How secondary liver cancer is diagnosed

You may see your family doctor (GP) or your cancer specialist (oncologist), who will examine you and arrange for any tests or scans that may be necessary. 

Initial examination Back To Top

The examination will include feeling your upper abdomen to see whether your liver is enlarged or tender to touch. A blood test will be taken to check your general health and also to check how well the liver is working. 

If you have had cancer before, and the doctor thinks you might now have a secondary cancer of the liver, they may do a number of tests to confirm the diagnosis.

If the doctors think you may have a secondary cancer in the liver, and if you have not had cancer before, the doctor will examine you to see if there are any signs of a cancer anywhere else in your body. They may order tests to try to find out where in the body the cancer started.

In some people with secondary liver cancer it may be impossible to find the original primary cancer. Understandably, many people find this difficult to accept. Sometimes the primary cancer can’t be found because it is too small to be detected by the tests available.

Your doctor may arrange for you to have one or more of the following tests at the hospital. The tests are designed to confirm whether you have liver cancer and, if so to:

• see whether the cancer is primary or secondary
• check the extent of the disease in the liver
• see whether the cancer has spread to other parts of the body as well as the liver.

Liver ultrasound Back To Top

Sound waves are used to make up a picture of the inside of the liver. This is done in the hospital scanning department. If you are having an ultrasound scan you will 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.

Abdominal CT scan Back To Top

A CT (computerised tomography) scan takes a series of x-rays of the abdomen which build up a three-dimensional picture of the size and position of the cancer. The scan is painless but takes from 10 to 30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with.

Before the scan you will 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 more serious reaction to the injection, so it is important to let your doctor know beforehand.

You will probably be able to go home as soon as the scan is over.

Liver biopsy Back To Top

Sometimes the doctors will take a small piece of tissue from the liver to look at under the microscope – this is called a liver biopsy. It may help the doctors decide on the best treatment.

A fine needle is passed into the tumour through the skin after the area has been numbed using a local anaesthetic injection. 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.

MRI scan Back To Top

An MRI (magnetic resonance imaging) scan is similar to a CT scan, but uses magnetic fields instead of x-rays to build up a series of cross-sectional pictures of the body.

During the test you will be asked to lie very still on a couch inside a metal cylinder that is open at both ends. The whole test may take up to an hour and is painless – although the machine is very noisy. You will be given earplugs or headphones to wear.

The cylinder is a very powerful magnet, so before going into the room you should remove all metal belongings. You should also tell your doctor if you have ever worked with metal or in the metal industry or if you have any metal inside your body (for example, a cardiac monitor, pacemaker, surgical clips, or bone pins). You may not be able to have an MRI because of the magnetic fields.

Some people are given an injection of dye into a vein in the arm, but this usually does not cause any discomfort.

You may feel claustrophobic inside the cylinder, but you may be able to take someone with you into the room to keep you company. It can help to mention to the staff beforehand if you do not like enclosed spaces. They can then offer extra support during your test.

You will probably be able to go home when the scan is over.

Laparoscopy Back To Top

This is a small operation which allows the doctor to look at the liver. While you are unconscious (under anaesthetic), the doctor makes a small cut in the lower abdomen and carefully inserts a thin fibre optic telescope tube with a camera attached (laparoscope).  The doctor can look at the liver through the laparoscope and take a small sample of tissue (biopsy) for examination under a microscope.

After a laparoscopy you will have one or two stitches in your lower abdomen. You should be able to get up as soon as the effects of the anaesthetic have worn off. You may need to stay in hospital for a day or so.

A laparoscopy may not be possible for someone who has had major surgery to their abdomen in the past.

Waiting for your test results Back To Top

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 one of the support organisations or call one of our cancer support specialists|.