Liver Cancer - Diagnosis

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How is liver cancer diagnosed?

The best way to detect liver cancer is through surveillance ultrasound of the liver done every six months in a patient with a diagnosis of cirrhosis and to treat the liver cancer as soon as it is detected.

Once a suspicion of liver cancer arises, a physician will order one the following:

  1. Blood tests: alfa-fetoprotein (AFP), which may be elevated in 70% of patients with liver cancer. AFP levels could be normal in liver cancer. A rising level of AFP is suspicious for liver cancer. Other labs tests include des-gamma-carboxy prothrombin, which can be elevated in most patients with liver cancer.
  2. Imaging studies: Multiphasic helical CT scan and MRI with contrast of the liver are the preferred imaging for detecting the location and extent of blood supply to the cancer. If any imaging study is inconclusive, then an alternative imaging study or follow-up imaging study should be performed to help clarify the diagnosis. Lesions smaller than 1 cm are usually difficult to characterize.
  3. Liver biopsy is performed to sample tissue from the lesion in the liver, which is then analyzed by the pathologist to confirm the suspected diagnosis of liver cancer. Liver biopsy is not needed in every case, especially if the imaging study and lab markers are characteristic for liver cancer. Risks of liver biopsy are infection, bleeding, or seeding of the needle track with cancer. Seeding is when cancer cells get on the needle used for a biopsy and spread to other areas touched by the needle. Liver biopsy of suspected liver cancer carries the added risk of seeding the liver biopsy needle track in 1%-3% of cases. If a liver biopsy is inconclusive, then a repeat imaging study is recommended at three- to six-month intervals. Liver biopsy as well as imaging studies help in classifying liver cancers as per the Barcelona Clinic Liver Cancer staging system.
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See what others are saying

Comment from: John, 65-74 Male (Patient) Published: October 08

My liver tumor was diagnosed after I was told I had hemochromatosis, with an iron reading of 1200, when my reading should have been around 300. I had many blood tests, but was never tested by my local doctor for iron level study test. Apparently the tumor has been there for a long while. I have had ablation treatment twice in 5 months, now am told there are a lot more tumors now on my liver and that I now have 3 to 6 months to live.

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Comment from: blindsided, 55-64 (Caregiver) Published: April 16

My husband was age 59 when he died in July 2013 from a large tumor in the upper lobe of his liver. He had not had any alcohol for over 24 years, did not smoke and never had hepatitis. He went the gym three days a week and we had been to the gym the day before he got sick. He had just had his annual physical in May, with blood work. He had been to an endocrinologist in June because he had type 2 diabetes and had many more blood tests. Nothing was abnormal. On a Monday morning, he had a pain in his side that got gradually worse, thought it was probably from throwing his granddaughter in the pool both Friday night and Sunday afternoon. The pain got worse, and he called 911, was taken to the emergency room where a CAT scan showed he had a lot of blood in his abdomen, and was taken to emergency surgery. They could not stop the bleeding and he was taken to another hospital where he had 2 more surgeries by a liver specialist. He died 32 hours after symptoms started. The bleeding could not be stopped or blood pressure sustained. The liver surgeon said he had had the tumor for years and it encased his whole liver. No one can explain to me how this could have happened.

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