Liver Cancer: Diagnosis

Blood Tests

Liver function tests (LFTs). A series of blood tests can help assess the how well the liver is working.

Blood clotting tests A damaged liver may not make enough of the proteins that allow the blood to clot and therefore prevent bleeding

Tests for viral hepatitis Infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) is linked both to cirrhosis of the liver (see above) and to liver cancer

Kidney function tests A series of blood tests can help assess the how well the kidneys are working.

Complete blood count (CBC) This test measures levels of red blood cells, white blood cells (which fight infections), and platelets (which help the blood clot). It also shows how well the bone marrow, where new blood cells are made, is functioning.

Blood chemistry tests and other tests Blood chemistry tests check the levels of a number of minerals and other substances in the blood, some of which might be affected by liver cancer.

Alpha-fetoprotein blood (AFP) test The AFP level can help determine what treatment options might be appropriate. Also ordered during treatment, to find out how well the therapy is working, or find out if the cancer has come back.
CA 19-9 Another tumor marker which tends to be elevated in patients with biliary cancers. Our group has shown that it also help to predict prognosis in patients with all kinds of liver cancer.

Imaging Studies

CT scan Computed Tomography (CT) scans take many different x-rays to produce detailed, cross-sectional images of the liver and other organs.

Magnetic resonance imaging (MRI) MRI scans use radio waves and strong magnets instead of x-rays to take pictures of the body. MRIs map the location, size, and sometimes even the type of tissue contained in the tumor.

Ultrasound This diagnostic technique uses sound waves to take create images of parts of the body. A small instrument called a transducer emits sound waves and picks up the echoes as they bounce off the liver. A computer converts these sound wave echoes into an image that is displayed on monitor.

Endoscopy An endoscope is a long, lighted tube that is passed through the patient’s esophagus, stomach and beginning of the lower intestine, allowing the physician to explore these areas without surgery. This technique, along with ERCP (described below) is used most commonly to evaluate bile duct cancers, or cholangiocarcinomas.

Endoscopic Retrograde Cholangiopancreatography (ERCP). A smaller tube or catheter is passed through the endoscope and into the bile ducts. Dye is injected into the ducts, and the physician takes X-rays to discover whether a tumor is present in the bile ducts.


The physician may also need to take a biopsy of the tissue to be examined under a microscope. This tissue can be obtained in the following procedures:

Needle biopsy A hollow needle is placed through the skin in the abdomen and into the liver. The skin is first numbed with local anesthesia.

During a fine needle aspiration (FNA) biopsy, tumor cells are sucked into a very thin needle with a syringe.

During a core needle biopsy, a slightly larger needle is used to take a bigger sample from the liver.

Whenever possible, biopsy for biliary cancers should be done via ERCP, because there is less risk of seeding the tumor to other areas. For those with underlying cirrhosis who may be curable (either with resection (cutting the tumor out) or liver transplantation (putting in a new liver), usually the imaging is sufficient to make the diagnosis without a biopsy.