A patient with the above symptoms that suggest liver cancer may be asked to undergo one or more of the following procedures:
Physical exam: During a physical exam, the doctor will feel the abdomen to examine the liver, spleen and nearby organs for abnormalities in their shape or size. The doctor will also check for ascites in the abdomen, which is an abnormal accumulation of fluid. Lastly, the doctor will also examine the skin and eyes for signs of jaundice.
Blood tests: One common blood test detects alpha-fetoprotein (AFP). High AFP levels can be a sign of liver cancer. Other blood may be performed to measure how effectively the liver is performing.
CT Scan: A CT scan uses X-rays to take many pictures of the body, which are then assembled in order to display images of slices of the part of your body being examined. CT scans are very helpful diagnostic tools for locating evidence of liver cancers.
Ultrasound: A test that uses sound waves to render images of internal organs. During an ultrasound the patient lies on a table while a wand is moved over the part of the body being examined
Angiogram: The doctor injects dye into an artery. This allows the blood vessels in the liver to be visible on an X-ray. For an angiogram, the patient may be in the hospital and may have anesthesia.
Biopsy: A sample of tissue is removed from the liver for examination under a microscope. A biopsy may be performed in several ways:
- Fine Needle Aspiration (FNA): A thin needle is inserted into the liver to remove a small amount of tissue
- Core Biopsy: Similar to FNA, but a thicker needle is used to remove small cylinder-shaped samples (cores)
- Laparoscopy: A small incision is made in the abdomen and a thin, lighted tube (laparoscope) is inserted to view the tumor site
- Surgical biopsy: Tissue is removed during an operation
Staging is an attempt to determine the size of the tumor, whether the disease has spread and, if so, to what parts of the body. Careful staging shows whether the tumor can be removed with surgery
Stage I: There is one tumor and it has not spread to nearby blood vessels.
Stage II: One of the following is found:
- One tumor that has spread to nearby blood vessels
- More than one tumor, none of which is larger than five centimeters.
Stage III: Divided into stages IIIA, IIIB and IIIC.
Stage IIIA: More than one tumor larger than five centimeters; or One tumor that has spread to a major branch of blood vessels near the liver
Stage IIIB: There are one or more tumors of any size that have either:
- Spread to nearby organs other than the gallbladder; or
- Broken through the lining of the peritoneal cavity
Stage IIIC: The cancer has spread to nearby lymph nodes.
Stage IV: The cancer has spread beyond the liver to other places in the body, such as the bones or lungs. Tumors may be of any size and may also have spread to nearby blood vessels and/or lymph nodes.
For adult primary liver cancer, stages are also grouped according to how the cancer may be treated:
- Localized resectable: The cancer is found in the liver only, has not spread and can be completely removed by surgery.
- Localized and locally advanced unresectable: The cancer is found in the liver only and has not spread, but cannot be completely removed by surgery.
- Advanced: Cancer has spread throughout the liver or has spread to other parts of the body, such as the lungs and bone.