How secondary cancer in the liver is diagnosed

You may see your family doctor (GP) or your cancer specialist, who will ask you about any symptoms you have and examine you.

You may have some of the following tests and scans:

  • blood tests
  • CT (computerised tomography) scan
  • liver ultrasound
  • MRI (magnetic resonance imaging) scan
  • liver biopsy
  • laparoscopy
  • PET-CT scan.

Occasionally, secondary cancer in the liver is found before the primary cancer is diagnosed. If this happens, your doctor may arrange for you to have tests to find out where the primary cancer is.

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. Or you can talk things over with one of our cancer support specialists on 0808 808 00 00.

Diagnosing secondary cancer in the liver

You may see your family doctor (GP) or your cancer specialist. They will ask you about any symptoms you have and examine you. You may have some of the following tests and scans.


Blood tests

You may have a blood test to check your general health and see how well your liver is working.


CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes about 10-30 minutes. CT scans use a small amount of radiation, which would be very unlikely to harm you or anyone you come into contact with. You'll be asked to not eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye that 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.


Liver ultrasound

A liver ultrasound uses sound waves to make up a picture of the liver. This test doesn’t hurt and only takes a few minutes. You will have it 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, the person doing the ultrasound spreads a gel onto your tummy. They then pass a small device like a microphone, which produces the sound waves, over the area. The sound waves are made into a picture by a computer.


MRI (magnetic resonance imaging) 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 or 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.


Liver biopsy

You may have a small piece of tissue taken from the liver to be looked at under a microscope. This is called a liver biopsy.

You will have blood tests taken before the biopsy to make sure your blood is clotting properly. You’ll 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.

After a liver biopsy you’ll need to stay in hospital for a couple of hours or sometimes overnight. This is because there is a small risk of bleeding afterwards. The nurses will check you regularly and monitor your blood pressure. You may have some pain in your tummy and right shoulder after the biopsy. Your doctor can prescribe painkillers for you.


Laparoscopy

This is a small operation that allows the doctor to look at the liver. You have it done under a general anaesthetic, so you may have to stay in hospital overnight. The doctor makes 3–4 small cuts in the skin and muscle of your lower tummy (abdomen). Carbon dioxide gas is pumped into the tummy to lift the tummy wall so the liver can be seen clearly.

The doctor then puts a thin, flexible tube with a tiny camera on the end (laparoscope) through one of the cuts into the tummy. The doctor looks at the liver through the laparoscope and may 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 tummy. 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 or shoulder after the laparoscopy. This goes away in a day or two. Some people have uncomfortable wind after a laparoscopy. Taking sips of peppermint water and walking around can help.

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


PET-CT scan

This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan.

A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body. PET-CT scans give more detailed information about the part of the body being scanned. You may have to travel to a specialist centre to have one. You can't eat for six hours before the scan, although you may be able to drink.

A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. The scan is done after at least an hour’s wait. It usually takes 30–90 minutes. You should be able to go home after the scan.


Diagnosing the primary cancer

Occasionally, secondary liver cancer is found before the primary cancer is diagnosed.

If this happens, your doctor may arrange for you to have tests to find out where the primary cancer is. You doctor will be able to tell you more about these and what they involve.

Our cancer support specialists on 0808 808 00 00 can also give you information about tests you may need to have.


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.