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How is liver cancer diagnosed?

Primary liver cancer may be diagnosed using a number of tests. These include blood tests and imaging scans. In some cases, a tissue sample (biopsy) may also be tested.

Blood tests cannot diagnose primary 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 the following 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.

Hepatitis tests – These check for hepatitis B and C, which can lead to primary liver cancer.

Tumour markers – Some blood tests look for proteins produced by cancer cells. These proteins are called tumour markers. Many people with HCC have higher levels of the tumour marker alpha‑fetoprotein (AFP). Other conditions such as pregnancy, hepatitis and jaundice can also raise the level of AFP in the bloodstream, and some people with HCC have normal levels. The level of AFP may tell your doctor more about the cancer and how well treatment is working.

Tests that create pictures of the inside of the body are known as imaging scans. Ultrasound is commonly used to look for primary liver cancer and also to monitor people with cirrhosis. Ultrasound alone cannot confirm a diagnosis of liver cancer, so you will also have one or more other scans.

Ultrasound – You will be asked not to eat or drink (fast) for about four hours before the ultrasound. You will lie on your back for the procedure. A gel will be spread onto your abdomen and a small device called a transducer will be moved across the area. The transducer creates soundwaves that echo when they meet something solid, such as an organ or tumour. A computer turns these echoes into pictures. An ultrasound is painless, and usually takes 15–20 minutes. An ultrasound is used to show if there is a tumour in the liver and how large it is. 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.

CT scan – A CT (computerised tomography) scan uses x-ray beams to create 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 disease has spread beyond the liver.

Before the scan, a liquid dye (called contrast) is injected into one of your veins. This helps ensure that anything unusual can be seen more clearly. The dye may make you feel flushed and cause some discomfort in your abdomen. These reactions should go away quickly, but tell the doctor if you feel unwell.

The CT scanner is large and round like a doughnut. You will need to lie still on a table while the scanner moves around you. The scan itself is painless and only takes a few minutes, but getting ready for it can take 10–30 minutes.

MRI scan – An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the liver and nearby organs. An MRI is used to show the size of the tumour and whether it is affecting the main blood vessels around the liver.

Before the scan, you may be injected with a dye (contrast) that highlights the organs in your body. During the scan, you will lie on an examination table that slides into a large metal tube that is open at both ends. Lying within the noisy, narrow machine makes some people feel anxious or uncomfortable (claustrophobic). If you think you may become distressed, mention this beforehand to your doctor or nurse. 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.

Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you have diabetes or kidney disease or are pregnant.

A biopsy is when doctors remove a sample of cells or tissue from the affected area, and a pathologist examines the sample under a microscope to see if it contains cancer cells.

A biopsy 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 the diagnosis is still not clear after the 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. If you are taking blood-thinning medicines talk to your doctor about whether you need to stop taking them in the days or weeks before the biopsy.

The sample of cells is usually collected with a core biopsy. 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 of tissue from the tumour. An ultrasound or CT 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.

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This information is reviewed by

This information was last reviewed June 2020 by the following expert content reviewers: Dr David Yeo, Hepatobiliary/Transplant Surgeon, Royal Prince Alfred, Chris O’Brien Lifehouse Cancer Centre and St George Hospitals, NSW; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Michael Coulson, Consumer; Dr Sam Davis, Interventional Radiologist, Staff Specialist, Royal Brisbane and Women‘s Hospital, QLD; Prof Chris Karapetis, Network Clinical Director (Cancer Services), Southern Adelaide Local Health Network, Head, Department of Medical Oncology, Flinders Medical Centre and Flinders University, SA; Dr Howard Liu, Radiation Oncologist, Princess Alexandra Hospital, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Lina Sharma, Consumer; Dr Graham Starkey, Hepato-Biliary and General Surgeon, Austin Hospital, VIC; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, Canberra Hospital and Health Services, ACT; Dr Michael Wallace, Western Australia Liver Transplant Service, Sir Charles Gairdner Hospital,