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.
The examination will include feeling your upper abdomen to see whether your liver is enlarged or tender to touch. They’ll take a blood test to check your general health and see how well the liver is working.
If you’ve 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 you’ve not had cancer before, and the doctor thinks you may have a secondary cancer in the liver, they’ll examine you to see if there are any signs of a cancer anywhere else in your body. They may arrange tests to try to find out where in the body the cancer started.
For some people with secondary liver cancer, the primary cancer can’t be found. Understandably, many people find this difficult to accept. Even if your doctors can’t tell where the cancer started they will try to discover the type of cell your cancer developed from. This will help them choose the most helpful treatment for you.
Your doctor may arrange for you to have one or more of the following tests at the hospital. These are designed to confirm whether you have liver cancer and, if so, to:
find out 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.
CT (computerised tomography) scan
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A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10-30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
You’ll probably be able to go home as soon as the scan is over.
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’re 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.
Sometimes the doctors will take a small piece of tissue from the liver to look at under a microscope. This is called a liver biopsy. The area is numbed using a local anaesthetic injection, then a fine needle is passed into the tumour through the skin. CT or ultrasound scans may be used at the same time to make sure the biopsy is taken from the right place. You’ll need to stay in hospital for a couple of hours after a liver biopsy, and possibly overnight. This is because there’s a risk of bleeding afterwards.
MRI (magnetic resonance imaging) scan
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This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips, or bone pins.
You should also tell your doctor if you’ve 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 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’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.
This is a small operation that allows the doctor to look at the liver. While you’re under anaesthetic, the doctor makes a small cut in the lower abdomen and carefully inserts a laparoscope. This is a thin fibre-optic telescope tube with a camera attached. The doctor can look at the liver through the laparoscope and take a small sample of tissue (a biopsy) to examine under a microscope. After a laparoscopy, you may 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 test results
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Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk with your partner, family or a close friend. Your specialist nurse can also provide support. You can also talk things over with one of our cancer support specialists.