Because signs and symptoms do not usually appear until the cancer is in its later stages, liver cancer is seldom diagnosed early. Small liver tumors are hard to detect by physical examination because most of the liver is covered by the right rib cage. By the time a tumor can be felt, it may already be quite large. But if a person is known to have cirrhosis, whatever the cause, most doctors recommend screening every 6 months with tests of alpha-fetoprotein and ultrasound. However, there are no studies showing that this will result in a higher cure rate.

AFP is a protein that is normally present at high levels in the blood of fetuses but disappears shortly after birth. If it is found in the blood of adults it suggests they may have liver cancer, or other cancers such as testicular or gestation trophoblastic neoplasms. It can also be found in the blood of pregnant women if the placenta has become damaged.

Tests for AFP are used to look for early tumors in people at high risk for liver cancer. But it is usually not advised for routine screening for liver cancer in people at average risk because there are potential problems with using it. Some liver tumors do not make much of this protein. Often by the time the AFP level is elevated, the tumor is too large to be removed or it has spread outside the liver. Some noncancerous liver diseases can also raise AFP levels.

In areas where liver cancer is very common, use of the AFP blood test for screening has resulted in detecting many tumors at an earlier stage. Still, many experts feel that AFP testing isn't sensitive enough for people living in the United States and Europe, and recommend ultrasound (see below) as the main test, although the AFP level may still be measured along with it.

Ultrasonography (Ultrasound)

Ultrasound is a test that uses sound waves and their echoes to produce a picture of internal organs or masses. A small instrument called a transducer emits sound waves and picks up the echoes as they bounce off the organs. The sound wave echoes are converted by a computer into an image that is displayed on a computer screen. This test can show masses growing in the liver, which can then be tested for cancer, if needed.

This is a very easy procedure to have done. It uses no radiation which is why it is often used to look at developing fetuses. When you have an ultrasound exam, you simply lie on a table while the transducer (which is shaped like a wand) is placed on the skin over the part of your body being looked at. Usually, the skin is first lubricated with oil.

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 or 12 months. But no one knows for certain what the right screening interval should be.

Who Should Be Screened?

People at higher risk from liver cancer may be helped by screening. Many doctors recommend testing for certain groups. This includes people with cirrhosis, whether it is due to HBV, HCV, alcohol, hemochromatosis, or other causes. In particular, if a person's cirrhosis is so severe that he or she is waiting to receive a liver transplant, he or she should be screened. Otherwise a cancer may develop during the wait and become so advanced that it is incurable. The development of a cancer will also move the person up on the transplant waiting list.

Some people with chronic HBV or HCV infections should also be screened, such as those with a family history of liver cancer. 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, talk to your doctor about whether screening is a good option for you.