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How is liver cancer diagnosed?

Liver cancer is diagnosed using a number of tests. These include blood tests and imaging scans such as ultrasound, CT and MRI. In some cases, a tissue sample (biopsy) may also be tested.

Blood tests cannot diagnose 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 various tests:

Liver function tests (LFTs) – Blood tests can check how well your liver is working.

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.

Tumour markers – Certain chemicals known as tumour markers are produced by cancer cells. The most commonly measured tumour marker for HCC is alpha-fetoprotein (AFP).

The most common imaging scan used to look for liver cancer is an ultrasound. Ultrasound alone cannot confirm a diagnosis of liver cancer, so you will also have one or more other scans as well.

Ultrasound – This scan uses soundwaves to create a picture of your organs. A computer turns the soundwaves into a picture.

CT scan – A CT (computerised tomography) scan uses x-ray beams to take pictures of the inside of the body. A computer compiles them into one detailed cross-sectional picture.

MRI scan − An MRI (magnetic resonance imaging) scan uses magnetic waves to create detailed cross-sectional pictures of organs in the body.

A biopsy is the removal of a tissue sample for examination under a microscope in a laboratory. It is not often needed for diagnosing primary liver cancer, as scans are usually enough. However, a biopsy may be suggested if there is still uncertainty about the diagnosis once scans have been done.

A sample of cells can be collected in two ways.

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 from the tumour. An ultrasound or CT is used to 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.

 Laparoscopy – You will need to have a general anaesthetic for this procedure. The doctor will make some small cuts in the abdomen and insert a thin tube containing a light and camera (laparoscope) to look at the liver and take samples. This procedure is done if your doctor thinks the cancer may have spread to other areas of the body. Laparoscopy is sometimes called keyhole surgery.