Diagnosing Liver Cancer

The following blood tests may be ordered to determine if a mass found in the liver is cancerous.

Liver function tests (LFTs)

A series of blood tests can help assess how well the liver is working.

Blood clotting tests

A damaged liver may not make enough of the proteins that allow the blood to clot and therefore prevent bleeding.

Tests for viral hepatitis

Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) is linked both to cirrhosis of the liver (see above) and to liver cancer.

Kidney function tests

A series of blood tests can help assess the how well the kidneys are working.

Complete blood count (CBC)

This test measures levels of red blood cells, white blood cells (which fight infections), and platelets (which help the blood clot). It also shows how well the bone marrow, where new blood cells are made, is functioning.

Blood chemistry tests and other tests

Blood chemistry tests check the levels of a number of minerals and other substances in the blood, some of which might be affected by liver cancer.

Alpha-fetoprotein blood (AFP) test

The AFP level can help determine what treatment options might be appropriate. Also ordered during treatment, to find out how well the therapy is working, or find out if the cancer has come back.

The diagnosis of liver cancer is usually confirmed through imaging studies. These include:

CT scan

Computed Tomography (CT) scans take many different x-rays to produce detailed, cross-sectional images of the liver and other organs.

Magnetic resonance imaging (MRI)

MRI scans use radio waves and strong magnets instead of x-rays to take pictures of the body. MRIs map the location, size, and sometimes even the type of tissue contained in the tumor, and are useful tools for planning biopsies.

Ultrasound

This diagnostic technique uses sound waves to take create images of parts of the body. A small instrument called a transducer emits sound waves and picks up the echoes as they bounce off the liver. A computer converts these sound wave echoes into an image that is displayed on monitor.

Endoscopy

An endoscope is a long, lighted tube that is passed through the patient’s esophagus, stomach and beginning of the lower intestine, allowing the physician to explore these areas without surgery. This technique, along with ERCP (described below) is used to evaluate cholangiocarcinomas.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

A smaller tube or catheter is passed through the endoscope and into the bile ducts. Dye is injected into the ducts, and the physician takes X-rays to discover whether a tumor is present in the bile ducts.

The physician may also need to take a biopsy of the tissue to be examined under a microscope. This tissue can be obtained in the following procedures:

Laparoscopy

In this procedure, the physician inserts a thin, lighted tube with a small video camera on the end through a small incision in the front of the abdomen to examine the liver and other internal organs. This procedure is done in the operating room usually under general anesthesia.

Laparoscopy can help doctors confirm the stage (extent) of the cancer and decide upon a treatment plan.

Laparoscopy is usually done at an outpatient surgery center. Because the surgeon only makes a small incision to insert the tubes and there is no need for general anesthesia, the patient can expect less pain and faster recovery time.

Needle biopsy

A hollow needle is placed through the skin in the abdomen and into the liver. The skin is first numbed with local anesthesia.

During a fine needle aspiration (FNA) biopsy, tumor cells are sucked into a very thin needle with a syringe.

During a core needle biopsy, a slightly larger needle is used to take a bigger sample from the liver.