Liver cancer may be diagnosed using several tests. These include blood tests and imaging scans. It is becoming more common for a tissue sample to also be tested. This is called a biopsy.
Blood tests alone cannot diagnose liver cancer, but they can help doctors work out what type of liver cancer may be present and how well the liver is working. Blood tests can also provide information on the type of liver disease that may be causing cirrhosis.
Types of blood tests
Samples of your blood may be sent for the following tests:
- Liver function tests (LFTs) – measures the levels of several substances that show how well your liver is working. You may have liver function tests done before, during and after treatment.
- Blood clotting tests – check if the liver is making proteins that help the blood to clot. Low levels of these proteins increase your risk of bleeding.
- Hepatitis and other liver tests – check for hepatitis B and C, which can lead to liver cancer, and other possible causes of liver disease such as too much iron in the bloodstream.
- Tumour markers – some blood tests look for proteins produced by cancer cells, which are called tumour markers. The most common tumour marker for primary liver cancer is called alpha-fetoprotein (AFP). It may be higher in many, but not all, cases of primary liver cancer. The AFP level may also be raised in people with conditions other than cancer, such as pregnancy, hepatitis and jaundice.
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Tests that take pictures of the inside of the body are known as imaging scans. An ultrasound scan is usually the imaging scan first used to look for liver cancer and to monitor people with cirrhosis. An ultrasound scan alone cannot confirm a diagnosis of liver cancer, so you will also have one or more other scans. You may have some imaging scans more than once during diagnosis and again during treatment.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans, if you have diabetes or kidney disease, or are pregnant or breastfeeding.
Types of imaging scans
- Ultrasound – used to show if there is a tumour in the liver and how large it is. If a solid lump is found, you will need other scans to show whether the lump is cancer. It is common to find non-cancerous (benign) lumps in the liver during an ultrasound.
- CT scan – uses x-ray beams to take detailed, cross-sectional pictures of the inside of your body. It helps show the features of the tumour in the liver. It may also show if the cancer has spread beyond the liver.
- MRI scan – uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the liver and nearby organs. It is used to show the size of the tumour and whether it is affecting the main blood vessels and bile ducts around the liver. This scan is particularly helpful for diagnosing small tumours.
- Bone scan – if a liver transplant is a potential treatment and/or you have pain in the bones, you may need a bone scan to be sure the cancer has not spread (metastasised) to the bones.
Tissue sampling (biopsy)
A biopsy is when doctors remove a sample of cells or tissue from the affected area and a pathologist examines the sample to see if it contains cancer cells. If the diagnosis is not clear after the imaging scans, a biopsy may be useful.
The liver has many blood vessels and there can be risk of bleeding with a biopsy. Before a biopsy, your blood may be tested to check if it clots normally. If you are taking blood-thinning medicines, ask your doctor if you need to stop taking them before and after the biopsy.
The sample of cells is usually collected with a core biopsy. The doctor will pass a needle through the skin of the abdomen to remove a sample of tissue from the tumour. An ultrasound or CT scan helps the doctor 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.
Staging liver cancer
The stage of a cancer describes how large it is, where it is and whether it has spread in the body. Knowing the stage of a liver cancer helps doctors plan the best treatment for you.
Primary liver cancer is staged using the Barcelona Clinic Liver Cancer (BCLC) staging system, which has 5 stages – 0 (very early), A (early), B (intermediate), C (advanced), D (end-stage).
To work out a cancer’s stage, your doctor will consider:
- the size of the tumour
- the number of tumours
- whether the cancer has spread to blood vessels, lymph nodes or other organs
- how well you are functioning in daily life and how active you are
- how well the liver is working (using a Child-Pugh score).
The Child-Pugh score records how well the liver is working. In this system, liver function is ranked as A (some damage but is working normally), B (moderate damage, affecting how well the liver is working), or C (very damaged and not working well). A severely damaged liver may not be able to cope with some types of cancer treatment.
The doctor may also check for portal hypertension. Cirrhosis can sometimes increase the blood pressure in the portal vein, which carries blood from the digestive organs to the liver. This can affect how the cancer can be treated.
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Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of a disease. To work out your prognosis, your doctor will consider:
- test results
- the type of liver cancer, its stage and how fast it is growing
- whether you have cirrhosis and how well the liver is working
- how well you respond to treatment
- other factors such as your age, fitness and overall health.
The prognosis for liver cancer tends to be better when the cancer is still in the early stages, but liver cancer is often found later.
It is important to know that although the statistics for primary liver cancer can be frightening, they are based on an average of many cases and may not apply to your situation. Talk to your doctor about how to interpret any statistics that you come across.
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Expert content reviewers:
A/Prof Simone Strasser, Hepatologist, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and The University of Sydney, NSW; A/Prof Siddhartha Baxi, Radiation Oncologist and Medical Director, GenesisCare, Gold Coast, QLD; Prof Katherine Clark, Clinical Director of Palliative Care, NSLHD Supportive and Palliative Care Network, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Anne Dowling, Hepatoma Clinical Nurse Consultant and Liver Transplant Coordinator, Austin Health, VIC; A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW; Karen Hall, 131120 Consultant, Cancer Council SA; Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre and St Vincent’s Hospital, VIC; Lina Sharma, Consumer; David Thomas, Consumer; Clinical A/Prof Michael Wallace, Department of Hepatology and Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital Medical School, The University of Western Australia, WA; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT
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The information on this webpage was adapted from Understanding Liver Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in July 2022.