If your healthcare provider thinks you might have liver cancer, you'll need certain exams and tests to be sure. Diagnosing liver cancer starts with your healthcare provider asking you questions. You'll be asked about your health history, symptoms, risk factors, and family history of disease. Your healthcare provider will also do a physical exam.
What tests might I need?
You may have one or more of the following tests:
You may have blood tests to look for signs of liver cancer.
Alpha-fetoprotein (AFP) blood test
AFP is a protein in the blood. AFP levels are often high in people with liver cancer. But other conditions can also raise AFP levels. So this test alone can't be used to diagnose liver cancer.
Liver function tests (LFTs)
These tests check your liver function. They can show liver irritation and inflammation. These tests can't tell for sure if you have liver cancer. But if the tests show that your liver has been damaged, your healthcare provider will likely do other tests to look for the cause of the damage. This could be many different things, including cancer.
Imaging tests may also be done to look for liver cancer.
This is often the first test done if your healthcare provider suspects liver cancer. An ultrasound is easy to do and doesn’t use radiation. This test is very helpful in seeing whether a liver tumor is a fluid-filled sac (cyst) that’s likely not cancer, or a solid mass that’s more likely to be cancer. An ultrasound uses sound waves to look for changes in the liver. The sound waves bounce off your insides and send back a series of signals. Then a computer turns these signals into images of your body.
This test creates detailed images of the liver and nearby organs. An MRI uses magnets and radio waves to take pictures of the inside of the body. MRIs can show more detail than other imaging tests. A contrast dye may be put into your blood through a vein before this test. The dye helps get clearer images.
A CT scan uses X-rays taken from many angles. This creates very detailed cross-section pictures of the liver and nearby organs.
If an imaging test shows something in your liver that looks like it might be cancer, your healthcare provider may take out small pieces or samples of liver tissue for testing. This is called a biopsy. A doctor who specializes in looking at cells, called a pathologist, checks the samples to tell whether cancer is there. A biopsy is the only way to know for sure that a change is cancer. There are a few ways to do a biopsy. They include:
For this test, a thin, hollow needle is put through your skin. It goes into the liver tumor to get a tiny piece of it. A needle biopsy is normally done during a CT scan or ultrasound of the liver. This allows your healthcare provider to be sure the needle is going into the tumor.
During laparoscopy, small cuts are made in your belly. Your healthcare provider then inserts long surgical tools into those cuts. One of these tools has a tiny video camera on the end that projects images on a monitor in the operating room. The surface of your liver and nearby organs are examined. If tumors or changed areas are seen, they can be removed for testing.
This is the most common type of biopsy used for liver cancer. In this case, the tissue for biopsy is taken out during surgery to treat the tumor.