Liver Cancer Diagnosis: Hospital Testing Methods And Procedures

There are several ways to test for liver cancer, including blood tests, imaging tests, and biopsies. Doctors will first perform a physical exam and take the patient's medical history, looking for signs of disease such as jaundice or lumps. They may then order imaging tests such as ultrasounds, CT scans, or MRIs to create images of the liver and look for tumors. Blood tests can also be used to detect liver cancer in its early stages by evaluating liver function and looking for tumor markers such as alpha-fetoprotein (AFP). If these tests suggest liver cancer, a biopsy may be performed, where a sample of the tumor or liver tissue is removed and examined under a microscope to confirm the presence of cancer cells.

Ultrasound, CT and MRI scans

Ultrasound, CT, and MRI scans are imaging tests used to detect liver cancer. These tests use sound waves, x-rays, or magnetic fields to create pictures of the inside of the body.

Ultrasound is often the first test used to examine the liver. It uses high-energy sound waves and their echoes to create an image on a computer screen, known as a sonogram. Ultrasound can show tumours growing in the liver, which can then be tested for cancer. A special type of ultrasound known as contrast-enhanced ultrasound (CEUS) can be used to get a better image of a liver tumour. For this test, a type of contrast agent containing tiny bubbles (microbubbles) is given through an IV line before the ultrasound exam.

Computed tomography (CT) scans are another imaging test used to detect liver cancer. CT scans use x-rays to create detailed images of the body from different angles. A CT scan of the abdomen can help find liver tumours and show their size, shape, and location. It can also be used to guide a biopsy needle into a tumour, a procedure known as a CT-guided needle biopsy. CT scans can also be used to look for possible cancer spread to other parts of the body, such as the lungs.

Magnetic resonance imaging (MRI) scans provide detailed images of soft tissues in the body. MRI can be used to look at blood vessels in and around the liver to detect any blockages (MR angiography or MRA). It can also show if liver cancer has spread to other parts of the body. MRI is particularly useful when evaluating the presence of fatty infiltration of the liver, as liver metastases can be obscured in cases of hepatic steatosis.

Biopsies

There are two types of surgical biopsy: incisional biopsy and excisional biopsy. An incisional biopsy involves removing a small piece of the tumour, whereas an excisional biopsy involves removing the entire tumour and some surrounding healthy liver tissue. Biopsies are often targeted at a specific lesion or abnormality, but they can also be non-targeted, i.e., not taken from any particular lesion within the liver.

Before a biopsy, patients will have blood tests to measure their total number of blood cells and platelets, and to check how well their blood clots. Patients may also be asked to fast for up to eight hours before the procedure. During the procedure, the patient is usually conscious, but they can be sedated if they wish. The procedure typically takes 15 to 60 minutes, depending on the type of biopsy. The main risks of a liver biopsy are bleeding and pain.

Blood tests

One type of blood test used to detect liver cancer is the alpha-fetoprotein (AFP) tumor marker test. Tumor markers are released into the blood by organs, tissues, or tumor cells. An increased level of AFP in the blood may indicate liver cancer, although it is not a definitive indicator as other cancers and conditions, such as cirrhosis, hepatitis, and pregnancy, can also elevate AFP levels. Doctors may check AFP levels before and after treatment to monitor the effectiveness of the chosen therapy.

Another blood test used for liver cancer detection is the platelet count, which can help detect the disease in its early stages. A low white blood cell count can be indicative of an enlarged spleen and/or increased blood pressure within the liver's blood vessels. Blood tests, also known as blood chemistries, can also evaluate liver function by measuring the amounts of certain substances released into the blood by the liver.

While blood tests are an important tool in the detection and diagnosis of liver cancer, they are typically used in conjunction with other tests and procedures, such as imaging scans and biopsies, as a diagnosis cannot be made on a blood test alone.

Physical exams

Physical examinations are an important part of diagnosing liver cancer. Doctors will ask about symptoms and medical history, including health habits, past illnesses, and treatments. They will also examine the patient's body, checking for signs of disease, such as lumps, or anything else that seems unusual.

During a physical exam, doctors will pay special attention to the abdomen, checking for any areas that might be swollen or don't feel normal, including lumps. They will also check for pain and listen to the abdomen and chest to determine if they sound normal. A key sign of liver cancer is jaundice, so doctors will check the skin and whites of the eyes for a yellowish colour.

Blood tests are also a common part of physical exams, checking the levels of certain substances in the blood that may be affected by liver cancer. For example, liver cancer can raise blood levels of calcium and cholesterol while lowering blood glucose levels. Doctors will also measure the level of proteins called alpha-fetoprotein (AFP), which can be elevated in many cases of primary liver cancer. However, it is important to note that AFP levels can also be raised by other factors, including pregnancy, hepatitis, and other types of cancer.

In addition to AFP, doctors may also check carbohydrate antigen (CA) 19-9 levels, which can be elevated in liver cancer cases. These blood tests can also show how well the liver is functioning and help determine the stage of the cancer, which is crucial for recommending treatment.

Tumour marker tests

Alpha-fetoprotein (AFP) is the most common tumour marker that doctors monitor for liver cancer. AFP is a molecule usually produced by the liver and yolk sac of unborn babies. Its main function is to help transfer molecules from the pregnant person to the fetus, such as copper, fatty acids, and bilirubin. AFP is normally found in small amounts in the blood of adults. High amounts of AFP suggest HCC, the most common type of liver cancer. However, high levels of AFP can also indicate other conditions, including cirrhosis, hepatitis, and pregnancy. AFP levels can also be normal even when there is liver cancer.

Other tumour markers that may be used in combination with AFP to improve detection rates include heat shock protein, DKK1, and OPN. Doctors can use tumour markers to determine whether a patient is responding to treatment. A notable increase in AFP, for example, can indicate that cancer has spread to distant parts of the body.

It is important to note that tumour marker tests are not the only method used to detect liver cancer. Doctors may also use imaging tests, biopsies, and physical examinations to diagnose and understand the progression of the disease.

Frequently asked questions