How primary liver cancer is diagnosed

Your GP will usually refer you to the hospital to have tests for primary liver cancer. At the hospital, you will see a liver specialist (hepatologist) or a stomach and bowel specialist (gastroenterologist). They will examine your tummy area (abdomen) 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 detailed picture of your body
  • laparoscopy – this uses a thin tube with a camera to look at the liver and other organs closely
  • liver biopsy – a fine needle is passed through the skin to take a sample of the tumour, which is tested to find out if it is cancerous (malignant).

Waiting for test results can be difficult. You may want to talk to someone close to you, or one of our cancer support specialists on 0808 808 00 00.

Being diagnosed with primary liver cancer

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 primary liver cancer (HCC) develops, these tests may find the cancer at an earlier stage.

Being diagnosed with cancer

GP David Plume explains what to expect if you're referred by your GP for tests for cancer.

About our cancer information videos

Being diagnosed with cancer

GP David Plume explains what to expect if you're referred by your GP for tests for cancer.

About our cancer information videos


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, and check whether you have risk factors for liver disease. The doctor will 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 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. It is done in the hospital scanning department. You will be asked not to eat anything for at least four hours before your appointment.

During the scan you lie on your back and the person doing the ultrasound spreads a gel on to your tummy area. They then pass a small device, which produces sound waves, over the area. The sound waves are turned into a picture of your liver by a computer.

The ultrasound scan was very easy. I wasn’t looking at it or anything. It was completely unworrying.

Jane


CT scan

A CT (computerised tomography) scan uses x-rays to build a three-dimensional (3D) 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 about 30 minutes and is painless. We have more detailed information about having a CT scan.

Having a CT scan
Having a CT scan

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Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


MRI scan

An MRI scan 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 is 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 have 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 is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not 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 will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will 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 close by. It helps them to decide if it is possible to remove the tumour with surgery. The laparoscopy is done under a general anaesthetic, so you may have to stay in hospital overnight.

The surgeon makes 3 or 4 cuts in the skin and muscle of your lower tummy (abdomen). Each cut is about 1cm (½ inch) long. They pump some carbon dioxide gas through one of the cuts and into the abdomen. This lifts up the tummy wall so it is easier to see the liver and other organs. The surgeon then puts a thin fibre-optic tube with a tiny camera on the end into the abdomen, through one of the small cuts. They use this to look at the liver and the area around it. They may also 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 wear off. You may have discomfort in your neck or shoulder after the laparoscopy. This will go 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

During a biopsy, a small piece of tissue or a sample of cells is removed so that it can be examined under a microscope. Not everyone needs a biopsy. Doctors may be able to diagnose HCC with scans. Or they may diagnose it after surgery to remove the tumour.

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

After a liver biopsy, you will usually stay in hospital for a few hours, or sometimes overnight. This is because there is a risk of bleeding afterwards. The nurses will check you regularly and monitor your blood pressure. This is to make sure there is no bleeding and that it is safe for you to go home.

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.

Waiting for test results was probably the most difficult time. Your mind goes like wildfire thinking about all the possible scenarios.

Pauline

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