Tests for liver cancer

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. Your doctor may also ask when you get them and whether anything you do makes them better or worse. If your doctor feels that further tests are needed, you will be referred to a specialist at your local hospital.

If you have established liver disease (cirrhosis) you will already have a liver specialist and 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). 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 as a secondary cancer.

You may have blood tests called liver function tests (LFT). 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 treatment.

One of the blood tests you may have detects the level of a chemical in your blood called alpha-fetoprotein (AFP). In many people with hepatocellular cancer the level of AFP is higher than normal. 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.

You may also be asked to have one or more of the following tests

• Ultrasound scan
• CT scan
• MRI scan
• Biopsy
• Laparoscopy

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. There is information about having an ultrasound in the cancer tests section of CancerHelp UK.

A CT scan may be used to look for signs of cancer in your liver and elsewhere in your body. The scan can help to show if you have a cancer anywhere else that might have spread to the liver. There is information about having a CT scan in the cancer tests section of CancerHelp UK.

MRI scan may also be used to look for signs of cancer in the liver or elsewhere in your body. There is information about having an MRI scan in the cancer tests section of CancerHelp UK.

The only clear way to tell the difference between a malignant or 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. Before you have a biopsy, doctors will check the condition of your liver to make sure it is safe for you to have it.

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 but definite 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

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 located. 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 some tissue from the liver can be removed. The doctor will take tissue samples from the abnormal part of the liver.

Or you may have a biopsy during a laparoscopy, when the surgeon can see the liver directly through the laparoscope.

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.