Being diagnosed with primary liver cancer

If your GP thinks you may have primary liver cancer you will go to the hospital to be diagnosed. If you have chronic liver disease, your liver specialist may diagnose you through regular blood tests that you have.

At the hospital you will see a liver specialist (hepatologist) or a stomach and bowel specialist (gastroenterologist). They will examine your tummy area and may do some tests, including:

  • blood tests
  • liver ultrasound scan – this uses sound waves to build up a picture of your body
  • CT (computerised tomography) scan – this uses x-rays to build up a three-dimensional picture of the inside of your body
  • MRI (magnetic resonance imaging) scan – this uses magnetism to build up a picture of your body
  • laparoscopy – this uses a thin tube with a camera on to see into the body clearly
  • liver biopsy – a fine needle is passed through the skin to take a sample of the lump, which is then tested to find out if it is cancerous.

Waiting for test results can be difficult. You may want to talk to someone close to you or one of our cancer support specialists.

How primary liver cancer is diagnosed

You usually begin by seeing your GP. They will ask about your symptoms and examine you.

Your GP will usually take blood samples to check your general health and may arrange other tests, such as an ultrasound. They will refer you to a hospital for specialist advice. If your GP suspects you may have cancer, you should see a specialist within two weeks.

If you are already seeing a liver specialist (hepatologist) because you have chronic liver disease, you may be diagnosed through having tests. People with liver cirrhosis usually have regular blood tests and ultrasound scans to monitor their liver. These tests can help to diagnose HCC at an earlier stage.


At the hospital

You may see a hepatologist straight away. Or you may see a doctor who specialises in treating conditions of the stomach and bowel (gastroenterologist).

They will ask about your symptoms and your general health and check whether you have risk factors for liver disease. The doctor will carefully examine you by feeling your tummy area (abdomen). They may take some more blood tests and they will explain which other tests you need.


Blood tests

You’ll have blood tests called liver function tests (LFTs) to check how your liver is working. You'll also have a blood test to check a chemical called alpha-fetoprotein (AFP) which is sometimes higher in people with HCC. Doctors sometimes check AFP levels before and after your treatment to see how well the liver is working.


Liver ultrasound scan

A liver ultrasound scan uses sound waves to make up a picture of the liver. This test is painless and only takes a few minutes. 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, the person doing the ultrasound spreads a gel onto your tummy area. They then pass a small device, which produces the sound waves, over the area. The sound waves are converted into a picture by a computer.


CT scan

A CT (computerised tomography) scan uses x-rays to build a three-dimensional picture of the inside of the body. You may be given either a drink or injection of dye. This is to make certain areas of the body show up more clearly. This scan takes around 30 minutes and is painless. We have more detailed information about having a CT scan.


MRI scan

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, bone pins, etc. 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.


Laparoscopy

This operation allows the surgeon to look at the liver and other organs in the area and helps them decide if surgery to remove the tumour is possible. You have it done under a general anaesthetic, so you may have to stay in hospital overnight.

The doctor makes 3–4 small cuts, approximately 1cm (½ inch) in length, in the skin and muscle of your lower tummy (abdomen). Some carbon dioxide gas is pumped into the abdomen to lift up the tummy wall so that the organs can be seen clearly. The doctor then puts a thin fibre-optic tube with a tiny camera on the end (laparoscope) through one of the cuts into the abdomen. This allows the surgeon to look at the liver and the area around it. They may take a small sample of tissue (biopsy) for examination under a microscope.

You should be able to get up as soon as the effects of the anaesthetic have worn off. You may have discomfort in your neck and/or shoulder after the laparoscopy. This goes away in a day or two. Some people have uncomfortable wind after surgery in the abdomen. Taking sips of peppermint water and walking around can help.


Liver biopsy

A biopsy is not always necessary. Doctors may be able to diagnose HCC with scans or after surgery to remove the tumour. Your doctor will explain if you need a biopsy.

You have a local anaesthetic injection into the skin to numb the area. The doctor then passes a fine needle into the tumour through the skin. A CT scan or ultrasound guides the doctor to the exact area to take the biopsy from.

You will stay in hospital for a couple of hours, or sometimes overnight, after a liver biopsy because there’s a risk of bleeding afterwards. The nurses will check you regularly and monitor your blood pressure.

There is a small risk of the cancer cells spreading when the doctor removes the biopsy needle. Your specialist will talk this over with you.


Waiting for test results

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 or one of the organisations listed on our database, can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.