Because signs and symptoms of liver cancer do not usually appear until it is in its later stages, it is seldom diagnosed early. 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 may already be quite large.

Many patients who develop liver cancer have long-standing cirrhosis (scar tissue formation due to liver cell damage). If a patient with cirrhosis gets worse for no apparent reason, doctors should suspect that liver cancer may be the cause and do appropriate tests.

If a person is known to have cirrhosis, whatever the cause, most doctors recommend liver cancer screening every 6 months with tests of alpha-fetoprotein (AFP) and ultrasound. But it's not yet clear if screening will result in more effective treatment of liver cancer.

Alpha-fetoprotein blood test

Alpha-fetoprotein (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 some types of germ cell tumors of the testicle (in men) or ovary (in women). It can also be found in the blood of pregnant women and can be used to help diagnose some birth defects and other problems with the fetus before birth.

Tests for AFP are used to look for early tumors in people at high risk for liver cancer. But it is usually not advised as a routine test to screen for liver cancer in people at average risk because there are potential problems with using it:

• 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 spread outside the liver.

• Some non-cancerous liver diseases can also raise AFP levels.

In areas 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 AFP testing isn't sensitive enough for people living in the U. S. and Europe, and recommend ultrasound (see the next section) as the main test, although the AFP level may still be measured along with it.

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 echoes are converted by a computer into a black-and-white image that is displayed on a video screen. This test can show masses (tumors) growing in the liver, which can then be tested for cancer, if needed.

This is a very easy procedure to have. It uses no radiation, which is why it is often used to look at developing fetuses. For most ultrasound exams, 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 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 or 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 that doctors consider to be accurate enough for screening in the general population.

People at higher risk for liver cancer may be helped by screening. Many doctors recommend testing for certain groups. This includes 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, while the person is waiting for a transplant, a cancer may develop and become so advanced that it is incurable. 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 HBV or HCV infections be screened, especially 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.

Last Medical Review: 11/05/2009
Last Revised: 11/05/2009