Liver Cancer: Diagnosis

If your healthcare provider thinks you might have liver cancer, certain exams and tests will be done to know for sure. The process starts with your healthcare provider asking you questions. You'll be asked about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done.

What tests might I need?

You may have one or more of these tests:

• Blood tests

• Imaging tests

• Biopsy

Blood tests

Blood tests help your healthcare provider get an idea of your overall health. Some can help to look for signs of liver cancer.

Alpha-fetoprotein (AFP) blood test

AFP is a protein in the blood. AFP levels are often high in people with liver cancer. But other conditions can also raise AFP levels. So this test alone can't be used to diagnose liver cancer.

Liver function tests (LFTs)

These tests can show liver irritation and inflammation. They can't tell for sure if you have liver cancer. But if the tests show liver damage, your healthcare provider will likely do other tests to look for the cause of the damage. The damage could be from many different things, like cirrhosis, hepatitis, or cancer.

Imaging tests

Imaging tests may also be done to look for liver cancer.

Ultrasound

This is often the first test done if your healthcare provider suspects liver cancer. An ultrasound is easy to do and doesn’t use radiation. It's very good at showing whether a liver tumor is a fluid-filled sac (cyst) that’s likely not cancer, or a solid mass that’s more likely to be cancer. An ultrasound uses sound waves to look for changes in the liver. The sound waves bounce off your insides and send back a series of signals. A computer turns these signals into images.

MRI

This test creates detailed images of the liver and nearby organs. An MRI uses magnets and radio waves to take pictures of the inside of the body. MRIs can show more detail than other imaging tests. A contrast dye may be put into your blood through a vein before this test. The dye helps get clearer images.

CT scan

A CT scan uses X-rays taken from many angles. It creates very detailed cross-section pictures of the liver and nearby tissues.

Biopsy

If an imaging test shows something in your liver that looks like it might be cancer, your healthcare provider may take out small pieces (called samples) of liver tissue for testing. This is called a biopsy. Then, a pathologist, a healthcare provider who specializes in looking at cells, checks the samples to find out if cancer is there. A biopsy is the only way to know for sure that a change is cancer. There are a few ways to do a biopsy. They include:

Needle biopsy

A thin, hollow needle is put through your skin. It goes into the liver tumor to get a tiny piece of it. A needle biopsy is normally done during a CT scan or ultrasound. The imaging tests help your healthcare provider be sure the needle is going into the tumor. 

Laparoscopic biopsy

During laparoscopy, small cuts are made in your belly. Your healthcare provider then puts long surgical tools into those cuts. One of these tools has a tiny lighted video camera on the end that projects images on a screen. This allows your provider to look at the surface of your liver and nearby organs. If tumors or changed areas are seen, the tools put in the other cuts can be used to take out samples for testing.

Surgical biopsy

This is the most common type of biopsy used for liver cancer. In this case, the tissue for biopsy is taken out during surgery to remove the tumor.

Getting your test results

When your healthcare provider has the results of your tests, they will contact you. It may take a few days. Ask how you can expect to find out about your test results. Will it be a phone call or do you need to make an appointment?

Your healthcare provider will talk with you about other tests you may need if liver cancer is found. Make sure you understand the results and what your next steps should be.