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How is liver cancer diagnosed?

Dr. Jill K. Onesti, MD
Surgical Oncologist

Liver cancer is diagnosed through a variety of imaging studies as well as blood tests and potentially a biopsy. Screening studies are often done using an ultrasound of the abdomen as well as a blood test for alpha-fetoprotein (AFP) level. Follow-up studies include computed tomography (CT) scan or magnetic resonance imaging (MRI). Often the findings on the scans are diagnostic of the cancer, however occasionally a needle biopsy is performed. The tissue from this biopsy is then looked at under a microscope, which can lead to a formal diagnosis.

Liver cancer can be diagnosed through tests. Sometimes doctors do blood tests to tell whether the liver is working properly. They also measure levels of a protein called alpha-fetoprotein. The level of this protein may go up in liver cancer. If it is high, the doctors check it again later on to see how well the treatment is working.

The doctors do scans that take pictures of the inside of the body, like an ultrasound scan, which uses sound waves to show the liver, MRI (magnetic resonance imaging) that uses magnetism and radio waves to take detailed pictures, and a CT (computerized tomography) scan that takes detailed x-rays of the abdomen. The scans can usually confirm a diagnosis of liver cancer.

Sometimes, a small operation called a laparoscopy might be needed too. This involves making a small cut in the abdomen and inserting a thin tube with a camera at the end of it. This allows the doctors to take a close look at the liver itself as well as the area around it. Sometimes a biopsy is needed. This means taking a sample of cells from the tumor, which are then sent to the lab for a detailed examination.

Once all these tests are done, a team of specialists work together to decide on the best treatment.

If liver cancer is suspected, physicians will perform a physical examination to check for lumps on the liver or hardening, and will take a medical history. To image the liver, a computed tomography (CT or CAT) scan and magnetic resonance imaging (MRI) will be performed.

In addition, blood tests are done to measure amounts of certain substances, called tumor markers, which are linked to liver cancer. The presence of one marker, alpha-fetoprotein (AFP) may indicate liver cancer, cirrhosis, or hepatitis if levels are elevated. Levels of red and white cells and platelets are also tested.

Physicians may also want to perform a liver biopsy to examine for cancer cells and damage from cirrhosis. During a liver biopsy, a physician removes a small amount of liver tissue using a thin needle inserted into the liver, which is guided by ultrasound or x-ray. Patients having a biopsy are given local anesthetic for the procedure and pain medication following it.

Liver cancer can be diagnosed with diagnostic tests including CT scan, MRI, ultrasound, PET scan, angiography, biopsy, laparoscopy and lab tests.

Dr. Ajay K. Sahajpal, MD
Transplant Surgeon

There are several methods for diagnosing liver cancer. These include a thorough history and physical along with imaging, biopsy, and blood tests. Imaging tests include CT scans and MRIs. Blood work includes looking at tumor markers such as Alpha fetaprotein. A biopsy is only done if imaging is considered if the diagnosis can't be made with the imaging and blood work. It involves removing a small tissue sample from the liver and examining it for cancer. A liver biopsy may be risky and cause infection and bleeding.

Blood tests may lead a physician to suspect liver cancer, which can then be diagnosed by CT, MRI, or ultrasound with contrast. Cholangiocarcinoma must be diagnosed with special endoscopic and contrast imaging techniques to explore the bile ducts.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.