How is liver cancer diagnosed?

Tests that examine the liver and the blood are used to detect and diagnose liver cancer. Every person will not receive all the tests described below.

The following tests and procedures may be used:

• Physical exam and health history: A physical exam of the body will be done to check a person’s health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Alpha-fetoprotein (AFP) tumor marker test: Tumor markers are released into the blood by organs, tissues, or tumor cells in the body. An increased level of AFP in the blood may be a sign of liver cancer. Other cancers and certain noncancerous conditions, including cirrhosis and hepatitis, may also increase AFP levels. Sometimes the AFP level is normal even when there is liver cancer.
• Liver function tests: These blood tests measure the amounts of certain substances released into the blood by the liver. A higher-than-normal amount of a substance can be a sign of liver cancer.
• CT scan (CAT scan): This procedure uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the abdomen, taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver. This is called triple-phase CT. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
• Magnetic resonance imaging (MRI): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the liver. To create detailed pictures of blood vessels in and near the liver, dye is injected into a vein. This procedure is called magnetic resonance angiography. Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver. This is called triple-phase MRI.
• Ultrasound exam: This procedure uses high-energy sound waves (ultrasound) that are bounced off the liver and make echoes. The echoes form a picture of the liver called a sonogram.
• Biopsy: During a biopsy, cells or tissues are removed so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the sample of cells or tissues include the following:
  • Fine-needle aspiration biopsy: A sample of fluid, tissue, or cells is removed using a thin needle.
  • Core needle biopsy: A sample of cells or tissue is removed using a slightly wider needle.
  • Laparoscopy: This surgical procedure is done to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Another instrument is inserted through the same or another incision to remove the tissue samples.

  A biopsy is not always needed to diagnose liver cancer. Sometimes the doctors can diagnose liver cancer based on the results of imaging tests such as CT scans and MRI.

After primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body. The process of determining the size and location of the cancer and whether it has spread is called staging.

Some of the tests and procedures used to diagnose liver cancer, such as CT scan and MRI, may be used in the staging process. A positron emission tomography (PET) scan may also be used:

• PET scan: This procedure is used to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

What affects liver cancer prognosis?

Once liver cancer has been diagnosed, the prognosis (chance of recovery) and treatment options depend on the following:

• the stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body)
• how well the liver is working
• the patient’s general health, including whether there is cirrhosis of the liver

Finding and treating liver cancer early may prevent death from liver cancer.

Learn more about trends and statistics for liver cancer.