Tests for liver cancer
This page tells you about the tests you may have if your doctor suspects you may have liver cancer. You can find the following information
Tests for liver cancer
You will usually see your family doctor (GP) first, who will examine you and ask about your general health. Your doctor will ask you about your symptoms, including when you get them and whether anything you do makes them better or worse. If your doctor feels that you need further tests, they will refer you to a specialist at your local hospital.
At the hospital
The specialist will ask about your medical history and symptoms. They will examine you and feel your tummy (abdomen). You may have some blood tests, called liver function tests (LFTs). Your doctor may also check the level of a chemical in your blood called alpha fetoprotein (AFP). The level can be raised in many people with hepatocellular cancer. You may also have scans such as an ultrasound scan, CT scan or MRI scan.
Biopsy and laparoscopy
The only way to definitely diagnose liver cancer is to take a sample of tissue. This is called a biopsy. You may have a biopsy at the same time as an ultrasound or CT scan. Or, you may have a small operation called a laparoscopy. The surgeon puts a thin tube, with a camera and a light, into your abdomen through a small cut. This allows your surgeon to look directly at your liver and take samples of tissue.
Not everyone needs a biopsy. Your doctor may be able to give a diagnosis from looking at the results of all your scans and blood tests. If you go on to have surgery to remove the cancer, your doctor can confirm the diagnosis afterwards.
You can view and print the quick guides for all the pages in the diagnosing liver cancer section.
If you are concerned about your health, you are most likely to start by seeing your GP (family doctor), who will examine you and ask about your general health. Your doctor will ask you about your symptoms. This will include what they are and how long you have had them. They may also ask when you get the symptoms and whether anything you do makes them better or worse. If your doctor feels that you need further tests, they will refer you to a specialist at your local hospital.
If you have been told before that you have liver disease (cirrhosis), you will already have a liver specialist and so you may go straight to them.
If you see a specialist, you will be asked again about your medical history and symptoms. The specialist will then examine you and feel your tummy (abdomen). If there is a possibility of cancer, the doctor will want to find out if your symptoms are associated with primary liver cancer or a cancer that has started elsewhere in the body and spread to the liver (secondary liver cancer).
You may have blood tests called liver function tests (LFTs). These show if the liver is working properly. It is important to remember that the liver can be affected by many conditions other than cancer.
LFTs are also useful as an indicator of how well the liver works before, during and after cancer treatment.
One of the other blood tests you may have detects the level of a chemical in your blood called alpha fetoprotein (AFP). In many people with hepatocellular cancer (HCC) the level of AFP is higher than normal. But the level can also sometimes be raised in people with liver cirrhosis who do not have HCC. It is useful for doctors to measure the level of AFP before and after treatment of primary liver cancer as this may give them an idea about how successful treatment has been.
This test uses high frequency sound waves to create a picture of a part of the body. The scan is used to show up any abnormal growths in your liver. You may be asked not to eat for 4 hours before the scan. Read our information about having an ultrasound.
People who are at high risk of liver cancer may have screening with ultrasound every 6 months to check for growths in the liver.
The only clear way to tell the difference between a cancerous (malignant) or non cancerous (benign) growth is to examine it. A biopsy can also show whether cancer in your liver is a primary liver cancer, or whether it is a secondary cancer that has spread to your liver from somewhere else in your body. A biopsy means removing a sample of tissue and looking at it under a microscope. Not everyone needs to have a biopsy. Your doctor may be able to give you a diagnosis from looking at the results of all your scans and blood tests. They can then make a plan for treatment if necessary.
If there is any possibility that your surgeon thinks your tumour could be removed, or that you might benefit from a liver transplant, you probably won't have a biopsy. There is a small risk that a liver biopsy could spread the cancer along the pathway of the biopsy needle. If your cancer hasn't already spread, it is important to avoid this risk. After surgery, your doctor can confirm the diagnosis.
If you are going to have a biopsy, you may have it at the same time as an ultrasound or CT scan. This allows the doctor to see where the abnormal part or parts of the liver are. The doctor can use the information from the scan to guide the needle into the right place. The needle goes through the skin and into the liver so that they can remove some tissue.
Another way of having a liver biopsy is during a laparoscopy. The surgeon can see the liver directly through the laparoscope and can take samples.
After a liver biopsy, you will have to stay in hospital for a few hours or overnight. The liver has a very rich blood supply and there is a risk of bleeding afterwards.
You will not get the results of your biopsy straight away. The specialist will send the liver tissue samples to a laboratory in the hospital for a pathologist to look at. It is a good idea to check with your doctor when the results will be due back and about how you will be contacted and told the result.
A laparoscopy is a small operation using an instrument called a laparoscope (a thin, flexible tube with a camera and light at the tip). The surgeon puts the laparoscope into your abdomen through a small cut. The laparoscope allows the surgeon to look directly at your liver. They can see whether there are any signs of cancer, and assess the stage of any cancer. You have this test under general anaesthetic, so you will have to stay in hospital overnight. You will have a small wound afterwards with a couple of stitches. Sometimes, the camera is put in through more than one cut, so you may have more than one wound.
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