Primary liver cancer is diagnosed using several tests.
Learn more about these tests to diagnose primary liver cancer:
Blood tests cannot diagnose liver cancer on their own, but they can help doctors work out what sort of liver cancer may be present.
Samples of your blood may be sent for various tests:
Liver function tests (LFTs)
Blood tests can check how well your liver is working. You may have liver function tests done before, during and after treatment.
Blood clotting tests
These check if the liver is making proteins that help the blood to clot. Low levels increase your risk of bleeding.
These check for hepatitis B and C, which can lead to primary liver cancer.
Certain chemicals known as tumour markers are produced by cancer cells. Tumour markers can help identify some types of cancer. The most commonly measured tumour marker for HCC is alpha-fetoprotein (AFP). Sometimes the AFP level is normal even when there is liver cancer. On the other hand, a raised AFP level does not always mean cancer – conditions such as pregnancy, hepatitis and jaundice can also increase AFP levels without cancer being present.
The most common imaging scan used to look for liver cancer is an ultrasound. It’s also used to monitor people with cirrhosis. Ultrasound alone cannot confirm a diagnosis of liver cancer, so you will also have one or more other scans as well.
This scan uses soundwaves to create a picture of your organs. It is used to show if cancer is present and how large it is.
You will be asked not to eat or drink (fast) for about four hours before the ultrasound. During an ultrasound scan, you will lie on an examination table with your abdomen uncovered. A gel will be spread on your skin and a device called a transducer will be moved across your abdomen. The transducer creates soundwaves that echo when they meet something solid, such as an organ or tumour.
A computer turns the soundwaves into a picture. An ultrasound is painless, and usually takes 15–20 minutes.
If a solid lump is found, other scans will need to be done to show whether it is cancer. It is common to find non-cancerous (benign) tumours in the liver during an ultrasound.
A CT (computerised tomography) scan uses x-ray beams to take many pictures of the inside of the body. A computer compiles them into one detailed cross-sectional picture.
As part of the procedure, a dye (called the contrast) will be injected into one of your veins. The contrast travels through the bloodstream and shows up any abnormal areas. It may make you feel flushed and cause some discomfort in your abdomen. Symptoms should ease quickly, but tell the doctor if you feel unwell.
You will lie on an examination table and pass through the CT scanner, which is large and round like a doughnut. The whole procedure takes 15–20 minutes.
The dye used in a CT scan can cause allergies. If you have had an allergic reaction to iodine or dyes during a previous scan, tell your medical team beforehand. You should also let them know if you’re diabetic, have kidney disease or are pregnant.
An MRI (magnetic resonance imaging) scan uses magnetic waves to create detailed cross-sectional pictures of organs in the body. These show the extent of the tumour and whether it is affecting the main blood vessels around the liver.
You may be injected with a dye (contrast) that highlights the organs in your body. You will then lie on an examination table inside a large metal cylinder that is open at both ends. The noisy, narrow machine makes some people feel anxious or uncomfortable (claustrophobic). If you think you may become distressed, mention it beforehand to your medical team. You may be given a mild sedative to help you relax, and you will usually be offered headphones or earplugs.
The MRI scan may take between 30 and 90 minutes.
A biopsy is the removal of a tissue sample for examination under a microscope in a laboratory. It is not often needed for diagnosing primary liver cancer, as scans are usually enough, particularly in people with cirrhosis. However, a biopsy may be suggested if there is still uncertainty about the diagnosis once scans have been done.
Before a liver biopsy, your blood may be tested to check it clots normally. This is because the liver has many blood vessels, and there is a risk of bleeding. A sample of cells can be collected in two ways.
The doctor will give you a local anaesthetic to numb the area, and then pass a needle through the skin of the abdomen to remove a sample from the tumour. An ultrasound or CT is used to guide the needle to the right spot. You may need to stay in hospital for a few hours, or overnight if there is a high risk of bleeding.
You will need to have a general anaesthetic for this procedure. The doctor will make some small cuts in the abdomen and insert a thin tube containing a light and camera (laparoscope) to look at the liver and take samples. This procedure is done if your doctor thinks the cancer may have spread to other areas of the body. Laparoscopy is sometimes called keyhole surgery.