Diagnosis of Liver Cancer

The following tests and procedures may be used to discover a liver cancer diagnosis:

Symptoms of liver cancer can lead you to your primary care physician, a urologist, urgent care or the emergency room. Depending on your health history and which phsycians you see, a number of tests and procedures can be preformed to discover a liver cancer diagnosis.
  • Physical exam and history
  • Serum tumor marker test: A procedure in which a sample of blood is examined to check for known tumor markers, which are increased levels of certain substances. An increased level of alpha-fetoprotein (AFP) in the blood may be a sign of liver cancer.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the number of red blood cells, white blood cells, platelets, and the amount of hemoglobin.
  • Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope is inserted.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
  • Ultrasound exam: A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

Factors Affecting Prognosis and Treatment Options

The prognosis (chance of recovery) and treatment options for liver cancer depend on the following:
  • The stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body).
  • How well the liver is working.
  • The patient’s general health, including whether there is cirrhosis of the liver.
  • Prognosis is also affected by alpha-fetoprotein (AFP) levels.

Tests used to Stage Liver Cancer

After a liver cancer diagnosis is made, the process used to find out if the cancer has spread within the liver or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Bone scan: A procedure to check if there are rapidly dividing cells in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
  • Doppler ultrasound: A type of ultrasound that uses differences in the ultrasound echoes to measure the speed and direction of blood flow. Tumors have decreased blood flow, causing them to be seen on the ultrasound.
 

Stages of Liver Cancer

Cancer spreads in the body through tissue, blood or lymph system. When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. Once a liver cancer diagnosis is given, it is staged to understand the best course of treatment for the cancer. The following stage perimeters are used for adult primary liver cancer:

Stage I

In stage I, there is one tumor and it has not spread to nearby blood vessels.

Stage II

In stage II, one of the following is found:
  • one tumor that has spread to nearby blood vessels; or
  • more than one tumor, none of which is larger than 5 centimeters.

Stage III

Stage III is divided into Stage IIIA, IIIB, and IIIC.
  • In stage IIIA, one of the following is found:
    • more than one tumor larger than 5 centimeters; or
    • one tumor that has spread to a major branch of blood vessels near the liver.
  • In stage IIIB, there are one or more tumors of any size that have either:
    • spread to nearby organs other than the gallbladder; or
    • broken through the lining of the peritoneal cavity.
  • In stage IIIC, the cancer has spread to nearby lymph nodes.

Stage IV

In stage IV, cancer has spread beyond the liver to other places in the body, such as the bones or lungs. The tumors may be of any size and may also have spread to nearby blood vessels and/or lymph nodes. For adult primary liver cancer, stages are also grouped according to how the cancer may be treated. There are 3 treatment groups: Localized resectable The cancer is found in the liver only, has not spread, and can be completely removed by surgery. Localized and locally advanced un-resectable The cancer is found in the liver only and has not spread, but cannot be completely removed by surgery. Advanced Cancer has spread throughout the liver or has spread to other parts of the body, such as the lungs and bone.

Recurrent Adult Primary Liver Cancer

Recurrent adult primary liver cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the liver or in other parts of the body. If you have been diagnosed with liver cancer, contact us to request an appointment with our oncology specialists.