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How is secondary cancer in the liver diagnosed?

Secondary cancer in the liver is diagnosed using several tests. These include blood tests and imaging scans.

Blood tests cannot diagnose secondary cancer in the liver on their own, but they can give doctors more information about the cancer. Samples of your blood may be tested to check how well the liver is working and to see if the liver is making proteins to help the blood clot.

You are likely to have a number of imaging scans to check the size of the cancer.

Common tests – The most common imaging scan used to check the liver is an ultrasound. You will also need to have CT and/or MRI 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.

PET–CT scan – A PET (positron emission tomography) scan combined with a CT scan is a specialised imaging test. The two scans provide more detailed and accurate information about where some cancers are in the body. A PET–CT scan is occasionally used for secondary cancer in the liver that has spread from the bowel or from a melanoma. Medicare does not subsidise this scan for all cancers. If this test is recommended, check with your doctor what you will have to pay.

For the PET scan, you will be injected in the arm with a glucose solution containing a small amount of radioactive material. It takes 30–90 minutes for the solution to go through your body. During this time, you will be asked to sit quietly. Your whole body will then be scanned for raised levels of radioactive glucose. Cancer cells show up brighter on the scan pictures because they are more active and take up more of the glucose solution than normal cells do.

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.

Occasionally, a tissue sample (biopsy) may be needed to confirm a diagnosis of secondary cancer in the liver. The sample is usually removed with a needle. A pathologist will look at the tissue under a microscope to check for signs of disease.

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.

If the tests show you have secondary cancer in the liver, the next step is to work out where in the body the cancer started. This may be clear if you have been treated for cancer in the past; otherwise, you will need further tests. Sometimes, even after several tests, the primary cancer can’t be found. This is called cancer of unknown primary (CUP).

Depending on where your doctor thinks the primary cancer started, you may have:

  • an examination of the bowel (colonoscopy), stomach (endoscopy) or breasts (mammogram)
  • a urine test to show whether the kidneys and bladder are working properly
  • a blood test to check for particular chemicals produced by cancer cells. These are known as tumour markers and they relate to the primary cancer – for example, bowel cancer sometimes produces a tumour marker called carcinoembryonic antigen (CEA).

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Understanding Cancer in the Liver

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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,