Liver cancer usually does not cause symptoms until it is in its 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 apparent reason, liver cancer may be the cause. The doctor would then look at testing for it.

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 produce 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 non-cancerous liver diseases can also raise AFP levels.

Ultrasound

Ultrasound is a test that uses sound waves to make pictures of internal organs such as the liver. For an ultrasound, you lie on a table while a wand is moved over the part of the body being looked at. Ultrasound may be done before a biopsy to see if the lump is a cyst (most likely benign) or a solid tumor.

Who Should Be Tested?

People at higher risk for liver cancer may be helped by screening, that is, tested before symptoms appear. Many doctors recommend testing for certain groups. This includes 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 HBV or HCV infections should also be screened, such as 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 option 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 (for no known reason and when not trying to lose weight) 
• on-going lack of appetite 
• feeling very full after a small meal 
• liver swelling or a mass that can be felt in the area of the liver (the right side of your belly)
• ongoing stomach pain 
• swelling in the area of the stomach 
• skin itching 
• yellow-green color to the skin and eyes (jaundice) 
• swollen veins that can be seen through the skin 
• becoming sicker if you have chronic hepatitis or cirrhosis

If you have any of these symptoms or if there is any reason to suspect liver cancer, your doctor will use one or more methods to find out if you really have the disease.

Tests to Get a Better Look at Liver Cancer

If there is any reason to think you may have cancer, the first step is for the doctor to gather facts about your symptoms, risk factors, family history, and health status. You will have a physical exam and your doctor will ask you questions about your health. Next you will have some tests done. Some of these tests are listed below.

Ultrasound

Ultrasound uses sound waves to produce a picture of the inside of the body. Most people know about ultrasound because it is often used to view a baby during pregnancy. Different echo patterns can help tell if there is a tumor and, in some cases, what type it is.

This is an easy test to take. You simply lie on a table and a kind of wand (transducer) is moved over the part of the body being looked at.

CT Scans (Computed Tomography)

A CT scan uses x-rays to take many pictures of the body. The pictures are then put together to show images of slices of the part of your body being studied. This is a very useful test for finding liver cancers. During the test you will most likely get an injection of a dye that helps outline the organs inside. You must lie still for 15 to 30 minutes while the pictures are taken, but CT scans are getting faster all the time.

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 image of parts of the body. MRI scans are very helpful in looking at liver cancers. Sometimes they can tell a benign tumor from a cancerous one. MRI scans take longer than CT scans and you may be inside a large tube-like machine, but now there are newer "open" machines.

Angiography

Angiography (an-jee-ahg-ruh-fee) is an x-ray method used to look at blood vessels. A dye is injected into 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 (local anesthetic).
 
Laparoscopy

In a laparoscopy (lap-uh-ros-kuh-pee) the doctor uses a thin, lighted tube to look at the liver and other organs. The tube is put in through a small incision in the front of the belly (abdomen). Laparoscopy allows doctors to see organs. 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 (called a biopsy). The patient is given drugs to make him sleepy during this test.

Biopsy

Although other tests can suggest that a liver cancer is present, 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 (by-op-see). There are many different ways to get the tumor sample. When a biopsy is done, the skin where the needle is placed is first numbed. The hard part of the test is lying still while the needle is moved to the right place. Biopsy samples can also be taken during laparoscopy. This lets the doctor to see the surface of the liver and take samples from areas that look abnormal.

Blood Tests

A series of 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 blood tests can also help the doctor learn how well the part of your liver that is not affected by cancer is doing. This information can help doctors decide whether surgery is an option for you.