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Some liver cancers can be found by testing people at high risk who don't have symptoms (screening), but most liver cancers are found because they are causing symptoms. If you have possible signs or symptoms of liver cancer, see your doctor, who will examine you and may order some tests.
Your doctor will ask about your medical history to learn more about your symptoms and possible risk factors. Your doctor will also examine you to look for signs of liver cancer and other health problems, probably paying special attention to your abdomen and checking your skin and the whites of your eyes looking for jaundice (a yellowish color).
If symptoms and/or the results of the physical exam suggest you might have liver cancer, more tests will probably be done. These might include imaging tests, lab tests, and/or biopsies of liver tissue.
Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. Imaging tests maybe done for a number of reasons both before and after a diagnosis of liver cancer, including:
Ultrasound is often the first test used to look at the liver. It uses sound waves to create an image on a computer screen. This test can show tumors growing in the liver, which then can be tested for cancer, if needed.
The CT scan is an x-ray test that makes detailed images of your body. A CT scan of the abdomen can help find many types of liver tumors. It can give specific information about the size, shape, and location of any tumors in the liver or elsewhere in the abdomen, as well as nearby blood vessels. CT scans can also be used to guide a biopsy needle precisely into a suspected tumor (called a CT-guided needle biopsy). If you are found to have liver cancer, a CT of your chest may also be done to look for possible cancer spread to the lungs.
Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. MRI scans can be very helpful in looking at liver tumors. Sometimes they can tell a benign tumor from a malignant one. They can also be used to look at blood vessels in and around the liver to see any blockages, and can help show if liver cancer has spread to other parts of the body.
An angiogram is an x-ray test that looks at blood vessels. Contrast medium, or dye, is injected into an artery to outline blood vessels while x-ray images are taken.
Angiography can be used to show the arteries that supply blood to a liver cancer, which can help doctors decide if a cancer can be removed and to help plan the operation. It can also be used to help guide some types of non-surgical treatment, such as embolization (see Embolization Therapy for Liver Cancer).
Angiography can be uncomfortable because a small catheter (a flexible hollow tube) must be put into the artery leading to the liver to inject the dye. Usually the catheter is put into an artery in your groin and eased up into the liver artery. You have to stay very still while the catheter is in place. A local anesthetic is often used to numb the area before inserting the catheter. Then the dye is injected quickly to outline all the vessels while the x-rays are being taken.
Angiography can also be done with a CT scanner (CT angiography) or an MRI scanner (MR angiography). These techniques are often used instead of x-ray angiography because they can give information about the blood vessels in the liver without the need for a catheter in the groin. You will still need an IV line in your arm so that a contrast dye can be injected into the blood during the test.
A bone scan can help look for cancer that has spread (metastasized) to bones. Doctors don't usually order this test for people with liver cancer unless you have symptoms such as bone pain, or if there's a chance you may qualify for a liver transplant to treat your cancer.
Other types of tests may be done if your doctor thinks you might have liver cancer but the imaging results aren’t certain.
A biopsy is the removal of a sample of tissue to see if it is cancer. Sometimes, the only way to be sure that liver cancer is present is to take a biopsy and look at it in the pathology lab. But in some cases, doctors can be fairly certain that a person has liver cancer based on the results of imaging tests such as CT and MRI scans. In these cases, a biopsy may not be needed.
Doctors are often concerned that sticking a needle into the tumor or otherwise disturbing it without completely removing it might help cancer cells spread along the needle's path. This is a major concern if surgery or a liver transplant might be an option to try to cure the cancer, as any spread of the cancer might make the person ineligible for a transplant. That is why some experts recommend that patients who could be transplant candidates only have biopsies done at the center where the transplant will be done.
If a biopsy is needed, it can be done in several ways.
Needle biopsy: A hollow needle is placed through the skin in the abdomen and into the liver. The skin is first numbed with local anesthesia before the needle is placed. This type of biopsy is typically done with the help of an ultrasound or CT scan to guide the needle.
Laparoscopic biopsy: Biopsy specimens can also be taken during laparoscopy. This lets the doctor see the surface of the liver and take samples of abnormal-appearing areas.
Surgical biopsy: An incisional biopsy (removing a piece of the tumor) or an excisional biopsy (removing the entire tumor and some surrounding normal liver tissue) can be done with surgery.
For more information about biopsies and how they are tested, see Testing Biopsy and Cytology Specimens for Cancer.
Your doctor could order lab tests for a number of reasons:
AFP is a protein that can be found in high levels in adults with liver disease, liver cancer, who are pregnant, or other cancers.
If AFP levels are very high in someone with a liver tumor, it can be a sign that liver cancer is present. But liver cancer isn’t the only reason for high AFP levels. Many patients with early liver cancer have normal levels of AFP, so high AFP levels aren’t very helpful in determining if a liver mass might be cancer.
This test, however, is sometimes useful in people already diagnosed with liver cancer. The AFP level can help determine treatment options. During treatment, the test can be used to give an idea of how well it is working, as the AFP level should go down if treatment is effective. The test can also be used after treatment, to look for possible signs that the cancer has come back (recurred).
Tests for viral hepatitis: Your doctor might order blood tests to check for hepatitis B and C.
Liver function tests (LFTs): Because liver cancer often develops in livers already damaged by hepatitis and/or cirrhosis, doctors need to know the condition of your liver before starting your treatment. If the part of your liver not affected by cancer isn’t working well, you might not be able to have surgery to try to cure the cancer, as the surgery might require removal of a large part of your liver. Other treatment options such as certain targeted therapy or chemotherapy may also not be good choices if your liver is not working well.
Blood clotting tests: The liver also makes proteins that help blood clot when you bleed. A damaged liver might not make enough of these clotting factors, which could increase your risk of bleeding. Your doctor may order blood tests to help measure this risk.
Kidney function tests: Tests of blood urea nitrogen (BUN) and creatinine levels are often done to assess how well your kidneys are working.
Complete blood count (CBC): This test measures levels of red blood cells (which carry oxygen throughout your body), white blood cells (which fight infections), and platelets (which help the blood clot). It gives an idea of how well the bone marrow (where new blood cells are made) is functioning.
Blood chemistry tests and other tests: Blood chemistry tests check the levels of a number of substances in the blood, some of which might be affected by liver cancer. For example, liver cancer can raise blood levels of calcium, while blood glucose levels may fall. Liver cancer can also sometimes raise cholesterol levels, so this may be checked as well.
For more information about tests see Exams and Tests for Cancer.
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National Cancer Institute. Physician Data Query (PDQ). Adult Primary Liver Cancer Symptoms, Tests, Prognosis, and Stages – Patient Version. Accessed at https://www.cancer.gov/types/liver/patient/about-adult-liver-cancer-pdq on March 12, 2019.
National Cancer Institute. Physician Data Query (PDQ). Adult Primary Liver Cancer Treatment. Accessed at https://www.cancer.gov/types/liver/hp/adult-liver-treatment-pdq on March 13, 2019.
Schwartz JM, Carithers RL, and Sirlin CB. Clinical features and diagnosis of hepatocellular carcinoma. UpToDate website. https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-hepatocellular-carcinoma. Updated November 2, 2018. Accessed March 12, 2019.
Last Revised: April 1, 2019
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