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Diagnosis of liver cancer
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 commonly used to rule out or diagnose liver cancer. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment.
Health history and physical exam
Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. In taking a health history, your doctor will ask questions about a personal history of:
- symptoms that suggest liver cancer
- scarring of the liver (called cirrhosis)
- infection with hepatitis B virus or hepatitis C virus
- drinking large amounts of alcohol
Your doctor may also ask about a family history of:
- liver cancer
- risk factors 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 there is a buildup of fluid
- 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 exam.
Blood chemistry tests
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities.
Blood chemistry tests used to diagnose liver cancer include the following.
Liver function tests
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. If liver cells are damaged, they do not make normal amounts of albumin. 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 (metabolizes) bilirubin. A high level of bilirubin may mean that the liver isn’t working properly and is a sign of liver damage. A buildup of bilirubin in the body can cause jaundice.
Prothrombin time (PT) is the amount of time it takes blood to clot. This test may also be called prothrombin time and international normalized ratio (PT/INR). The international normalized ratio is a standard way to report test results. 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.
Other blood chemistry tests
Other blood chemistry tests that may be used to look for problems with the liver include:
Blood glucose levels to measure the amount of sugar in the blood. The liver releases glucose into the blood to maintain normal blood sugar levels. Low levels of blood glucose, or blood sugar, may mean the liver is damaged.
Alkaline phosphatase (ALP) is an enzyme (a protein that speeds up certain chemical reactions in the body). It is 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, muscle 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 another 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.
Partial thromboplastin time (PTT) measures the amount of time it takes a sample of blood to form a clot in a test tube when certain chemicals are added.
Find out more about blood chemistry tests.
An ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to see if the liver is larger than normal, if it has thickened or if a growth in the liver is solid or filled with fluid (like a cyst).
Doctors may also use ultrasound to guide them to specific parts of the liver during a biopsy.
Find out more about ultrasound.
A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.
To diagnose hepatocellular carcinoma (HCC), 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 HCC. When doctors identify HCC 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 scan.
Magnetic resonance imaging (MRI) uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.
MRI may be used to look for signs that primary liver cancer has spread to nearby lymph nodes, tissues or organs.
Find out more about MRI.
During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. The report from the lab will confirm whether or not cancer cells are present in the sample.
In most cases, doctors use a 4-phase CT scan to diagnose liver cancer. If they can’t confirm that there is a tumour in the liver based on imaging tests, doctors may do a liver biopsy.
Core needle biopsy uses a large, hollow, cutting needle to remove a cylinder-shaped sample (core) from a tumour or abnormal mass. It is the most commonly used biopsy for liver cancer because it provides enough tissue for doctors to make a diagnosis.
Find out more about biopsy.
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.
Complete blood count (CBC)
A 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 before treatment starts.
Find out more about complete blood count (CBC).
An x-ray uses small doses of radiation to make an image of the body’s structures on film. A chest x-ray is used to see if liver cancer has spread to the lungs.
Find out more about x-ray.
Tumour marker tests
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 hepatocellular carcinoma, doctors no longer recommend it as a diagnostic test for liver cancer.
Find about more about tumour marker tests.
Questions to ask your healthcare team
A sac in the body that is usually filled with fluid or semi-solid material.
A substance used in some diagnostic procedures to help parts of the body show up better on x-rays or other imaging tests.
In most cases, contrast medium is injected into or around the structure to be examined.
Also called contrast dye or contrast agent.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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