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  • How is liver cancer diagnosed?


    Primary liver cancer and secondary cancer in the liver are diagnosed using a number of different tests. These include blood tests and scans. Tissue examination (biopsy) is only done rarely.

    Blood tests

    You will probably have a blood test to check how the liver is working (liver function) and how well your blood clots. You may also have liver function tests before, during and after treatment.

    If primary liver cancer is suspected, you will have blood tests to check for hepatitis B or C and various genetic problems.

    You may need a blood test to check the level of certain chemicals known as tumour markers that are produced by cancer cells. Tumour markers can help diagnose some types of cancer. The tumour markers used to diagnose primary liver cancer include alpha-fetoprotein (AFP), cancer antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). Carcinoembryonic antigen (CEA) can also be helpful in diagnosing secondary cancer that has spread from the large bowel.

    However the tumour markers do not rise in all people with these cancers. Also some conditions, such as pregnancy, hepatitis and jaundice, can increase tumour marker levels without cancer being present. If the markers are high due to cancer they should fall when treatment ends.

    After blood tests, other tests will need to be done to confirm the diagnosis.

    Scans (imaging tests)

    You will have at least one of these scans but you may have more than one if the doctor needs further information about the cancer.

    CT scan
    A CT (computerised tomography) scan is a type of x-ray that takes three-dimensional pictures of several organs at the same time. It helps doctors make a diagnosis and see if the cancer has spread. It can also help doctors plan surgery if this is appropriate.

    MRI scan
    An MRI (magnetic resonance imaging) scan uses both magnetism and radio waves to take detailed cross-sectional pictures of the body. These show the extent of the tumour and whether it is affecting the main blood vessels around the liver.

    PET-CT scan
    A positron emission tomography (PET) scan combined with a CT scan (see above) is a type of imaging test available at some major metropolitan hospitals. It produces a three-dimensional colour image that shows where some cancers are in the body.

    An ultrasound uses soundwaves to create a picture of a part of your body. It can show the size and location of abnormal tissue in your liver. The test takes about 15 minutes and is painless.

    If a solid lump is found the scan will help show whether it is cancer. Non-cancerous (benign) tumours in the liver can also be found during an ultrasound. These occur in about four out of 10 people.

    Other tests

    A biopsy means removing a small amount of tissue to examine under a microscope. Tissue samples are taken from the liver in either a fine needle aspiration or a laparoscopy. The biopsy can sometimes show if the cancer in your liver is a primary or secondary cancer.

    A biopsy can be done to make a diagnosis if no surgery is planned.

    Before a biopsy you may have a test to check how well your blood clots (how quickly you stop bleeding) because the liver has many blood vessels.

    This operation is also called keyhole surgery. It allows the doctor to look at the liver and surrounding organs using a thin tube containing a light and a camera (a laparoscope). It is often done if your doctor thinks the cancer is in other areas besides the liver.

    Which health professionals will I see?

    Your GP will arrange the first tests to assess your symptoms. If these tests do not rule out cancer you will probably be referred to a gastroenterologist who will organise further tests for you and advise you about treatment options. You may see other specialists such as a surgeon or a medical oncologist to discuss the different types of treatment.

    You will be cared for by a range of health professionals who specialise in different aspects of your treatment. The multidisciplinary team may include some of the professionals from the list below.

    Health professional Job description
    Hepatobiliary surgeon A doctor who specialises in surgery of the liver and its surrounding organs
    Gastroenterologist A specialist in diseases of the digestive system
    Hepatologist A gastroenterologist who has further specialised in diseases of the liver and gall bladder
    Medical oncologist Prescribes and coordinates the course of chemotherapy
    Cancer nurse coordinators and nurses Administer drugs - including chemotherapy - provide care, information and support throughout your treatment
    Social worker, physiotherapist, occupational therapist  Link you to support services and help you to resume your activities
    Dietitian Recommends an eating plan for you to follow while you are in treatment and recovery
    Palliative care team Aims to improve people’s quality of life by symptom management without trying to cure the disease

    This website page was last reviewed and updated July 2017.

    Information reviewed by: Dr Benjamin Thomson, Hepato-pancreato-biliary Surgeon, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, VIC; Joyce Bonello, Cancer Care Coordinator – GIT, Prince of Wales Hospital, NSW; Carol Cameron, Cancer Nurse Coordinator Upper GI, WA Cancer & Palliative Care Network; Karen Hall, Clinical Nurse Cancer Services Division, Flinders Medical Centre, and Cancer Council Helpline Nurse, SA; Robyn Hartley, Consumer; Mamta Porwal, Project Coordinator, B Positive Project, Cancer Council NSW; Chris Rivett, Clinical Nurse Oncology, Western Hospital, and Cancer Council Helpline Nurse, SA; and Dr Kellee Slater, Hepatobiliary, General and Liver Transplant Surgeon, Princess Alexandra Hospital, QLD.

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