How is liver cancer diagnosed?
On this page:
> Diagnosing liver cancer
> Tests and investigations
> Waiting to have tests carried out
> Staging
> Receiving a liver cancer diagnosis
Diagnosing liver cancer
Blood tests and imaging scans are used to confirm a diagnosis of liver cancer. Your doctors will use the test results to work out the best treatment for you. Although you will have had some of these tests, you may need others to find out exactly what type of liver cancer you have and what stage it is.
Liver cancer tests and investigations
The following tests and scans are used to confirm a liver cancer diagnosis. Your doctors will use the test results to work out the best treatment for you. You may not need all the tests listed below. Your specialist will give you more detailed information about what tests are most appropriate for your condition.
If you have symptoms of liver cancer, your doctor may carry out a general clinical examination to feel your abdomen to check for lumps or swelling. The doctor will ask about your medical history to learn about your symptoms and possible risk factors.
Various blood tests are used to check your blood count, liver and kidney function and your general health. Blood tests can also check for tumour markers. These are chemical substances produced by cancers that show up in the bloodstream. Blood samples are usually examined in the hospital laboratory within a day or two. Sometimes samples have to be sent away for analysis and it can take several days to get the results.
Ultrasound is the most common imaging scan used to look for liver cancer. Ultrasounds use sound waves to create a picture of the inside of the body. A probe is passed over your abdomen, and the images are collected on a screen – usually an outline of the liver, pancreas, gall bladder and bile ducts.
A CT scan uses X-rays to build up a three-dimensional picture of the liver and the other organs around it. It is also usual to scan your chest and pelvic area to check for any signs of cancer outside the liver. A CT scan can also be used to guide the needle during a biopsy that is performed in some cases. This procedure involves a tissue sample being taken for examination under a microscope.
MRI scan uses radio waves and magnets to take pictures of organs and structures inside the body by measuring their energy. Like a CT scan, an MRI photographs the organs several times while a patient lies on a table. A computer creates a 3D image that doctors can use to help diagnose and monitor liver cancer.
Positron Emission Tomography (PET) is a test where a small amount of radioactive substance is injected into a vein. On the scans, the injected substance shows up areas where the cells are more active in the body. Cells need glucose (sugar) for energy. Growing cells, such as cancer cells, use glucose faster than other cells. PET imaging shows this change. PET scans may indicate whether the mass is cancerous, help the healthcare team figure out the right treatment, including whether surgery is possible or show if and where liver cancer has spread.
In some circumstances a biopsy is performed as part of the investigations to be certain about your diagnosis. Tissue samples for examination under a microscope can be taken during an EUS, ERCP or laparoscopy, or through your skin with local anaesthetic and guided by CT. A biopsy may not be performed in certain cases when surgical removal is planned upfront. In cases when surgery is not planned at the beginning, you will need to have a biopsy before starting chemotherapy or taking part in a clinical trial, to obtain a definite cancer diagnosis.
Waiting to have tests carried out
Even if you have been given an urgent referral for a particular scan or investigation you may have to wait several days or possibly weeks for your appointment. This can be frustrating and worrying, especially if you are already feeling unwell.
If your symptoms get worse or you start to feel more unwell while you are waiting, it’s a good idea to get in touch with your GP or specialist if you already have one. If you cannot get in contact with them, you may need to present to the closest emergency department of your symptoms cannot be controlled at home.
How long will I have to wait for my test results?
Depending on which tests you have had it may take from a few days to a few weeks for the results to come through. Waiting for test results can be an anxious time.
It is a good idea to ask how long you may have to wait when you go for tests. If you think you have been waiting too long, then contact your GP or a specialist to follow up on the progress of your results. Usually, the doctor who does the test will write a report and send it to your specialist. If your GP sent you for the test the results will be sent to the GP clinic.
You will need an appointment with your specialist or GP to discuss the test results and how they might affect your treatment. Usually, your specialist will discuss your results and plan your subsequent care.
Staging of primary liver cancer (hepatocellular carcinoma)
Your test results will enable your doctors to make a detailed diagnosis and indicate to them at what stage your cancer is.
Staging is how doctors refer to the size of a cancer and whether it has spread around the tumour site or to other areas of the body. It is an important part of their assessment and contributes to treatment planning.
Barcelona Clinic Liver Cancer (BCLC) staging system
The BCLC system is often used to stage hepatocellular carcinoma (HCC). The stages are based on how well you can carry out daily tasks, what the tumour is like and how well the liver is working. Your doctor will record how well the liver is working using the Child-Pugh score.
| Stage 0 | Single tumour less than 2 cm; Child–Pugh A. |
| Stage A | Single tumour greater than 2 cm or up to 3 tumours less than 3 cm; Child–Pugh A or B. |
| Stage B | Multiple tumours in the liver; Child–Pugh A–B. |
| Stage C | The tumour has grown into one of the main blood vessels of the liver, or spread to the lymph nodes or other body organs; Child–Pugh A–B. |
Child–Pugh score
A system for scoring how well the liver is working based on the level of damage caused by cirrhosis.
| A | liver is working well and cirrhosis is less advanced |
| B | liver is working moderately well |
| C | liver is not working well and cirrhosis is advanced |
Liver cancer is staged using the BCLC system and the information is used to help decide the best treatment.
Receiving a liver cancer diagnosis
Receiving the diagnosis of liver cancer can be unnerving, confusing, and disorienting. You have mixed emotions of surprise, disbelief, and anger; and you may feel sad and disappointed, with fear and uncertainty for the future. But you are not alone.
The PanSupport Team is here for you – to connect you with a community of people who have a shared experience and to support you through all stages of your experience.
A Common Path: Liver cancer
The ‘A Common Path’ suite of cancer support and advice videos have been developed by the North Eastern Melbourne Integrated Cancer Service, with support from Pancare, for people who have been newly diagnosed with cancer. They provide people with an opportunity to learn from others who have already experienced a cancer diagnosis and treatment, highlighting how they made decisions, the things they learned along the way, the things that helped, and the things they wish they had known or done better.
Read more:
> Liver cancer treatment options
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