Diagnosis of liver cancer

Diagnosis is the process of finding out the cause of a health problem. Usually, diagnosing liver cancer begins when a routine test suggests a problem with the liver. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for liver cancer or other health problems.

The process of diagnosis may seem long and frustrating. It's normal to worry, but try to remember that other health conditions can cause similar symptoms as liver cancer. It's important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of liver cancer.

The following tests are usually used to rule out or diagnose liver cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest liver cancer
• scarring of the liver (called cirrhosis)
• infection with hepatitis B virus (HBV) or hepatitis C virus (HCV)
• drinking large amounts of alcohol
• smoking tobacco

Your doctor may also ask about a family history of:

• liver cancer
• risks for liver cancer
• other cancers

A physical exam allows your doctor to look for any signs of liver cancer. During a physical exam, your doctor may:

• feel the abdomen to find out if any organs are larger than normal or if there is a buildup of fluid (called ascites)
• look at the eyes or skin for yellowing (called jaundice)
• check for swelling in the legs and feet from a buildup of fluid (called edema)

Find out more about physical exams.

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to get basic information about your general health.

Find out more about a complete blood count (CBC).

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find abnormalities. Blood chemistry tests used to diagnose liver cancer include the following.

Liver function tests (also called a liver panel) are a group of blood chemistry tests that are often ordered together. While they do not diagnose liver cancer, they can tell the doctor that there may be a problem with the liver.

Albumin is a protein made by the liver. Low levels of albumin suggest that the liver is damaged.

Bilirubin is made when old red blood cells (RBCs) break down. The liver absorbs and uses bilirubin. A high level of bilirubin may mean that the liver isn't working properly. A buildup of bilirubin in the body can cause jaundice.

Prothrombin time (PT) is the amount of time it takes blood to clot. The liver makes proteins that the blood needs to clot (called coagulation factors). Doctors use bleeding and blood-clotting factor tests to see how well the body can clot blood. Slower clotting time may be caused by liver damage or disease.

Alkaline phosphatase (ALP) is an enzyme found in the liver and other body tissues. A high level of ALP may be a sign of liver damage.

Aspartate aminotransferase (AST) is an enzyme found in liver and heart cells. When liver or heart cells are damaged, they release AST into the blood. A high level of AST in the blood may be a sign of liver damage or disease.

Alanine aminotransferase (ALT) is an enzyme found in the liver and kidneys. A high level of ALT in the blood is often found before symptoms of liver damage, such as jaundice, develop.

Find out more about blood chemistry tests.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to see if the liver is larger than normal. It can also be used to see if a growth in the liver is solid or filled with fluid (like a cyst).

Find out more about ultrasound.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

To diagnose liver cancer, a CT scan is done 4 times. This is called a 4-phase, or multiphase, CT scan. A CT scan is first done without any contrast medium. The next 3 scans are done after contrast medium is injected into a vein. The way the contrast medium flows through the liver can tell doctors if a tumour in the liver is cancerous. When doctors identify liver cancer with a CT scan, they don’t need to do a liver biopsy.

Doctors also use a CT scan to get information about the tumour’s size, shape and location. They use a CT scan to look for signs that the cancer has spread to nearby lymph nodes, tissues or organs. A CT scan also helps the doctor decide if the liver tumour can be removed by surgery.

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI may be used to look for signs that liver cancer has spread to nearby lymph nodes, tissues or organs.

Find out more about MRIs.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample.

In most cases, doctors use a CT scan to diagnose liver cancer. If they can’t confirm that there is a tumour in the liver based on the imaging test results, doctors may do a liver biopsy.

A core needle biopsy uses a large, hollow cutting needle to remove a cylinder-shaped sample (core) from a tumour. It is the most commonly used biopsy for liver cancer because it gives enough tissue for doctors to make a diagnosis.

Find out more about biopsies.

If doctors think someone has liver cancer, they will order a blood test to check for hepatitis viruses. Chronic infection with hepatitis B virus (HBV), hepatitis C virus (HCV) or both increases the risk of developing liver cancer.

Find out more about hepatitis viruses.

An x-ray uses small doses of radiation to make an image of parts of the body on film. It is used to see if liver cancer has spread to the lungs.

Find out more about x-rays.

Tumour markers are substances found in the blood, tissues or fluids removed from the body. An abnormal amount of a tumour marker may mean that a person has liver cancer.

Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to diagnose liver cancer.

In the past, alpha-fetoprotein (AFP) was the tumour marker used for liver cancer. Recent research shows that AFP may also be higher than normal in people who have other types of cancer, including intrahepatic bile duct cancer. Because the test does not specifically identify liver cancer, doctors no longer recommend it as a diagnostic test for liver cancer.

Find about more about tumour markers.

To make the decisions that are right for you, ask your healthcare team questions about diagnosis.