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How is liver cancer diagnosed?

Liver cancer is also known as hepatocellular carcinoma, HCC. It is a cancer that originates in liver. Liver cancers are malignant tumors that grow on the surface or inside the liver.

Diagnosis of Liver Cancer

Blood Tests
– Liver cancer depends so much on the vigilance of the physician screening with a tumor marker (alpha-fetoprotein) in the blood and radiological imaging studies.
– If the blood tests become abnormal or worsen due to liver cancer, this usually signifies extensive cancerous involvement of the liver.
– in liver cancer, the cancerous liver cells may take on the characteristics of other types of cells.
– For example, liver cancer cells sometimes can produce hormones that are ordinarily produced in other body systems.
– These hormones then can cause certain abnormal blood tests
– These include a high red blood count (erythrocytosis), low blood sugar (hypoglycemia) and high blood calcium (hypercalcemia).
– High serum cholesterol (hypercholesterolemia), is seen in up to 10% of patients from Africa with liver cancer.
– The high cholesterol occurs because the liver cancer cells are not able to turn off (inhibit) their production of cholesterol.
– There is no reliable or accurate screening blood test for liver cancer.
– The most widely used biochemical blood test is alpha-fetoprotein (AFP)
– AFP is a protein normally made by the immature liver cells in the fetus.

In adults, high blood levels (over 500 nanograms/milliliter) of AFP are seen in only three situations:
– Liver cancer.
– Germ cell tumors (cancer of the testes and ovaries).
– Metastatic cancer in the liver (originating in other organs).

There are a number of other liver cancer tumor markers like:
– Des-gamma-carboxyprothrombin (DCP),
– A variant of the gamma-glutamyltransferase enzymes,
– Variants of other enzymes (for example, alpha-L-fucosidase).

Imaging Studies
These studies provide information
– as to the size of the tumor.
– the number of tumors.
– whether the tumor has involved major blood vessels locally or spread outside of the liver.

Ultrasound Examination
– It is usually the first study ordered if liver cancer is suspected in a patient.
– The accuracy of an ultrasound depends very much on the technician and radiologist.
– Computerized axial tomography (CT scan) is a very common study used in the U.S.
– The ideal CT study is a multi-phase, spiral CT scan using oral and intravenous contrast material.

Pictures are taken in three phases:
– Without intravenous contrast.
– With intravenous contrast (enhanced imaging) that highlights the arterial system (arterial phase).
– When the contrast is in the venous phase.

Magnetic Resonance Imaging (MRI)
– It can provide very clear images of the body.
– Its advantage over CT is that MRI can provide sectional views of the body in different planes.

Others
– If there is uncertainty about the diagnosis, the presence of liver cancer may be confirmed with a biopsy.
– Tissue from the liver is removed through a needle or during an operation and checked under a microscope for the presence of cancer cells.
– Laproscopy is another method.

Staging
The following stages are used for adult primary liver cancer:
Localized resectable
Cancer is found in one place in the liver and can be completely removed by surgery.
Localized unresectable
Cancer is found only in one part of the liver, but the cancer cannot be totally removed.
Advanced
Cancer has spread through much of the liver or to other parts of the body.
Recurrent
Cancer has come back or recurred after it was treated. It may come back in the liver or in another part of the body.

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