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It is often hard to find liver cancer early because signs and symptoms often do not appear until it is in its later stages. 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 might already be quite large.
At this time, there are no widely recommended screening tests for liver cancer in people who are at average risk. (Screening means testing for cancer in people who have no symptoms or history of cancer.) But testing might be recommended for some people at higher risk.
Many patients who develop liver cancer have long-standing cirrhosis (scar tissue formation from liver damage). Doctors may do tests to look for liver cancer if a patient with cirrhosis gets worse for no apparent reason.
For people at higher risk of liver cancer because they have cirrhosis (from any cause), hereditary hemochromatosis, or chronic hepatitis B infection (even without cirrhosis), some experts recommend screening for liver cancer with alpha-fetoprotein (AFP) blood tests and ultrasound exams every 6 months. In some studies, screening was linked to improved survival from liver cancer.
AFP is a protein that can be measured in the blood of patients with liver cancer. But looking for high AFP levels isn’t a perfect test for liver cancer. Many patients with early liver cancer have normal AFP levels. Also, AFP levels can be increased from other kinds of cancer as well as some non-cancerous conditions.
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Abou-Alfa GK, Jarnigan W, Dika IE, D’Angelica M, Lowery M, Brown K, et al. Ch. 77 - Liver and Bile Duct Cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020:1314–1341.
Bevers T, El-Serag H, Hanash S, Thrift AP, Tsai K, Maresso KC, and Hawk E. Ch. 23 – Screening and Early Detection. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020:375-398.
Brawley OW and Parnes HL. Ch. 37 - Cancer Screening. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019:-454-470.
Colombo M and Sirlin CB. Surveillance for hepatocellular carcinoma in adults. UpToDate website. https://www.uptodate.com/contents/surveillance-for-hepatocellular-carcinoma-in-adults. Updated September 17, 2018. Accessed March 12, 2019.
National Cancer Institute. Physician Data Query (PDQ). Liver (Hepatocellular) Screening. Accessed at https://www.cancer.gov/types/liver/hp/liver-screening-pdq#_16_toc. on March 12, 2019.
Last Revised: April 1, 2019
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