How Is Liver Cancer Diagnosed?

If you have some of the symptoms of liver cancer, your doctor will begin your diagnosis with a medical history and physical exam.

• Medical history and physical examination - Your doctor will take a complete medical history by asking you about your risk factors, symptoms, and other health problems or concerns. In particular, the doctor will ask about your family history of diseases that could increase your risk of liver cancer. The doctor will feel your abdomen to check your liver, spleen, and other organs for lumps or changes in shape or size. The doctor will also feel your abdomen for abnormal fluid buildup (ascites) and look at the whites of your eyes and you skin to see if they look yellow (jaundice).
  

Imaging procedures allow doctors to learn where the cancer is located and whether it has spread from the liver to other areas of the body.

• Angiography - This x-ray procedure is used to look at blood vessels. A dye is injected into your artery and x-ray images are taken. The dye shows the arteries that supply blood to the liver on the x-ray. This information is helpful in deciding whether the tumor can be removed by surgery. Sometimes, CT scanning and angiography are combined (dynamic sequential CT scanning) to help your doctor plan your surgery.
• Computed tomography (CT or CAT) scan - Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer combines these pictures into an image of a slice of your body (like a loaf of sliced bread). CT scans can show how large the tumor is and whether it has spread to other organs or to the lymph nodes. CT scans are very useful for identifying many types of liver tumors.
• Magnetic resonance imaging (MRI) - MRI uses powerful magnets and radio waves to take detailed cross-sectional images. MRI produces images of cross-sectional slices of your body like a CT scanner. It can also make images of slices that are parallel to the length of your body. In some cases, your doctor may be able to tell from your MRI scan whether your tumor is benign (noncancerous) or malignant (cancerous).
• Ultrasound (ultrasonography) - The doctor glides a small instrument (transducer) over your abdomen. The transducer sends out sound waves that echo off the cells in your organs. A computer translates these sound waves into an image on a monitor so that the doctor can see if any masses are growing in your liver. If the doctor sees any masses, he or she can order more tests to find out if they are cancerous.
  

A biopsy is the only way to be sure whether you have liver cancer. This involves cutting out a small piece of tissue and sending it to a laboratory. A pathologist (doctor who specializes in diagnosing diseases) in the laboratory will look at the tissue under a microscope to see whether it has cancerous cells. The tissue sample can be collected in several different ways:

• Needle biopsy - The doctor uses a fine needle to collect a tiny piece of tissue or a core needle to collect a thin cylinder of tissue. The doctor might also insert a needle attached to a syringe through the abdomen and into the abdominal cavity to collect samples of fluid from the abdomen. The doctor might use CT scans or ultrasound to guide the needle.
• Laparoscopy - The doctor makes one or more small incisions near the belly button. He or she passes a narrow tube (laparoscope) attached to a small camera in the abdomen. The camera takes pictures of the organs in the abdomen. These pictures are projected on a monitor. If tissue looks abnormal, the doctor can insert small instruments through the incision to take small tissue samples.
• Surgical biopsy - Biopsies are sometimes taken during surgery. But doctors often use other biopsy techniques because they prefer to know as much as possible about the tumor before surgery.
  

Your doctor might also order certain blood tests:

• Liver function tests - Liver function test results give your doctor important information about the part of your liver that is not affected by cancer. The doctor needs to know whether surgery to remove the cancer will leave enough healthy liver tissue behind to carry out the liver’s functions.
• Alpha-fetoprotein (AFP) blood test - Fetuses have high levels of AFP in their blood, but this protein usually disappears soon after birth. AFP is found in the blood of about 50 percent to 70 percent of adults who have liver cancer.
  

This content has been reviewed and approved by Myo Thant, MD.