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Usually, you begin by seeing your family doctor (GP) who will examine you and arrange any tests that may be necessary to check your general health.
If your GP isn’t sure what the problem is, or thinks that cancer may be present, you will be referred to hospital for specialist advice. If your GP suspects that you might have a cancer you should be seen at the hospital within two weeks.
The specialist will ask you about your symptoms and your general health. You’ll also be asked if you have any other health problems. The doctor will examine you by feeling your abdomen (tummy area). You may have a blood test and a chest x-ray to check your general health. To help make the diagnosis, you’ll probably have a number of further tests as well.
Several tests may be used to diagnose primary liver cancer. The tests may also show the stage of the cancer – whether or not it has spread to other parts of the body. These tests help your doctor to know the best way to treat the cancer. It can help to have a friend or relative with you when you go for any tests or to get your results. You may have one or more of the following tests:
It will probably take several days for the results of your tests to be ready and a follow-up appointment will be made for you. Obviously this waiting period can be an anxious time. It will probably help if you can talk things over with a relative or friend. You can also contact a support organisation| or call one of our cancer support specialists.
As well as blood tests to check your general health you will have other blood tests, known as liver function tests (LFTs) to see how well your liver is working.
Another blood test checks the amount of a chemical called alpha-fetoprotein (AFP) in your blood. The amount of AFP in the blood can be higher than normal in people with hepatocellular cancer – HCC. The doctors may monitor the level of AFP before and after treatment of HCC as it can show how well treatment is working.
A liver ultrasound scan uses sound waves to make up a picture of the liver. It’s done in the hospital scanning department. You’ll be asked not to eat anything for at least four hours before your appointment.
Once you are lying comfortably on your back, a gel is spread onto your abdomen. A small device like a microphone, which produces sound waves, is passed over the area. The sound waves are then converted into a picture by a computer.
This is a painless test and only takes a few minutes.
A CT scan takes a series of x-rays of the abdomen which build up a three-dimensional picture of the inside of the body. It can be used to show the size and position of a cancer, and whether it has begun to spread.
The scan is painless and takes 10–30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and won’t harm anyone you come into contact with.
Before the scan you’ll be asked to drink a special liquid which shows up on x-ray and ensures that a clear picture is obtained. Once you are lying in a comfortable position, the scan will be taken. About halfway through the scan, a special dye may be injected into one of your veins to show up the blood vessels in the liver. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a serious reaction to the injection, so it’s important to let your doctor know beforehand.
You will probably be able to go home shortly after the scan is over.
This test is similar to a CT scan but uses magnetism instead of X-rays to build up a detailed picture of areas of your body.
Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan (because the scanner is a powerful magnet). The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips, bone pins etc. You should also tell your doctor if you have ever worked with metal or in the metal industry (as very tiny fragments of metal can sometimes lodge in the body). If you do have any metal in your body it’s likely that you won’t be able to have an MRI scan. In this situation another type of scan can be used.
Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you will be asked to lie very still on a couch inside a long tube for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones. You will be able to hear, and speak to, the person operating the scanner.
The only way to be sure of the diagnosis is to take some cells or a small piece of tissue from the affected area to look at under a microscope. This is called a biopsy. A biopsy isn’t always done and sometimes the diagnosis is confirmed after an operation to remove the tumour.
After the area has been numbed using a local anaesthetic injection, a fine needle is passed into the tumour through the skin. CT or ultrasound may be used at the same time, to make sure that the biopsy is taken from the right place.
You will need to stay in hospital for a couple of hours after a liver biopsy, and possibly overnight. This is because there is a risk of bleeding afterwards.
If your cancer hasn’t already spread, and if there is a chance your tumour can be removed, you may not have a biopsy. This is because there is a small risk that the cancer can spread along the pathway of the needle when the biopsy needle is removed.
A laparoscopy is a small operation that allows the doctors to look at the liver and other internal organs in the area. It’s done under a general anaesthetic and will mean a short stay in hospital. While you are under anaesthetic the doctor will make a small cut in the front of your abdomen and insert a thin tube containing a light and a camera (laparoscope). Using the laparoscope, the doctor is able to look at the liver and can take a small sample (biopsy) for examination under a microscope. After the laparoscopy you will have one or two stitches in your abdomen. During the operation, carbon dioxide gas is passed into the abdominal cavity and this can cause uncomfortable wind and/or shoulder pains for several days. The pain is often eased by walking about or taking sips of peppermint water.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.