Diagnosis
Can liver cancer be diagnosed early?
Most liver cancers are asymptomatic and are hard to detect until they are in their later stages. Generally, small liver tumors are hard to detect even during physical examination and by the time a tumor can be felt, it might already be quite large.
For this reason, periodic testing or screening is often recommended for high-risk individuals.
Testing people at high risk for liver cancer
Patients who develop liver cancer usually have long-standing cirrhosis. Therefore, surgeons may do tests to look for liver cancer if a patient with cirrhosis gets worse for no apparent reason.
Also, high-risk patients are advised to get alpha-fetoprotein (AFP) blood tests and ultrasound exams every 6 months.
AFP tumor marker test is used to measure the level of protein in the blood of patients with liver cancer. However, this test has certain limitations as many patients with early liver cancer have normal AFP levels.
Tests for liver cancer
Physical exam
After checking a patient’s medical history, a cancer specialist may learn more about symptoms and risk factors, if any.
If symptoms or the results of the physical exam suggest that the patient might have liver cancer, confirmatory tests such as imaging tests, lab tests, and/or biopsies of liver tissue are often prescribed.
Imaging tests
Imaging tests, such as liver cancer X-ray is done both before and after a diagnosis of liver cancer.
These liver cancer X-ray images help in the following ways:
- To find suspicious areas that might have cancer cells
- Help surgeons to guide a biopsy needle into a suspicious area to take a sample
- Learn how far cancer might have spread
- Aids in planning certain treatments in the liver
- Look for a possible sign of cancer coming back after treatment.
Liver cancer ultrasound
It is generally the first screening test that uses sound waves to create an image on a computer screen. Ultrasound detects liver cancer, which then can be tested for confirmation, if needed.
Computed tomography (CT)
A CT scan of the abdomen helps in detecting liver tumors. The test can give specific information about the size, shape, and location of any tumor in the liver or elsewhere in the abdomen or nearby blood vessels.
Results of liver cancer on CT scan can also be used to guide a biopsy needle precisely into a suspected tumor.
Magnetic resonance imaging (MRI)
Like CT scans, liver MRI scan provides detailed images of soft tissues in the body. Liver MRI scan can be helpful in specifically looking at liver tumors. Sometimes, they can help to differentiate a benign tumor from a malignant one. They can also be used to look at blood vessels in and around the liver to see any blockages, and the results can reveal if liver cancer has spread to other parts of the body.
Angiography
This test is used to show the arteries that supply blood to the liver cancer, thereby helping oncologists to decide if the cancer can be removed. The angiography test helps the surgeon to plan the surgery. Generally, a dye is injected into the bloodstream of the patient so the blood vessels of the liver show up on an X-ray.
Angiogram for liver cancer can also be used to plan some non-surgical treatment therapies, such as embolization.
Bone scan
This helps to diagnose cancer that has spread (metastasized) to bones. Oncologists seldom prescribe this test liver cancer unless the patient shows symptoms of bone pain.
Other tests and procedures
Here’s a list of other diagnostic tests that may be prescribed in case your doctor thinks you might have liver cancer but the imaging results aren’t certain.
Biopsy
A biopsy is the removal of a sample of tissue to see if it is cancerous. In selective few cases, biopsy is the only way to diagnose liver cancer. But, in some cases where oncologists are fairly certain that a person has liver cancer based on results of imaging tests, such as, CT and MRI scans, a liver biopsy test may not be needed at all. That’s also because surgeons are often concerned that sticking a needle into the tumor or by disturbing it without completely removing it might promote the growth of cancer cells.
However, if at all a liver biopsy test is needed, it can be done in one of the following ways:
Needle biopsy: Before starting the procedure, skin is numbed, followed by which a hollow needle is placed through the skin in the abdomen and into the liver. This type of biopsy is typically done with the help of an ultrasound or CT scan to guide the needle.
Laparoscopic biopsy: This is the procedure when biopsy specimens are taken during laparoscopy.
Surgical biopsy: It could be either incisional biopsy, where only a piece of tumor is removed or an excisional biopsy, where the entire tumor and some surrounding normal liver tissue is extracted surgically.
Alpha-fetoprotein blood (AFP) test
AFP is a tumor marker test and is performed to measure the level of protein in adults with any kind of liver disease, liver cancer or other cancers.
Generally, if AFP levels are very high, it may signify presence of liver cancer. But because liver cancer isn’t the only reason for high protein levels, AFP blood test for liver cancer can prove to be useful confirmatory test where an individual is already diagnosed with liver cancer.
List of liver cancer blood test:
Hepatitis tests to detect liver cancer: Your doctor might prescribe liver hepatitis tests to check for hepatitis B and C.
Liver function tests (LFTs): Liver function test for liver cancer is important because if the part of the liver that’s not affected by cancer isn’t functioning well, option of surgery is ruled out in such cases. Basically, it is a test to know the overall health of the liver. Infact, in such a scenario where liver is not functioning well, other treatment options such as targeted therapy or chemotherapy are also ruled out.
Blood clotting tests: The healthy liver makes proteins that promote blood clotting. A damaged liver, on the other hand, might not make enough of these proteins, which could even increase the risk of blood loss. The blood clotting test helps to measure this risk.
Kidney function tests: This test is crucial as it measures blood urea nitrogen (BUN) and creatinine levels to assess how well kidneys are functioning.
Complete blood count (CBC): This test is conducted to measure levels of red blood cells (RBCs) which carry oxygen throughout the body, white blood cells (WBCs) which fight infections and platelets. This gives an idea of how well the bone marrow is functioning.
Blood chemistry tests and other tests: Blood chemistry test checks the level of a number of substances in the blood, some of which might be affected by liver cancer.
Can liver cancer be detected by ultrasound?
Ultrasound is usually the first screening test carried out if hepatocellular carcinoma (HCC) is suspected. Otherwise too, ultrasound imaging and blood tests could catch liver cancer in early stages.
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