Diagnosis of liver cancer

Some people are diagnosed with liver cancer if they have symptoms. People with long-term liver disease may be diagnosed before they have any symptoms.

How liver cancer is diagnosed

Some people are diagnosed with liver cancer if they have symptoms. People with long-term liver disease may be diagnosed before they have any symptoms.

If you have symptoms

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. They 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 have long-term liver disease

You may have regular blood tests and ultrasound scans to check your liver. If liver cancer (HCC) develops, these tests may find the cancer at an earlier stage.

At the hospital

You may see a liver specialist (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. They will also check whether you have risk factors for liver disease. The doctor will examine you by feeling your tummy area (abdomen). They may take some blood samples and explain which other tests you need.

Tests and diagnosis

You will have some of the following tests:

  • Blood tests

    You will have blood tests called liver function tests (LFTs). These check how well your liver is working. You will also have a blood test to check a chemical called alpha-fetoprotein (AFP). AFP is called a tumour marker for HCC because it is sometimes higher in people with this type of liver cancer. Doctors may also check AFP levels after treatment. This is to check for signs of the cancer coming back (recurrence).

  • 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. You have it in the hospital scanning department. You will be asked not to eat anything for at least four hours before your appointment.

  • CT scan

    A CT scan uses x-rays to build a three-dimensional (3D) picture of the inside of the body.

  • MRI scan

    An MRI scan uses magnetism to build up a detailed picture of areas of your body. It takes about 30 minutes.

  • Laparoscopy

    A laparoscopy is a small operation that allows the surgeon to look at the liver and other organs close by. It helps them to decide if it is possible to remove the tumour with surgery. They may also take a small sample of tissue (biopsy) for examination under a microscope.

  • Liver biopsy

    During a liver biopsy, a small piece of tissue is taken from the liver to be looked at under a microscope. Your doctor may take the biopsy from a growth in the liver to help diagnose a cancer. Sometimes they take the biopsy from a healthy area of the liver to check how well it is working. Not everyone needs a biopsy. Doctors can often diagnose HCC with scans. Or they may diagnose it after surgery to remove the tumour.

    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 can be a difficult time. We have more information about waiting for results that may help.

About our information

  • References

    Below is a sample of the sources used in our primary liver cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016; 40: 2425–2440. Available from: doi.org/10.1007/s00268-016-3700-1 [accessed Feb 2020] 

    NICE. Lenvatinib for untreated advanced hepatocellular carcinoma: Technology appraisal guidance (TA 551) [Internet]. 2018. Available from: www.nice.org.uk/guidance/TA551 [accessed Feb 2020] 

    NICE. Liver disease. Quality standard (QS 152) [Internet]. 2017. Available from: www.nice.org.uk/guidance/QS152 [accessed Feb 2020] 

    NICE. Liver cancers overview [Internet]. 2019. Available from: pathways.nice.org.uk/pathways/liver-cancers/liver-cancers-overview [accessed Feb 2020]

    NICE. Regorafenib for previously treated advanced hepatocellular carcinoma. Technology appraisal guidance (TA555) [Internet]. 2019. Available from: www.nice.org.uk/guidance/ta555 [accessed Feb 2020]

    Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2018; 29 (S4): iv238–iv255. Available from doi.org/10.1093/annonc/mdy510 [accessed Feb 2020]    


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.