Diagnostic Tests for Liver Cancer
The best way to detect liver cancer is through surveillance ultrasound of the liver done by an oncologist every six months in a patient with a diagnosis of cirrhosis. As with most forms of cancer, it is best 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 to confirm a diagnosis:
- Blood tests: alpha-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. The AFP may be elevated with cirrhosis and chronic active hepatitis. Other labs tests include des-gamma-carboxy prothrombin, which can be elevated in most patients with liver cancer.
- 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.
- Liver biopsy is performed to sample tissue from the lesion in the liver, which is analyzed by a 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.