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Liver cancer often does not cause symptoms until it is inits
later stages, so it is seldom found early. Also, there are no
screening tests for liver cancer, and small tumors are hard to find by
physical exams.
Tests that may be done to find liver cancer
Many patients who develop liver cancer have had cirrhosis for
a long time. If a patient with cirrhosis gets worse for no known
reason, doctors should suspect that liver cancer may be the cause and
do the tests needed to find out if this is the case.
AFP test
Liver cancers can sometimes be found using a blood test for a
protein called AFP (alpha-fetoprotein). It is normal for AFP to be
found in the blood of unborn babies, but it disappears shortly after
birth. If it is found in the blood of adults they may have a liver
cancer (or another kind of cancer).
Tests for AFP have been used to look for early tumors in
people at high risk for liver cancer. Some tumors, though, do not make
much of this protein. So by the time the AFP is high enough to
be found, the tumor may be too large to be removed or may have spread
outside the liver. Some liver diseases that are not cancer can also
raise AFP
levels.
Ultrasound
Ultrasound is a test that uses sound waves to make pictures of
organs inside the body. For an ultrasound, you lie on a
table while a wand is moved over the part of the body being looked at.
Ultrasound is sometimes used in people with certain liver cancer risk
factors to help find cancers earlier. Any masses (tumors) seen in the
liver can then be tested for cancer, if needed.
Who should be tested?
People at higher risk for liver cancer may be helped by
screening. (Screening is testing people for cancer before they have
symptoms.) Many
doctors recommend testing for certain groups. These include people with
cirrhosis, especially if it is so bad that the patient is waiting to
get a liver transplant. Otherwise a cancer may start during the wait
and become so advanced that it can't be cured. Having liver cancer will
also move the person up on the transplant waiting list.
Some people with chronic hepatitis B or C infections should
also be
screened, like those with liver cancer in the family. 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.
Symptoms of liver cancer
Most of the time liver cancer does not cause symptoms in the
early stages. The symptoms below could be caused by liver cancer. But
they can also be caused by other cancers or conditions. Still, if you
have any of the following problems, see a doctor right away.
- Weight loss (when you're not trying to lose weight)
- On-going lack of appetite
- Nausea or vomiting
- Fever
- Feeling very full after a small meal
- A swollen liver or a mass that can be felt on the right
side
- A swollen spleen, felt as a mass under the ribs on the
left side
- Constant stomach pain
- Swelling in your belly (abdomen)
- Itching
- Yellowing of the skin and eyes (jaundice)
- Swollen veins on the belly that can be seen through the
skin
- Becoming sicker if you have chronic hepatitis or cirrhosis
Some liver tumors make hormones that act on organs other than
the liver. These hormones may cause:
- High blood calcium levels that can cause nausea,
confusion, constipation, weakness, or muscle problems
- Low blood sugar levels, which can make you feel very tired
or faint
- Breast enlargement and/or shrinking of the testicles in men
- High counts of red blood cells which can cause someone to
look red and flushed
These findings may cause doctors to suspect a disease of the
nervous system or an endocrine (hormone-making) gland, rather than a
liver cancer. Tests will be 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 make 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 a baby during
pregnancy. This is an easy test to do. You lie on a table, a
gel is put on your skin, and a
kind of wand is moved over your belly (abdomen)..
CT scans
(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 in the belly (abdomen).
CT scans take longer than regular x-rays. You will need to lie
still on a table while the scans are done. 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 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 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 are very helpful in looking at liver cancers. Sometimes they
can show whether a tumor is cancer. MRI scans take longer
than CT scans. You may be inside a large tube-like machine, which some
people do not like. Some areas now have newer, more open machines.
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 make the area numb before this is done (this is
called local
anesthetic).
Other tests can suggest that a liver cancer is present, but in most
cases the only way to be sure is to take a piece of the tumor and look
at it under a microscope. This is called a biopsy. There are different
ways to get the tumor sample. In some cases, a biopsy sample may be
taken during surgery that is meant to treat the tumor. If the tumor is
large or has spread throughout the liver, a hollow needle can be placed
through the skin in the belly (abdomen) and into the liver. 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.
Laparoscopy:
In a laparoscopy the doctor uses a thin, lighted tube 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 in planning 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). You will be given
drugs to make you relaxed and sleepy during this test.
Biopsy
Other tests can suggest that a liver cancer is present, but in
most cases the only way to be sure is to take a piece of the tumor and
look at it under a microscope. This is called a biopsy. There are
different ways to get the tumor sample. In some cases, a biopsy sample
may be taken during surgery that is meant to treat the tumor. If the
tumor is large or has spread throughout the liver, a hollow needle can
be placed through the skin in the belly (abdomen) and into the liver.
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.
Blood tests
Blood tests can be done to check for a substance called AFP
(alpha-fetoprotein). AFP levels are often high in people with liver
cancer. Doctors 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 the part of your liver that is not
affected by cancer is doing, and how well your other organs are
working. This information can help doctors decide whether surgery is an
option for you.
Last Medical Review: 12/15/2009 Last Revised: 12/15/2009
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