How is liver cancer diagnosed?

Imaging studies of the liver
Ultrasound: the ultrasound machine produces sound waves which bounce off internal organs and produce echoes that are interpreted by a computer to produce an image. It can detect tumours in the liver as well as abnormal lymph nodes and abnormal fluid (ascites) in the abdomen. Doppler ultrasound can also show the relationship of important blood vessels in the liver with the tumour.

Computed tomography (CT) scan: this uses X-rays linked to a computer to give a detailed picture of the organs and blood vessels in the abdomen.

Magnetic resonance imaging (MRI): a powerful magnet linked to a computer produces detailed pictures of the internal organs and blood vessels. It has the advantage over a CT scan in that the patient is not exposed to X-ray radiation.

Angiogram: dye is injected into the artery to show up the blood vessels of the liver. This can show a liver tumour as well as involvement of the portal vein, which drains blood to the liver. This test is not used routinely, as non-invasive tests such as ultrasound, MRI and CT scans can provide the information.

Blood tests
Blood tests can show how well the liver is working, but abnormalities are not specific to HCC. Alpha-fetoprotein (AFP) levels are raised in 90 percent of patients with HCC and, if elevated, could be a sign of liver cancer. Levels may also be raised in other liver diseases and cancers. Previous or current infection with the hepatitis B or C virus is also detectable.

Biopsy
A sample of tissue can be removed and examined under the microscope to look for cancer cells. This is usually done under ultrasound or CT scan guidance and can be performed using a thin needle (fine needle aspiration) or a thick needle (core biopsy). It can also be performed via laparoscopy or during an open operation.

Possible complications include bleeding and rupture of the tumour. There is also a small, but definite risk (1 percent) of tumour seeding in the needle biopsy tract, which would compromise the chance of curing the cancer by removing part of the liver. For this reason, routine biopsies of possibly cancerous liver lesions that could potentially be surgically removed are not recommended.