Liver Cancer Diagnosis

Liver cancer is usually diagnosed through blood tests, diagnostic imaging, and invasive procedures, such as a biopsy.

Our multidisciplinary Liver Tumor Clinic team diagnoses and treats all forms of liver cancer, as well as benign (noncancerous) liver conditions and cancers of the bile ducts and gallbladder, which are closely related to the liver.

Blood Tests for Liver Cancer

The alpha-fetoprotein (AFP) test measures the level in the blood of a certain protein produced by the liver. Levels of AFP are often high in people with hepatocellular carcinoma, the most common type of primary liver cancer.

Other blood tests used in diagnosing liver cancer include the following:

  • Liver-function tests, such as to check your level of the liver pigment bilirubin or the liver protein albumin
  • Coagulation panel to check for problems with blood clotting
  • Blood counts to check your levels of different types of blood cells
  • Kidney-function tests
  • Viral serology to test your immune system’s response to certain viruses
  • Tests for tumor markers (substances, such as CA19-9 or CEA, that may be found in your body if you have cancer)

Diagnostic Imaging for Liver Cancer

Several types of imaging may be used.

  • Ultrasound, which uses sound waves to produce a picture of the inside of the body. This is used most often to screen for liver cancer and to guide biopsies.
  • Computed tomography (CT) scan, which uses X-rays to take pictures of the body. A computer combines the pictures and displays detailed cross-sectional images.
  • Magnetic resonance imaging (MRI) scan, which uses magnetic fields to provide a detailed image of the body.
  • Angiography, which is an X-ray procedure for examining blood vessels.
  • Cholangiography, in which the doctor injects dye into the drainage system of the liver using a needle and then takes X-rays to outline the bile ducts.
  • Positron-emission tomography (PET) scan with CT, which examines the metabolism of tumors throughout the body. This is particularly helpful to detect spread of the disease beyond the liver and to check treatment response. It is used primarily for cholangiocarcinoma and secondary liver tumors and less so for hepatocellular carcinoma.

Liver Biopsy

If your doctor cannot make an accurate diagnosis of your liver mass based on your medical condition, blood tests, and imaging, you may need a biopsy to determine or confirm the diagnosis. This means removing a sample of the tumor and examining the cells under a microscope. A sample can be removed with a hollow needle pushed through the skin into the liver (fine-needle aspiration or core needle biopsy), or a sample can be removed during surgery (usually done laparoscopically, through small incisions in your abdomen, under general anesthesia).