to do tests to look for liver cancer.Screening for liver cancer

Screening tests are not advised for people at average risk for liver cancer, but they may be done in people at high risk. (Screening is testing people for a disease before they have symptoms.) Many doctors recommend testing for certain high-risk groups, such as people with cirrhosis and certain people with chronic hepatitis B infections.

For other people at higher risk, the benefits of screening may not be as clear. If you think you are at high risk for liver cancer, talk to your doctor about whether screening is a good idea for you.

The tests used most often to screen for liver cancer are the AFP test and ultrasound of the liver.

AFP test

A protein called AFP (alpha-fetoprotein) is considered a tumor marker for liver cancer. In adults, high blood levels can be a sign of certain types of cancer, including liver cancer.

Blood tests for AFP may be used to look for early tumors in people at high risk for liver cancer. This test isn’t perfect, though. Some cancers do not make much of this protein. Also, some liver diseases that are not cancer can also raise AFP levels. For these reasons, AFP blood tests are not advised for everyone.


An ultrasound test uses sound waves to make pictures of organs inside the body. For a liver ultrasound, you lie on a table while a wand is moved around on the skin over the right side of the belly. Any masses (tumors) seen in the liver can then be tested for cancer if needed.

Tests to get a better look at liver cancer

If you have any symptoms or if there is any reason to suspect liver cancer, your doctor will use one or more tests to find out if you really have the disease. You will have a physical exam, and your doctor will ask you questions about your health. Some of the tests that may be done are described below.

Imaging tests

These tests create pictures of the inside of your body. They may be done to help find tumors that might be cancer, to learn how far cancer may have spread, or to help find out if treatment is working.

Ultrasound: This test is used to find tumors in the liver. Sound waves are used to make a picture of the inside of the body. Most people know about ultrasound because it is often used to look at the baby during a pregnancy. This is an easy test to have. You lie on a table, a gel is put on your skin, and a kind of wand is moved over your belly (abdomen).

CT scan (computed tomography): A CT scan uses x-rays to take many pictures of your insides. The pictures are then put together to show images of slices of the part of your body being studied. CT scans can give precise information about the size, shape, and place of any tumors in the liver or other places.

CT scans take longer than regular x-rays. You need to lie still on a table while they are being done. During the test, the table slides in and out of the scanner, a ring-shaped machine that surrounds the table. You might feel a bit confined by the ring you have to lie in while the pictures are being taken.

You may also have an IV (intravenous) line through which you get a dye. This helps better outline structures in your body. Some people are allergic to the dye and get hives or, rarely, problems like trouble breathing and low blood pressure. Be sure to tell the doctor if you have any allergies or have ever had a problem from any dye used for x-rays. You may also be asked to drink 1 to 2 pints of a liquid that helps outline the intestine so that it is not mistaken for tumors.

MRI (magnetic resonance imaging): MRI scans can be very helpful in looking at liver cancers. Sometimes they can tell a benign tumor from one that is cancer. They can also be used to look at blood vessels in and around the liver and can help show if liver cancer has spread to other parts of the body.

MRI scans use radio waves and strong magnets instead of x-rays to take pictures. A computer makes the pattern of radio waves into a detailed picture of parts of the body. MRI scans take longer than CT scans. You may be inside a large tube-like machine for the scan, which some people do not like. Newer, more open MRI machines can sometimes be used instead.

Angiography: Angiography is an x-ray method used to look at blood vessels. A dye is put into (injected) an artery before the x-rays are taken. The dye outlines the blood vessels on the pictures, showing which ones take blood to the liver cancer. This can help surgeons decide whether the cancer can be removed and, if so, how best to plan the operation.

This test can be uncomfortable because a tiny tube (catheter) has to be threaded from the groin up into the liver artery. Usually drugs are used to numb the groin area before this is done.

Angiography may also be done with a CT or MRI scanner. These are often used instead of x-rays because they can outline the blood vessels in the liver without the need for a catheter in the groin.

Bone scan: A bone scan can help look for cancer that has spread to bones. Doctors might not order this test unless you have symptoms such as bone pain, or if there's a chance you could have a liver transplant to treat your cancer.

For this test, a small amount of low-level radioactive substance is put into a vein. The substance settles in areas of damaged bone throughout the entire skeleton over the course of a couple of hours. You then lie on a table for about 30 minutes while a special camera detects the radioactivity and creates a picture of the skeleton. Bone changes appear as "hot spots" on the skeleton. This may suggest the cancer has reached the bones, but other bone diseases can also cause the same pattern. To find out for sure, other tests such as plain x-rays or MRI scans, or even a bone biopsy might be needed.

Other methods

Other types of tests may be done if your doctor thinks you might have liver cancer but the imaging test results can’t tell for sure.

Laparoscopy: In a laparoscopy the doctor uses a thin, lighted tube with a tiny camera on the end to look at the liver and other organs. The tube is put in through a small cut (incision) in the front of the belly (abdomen). This can help the doctor plan surgery or other treatments. Also, doctors can use small instruments through this tube to take out tissue samples to be looked at under the microscope (see biopsy below).

This test is done in the operating room. You will be given drugs to make you relaxed or asleep during the test. You should be able to go home after you recover.

Biopsy: Other tests can suggest that you may have liver cancer, but sometimes the only way to be sure is to take out a piece of the tumor and look at it under a microscope. This is called a biopsy. (But in some cases, such as in people with cirrhosis whose CT or MRI tests show a liver tumor that is most likely cancer, a biopsy may not be done.)

There are different ways to get the tumor sample. In some cases, a biopsy sample may be taken during surgery to treat the tumor. Another option may be to place a hollow needle through the skin in the belly (abdomen) and into the liver to get a small biopsy sample. The skin where the needle is placed is first numbed. Biopsy samples can also be taken during laparoscopy (see above), when the doctor looks at the surface of the liver and takes samples from any areas that look abnormal.

Lab tests

Blood tests can be done to check for a substance called AFP (alpha-fetoprotein). People with liver cancer often have high AFP levels. Doctors also can compare the AFP levels before and after treatment to see how well the treatment is working.

Other tests can also help the doctor learn how well your liver is working, and how well your other organs are working. This information can help doctors decide whether surgery is an option for you.

Last Medical Review: 10/07/2013
Last Revised: 02/10/2014