Liver Cancer: Diagnosis

Approved by the Cancer.Net Editorial Board, 08/2023

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible or recommended, the doctor may suggest other tests that will help make a diagnosis.

How liver cancer is diagnosed

There are different tests used for diagnosing liver cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

The following tests may be used to diagnose hepatocellular carcinoma (HCC):

  • Physical examination. If a person has symptoms of HCC, the doctor will feel the abdomen to check for lumps, swelling, or other changes in the liver, spleen, and other nearby organs. The doctor will also look for an abnormal buildup of fluid in the abdomen and for signs of jaundice, including yellowing of the skin and whites of the eyes.

  • Blood tests. At the same time as the physical examination, the doctor will most likely do a blood test to look for a substance called alpha-fetoprotein (AFP). In the United States, AFP is found in elevated levels in the blood of about 50% to 70% of people who have HCC. The doctor will also test the person’s blood to see if there is hepatitis B or C. Other blood tests can show how well the liver is working.

In addition, other tests are commonly needed to diagnose HCC, to find where the tumor is located in the liver, and to see if it has spread to other parts of the body. After the physical examination and blood tests, the doctor may recommend 1 or more of the following tests:

  • Ultrasound. An ultrasound creates a picture of the internal organs using sound waves. The sound waves bounce off the liver, other organs, and tumors. Each creates a different picture on a computer monitor.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional image of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow. Often, HCC can be diagnosed based on features specific to the cancer that are seen on a CT scan. This helps patients avoid a liver biopsy (see below). A CT scan can be used to measure the tumor’s size.

  • Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Angiogram. An angiogram is an x-ray picture of the blood vessels. A dye is injected into the bloodstream so the blood vessels of the liver show up on an x-ray.

  • Laparoscopy. Laparoscopy is a test that shows the inside of the body using a thin, lighted, flexible tube called a laparoscope. The person is sedated as the tube is inserted through a small incision in the abdomen. Sedation uses medication to make the person relaxed and sleepy. Local anesthetic is also used to numb the area. Laparoscopy is used very rarely in diagnosing liver cancer.

  • Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    The type of biopsy performed will depend on the location of the cancer. The biopsy can be done during a laparoscopy, a fine-needle aspiration, or a core biopsy. During a fine-needle aspiration, cells are removed using a thin needle inserted into the tumor. A core biopsy uses a thicker needle. Either procedure is done by a radiologist who uses an ultrasound to direct the needle to the particular part of the liver with the tumor. The actual biopsy procedure usually lasts for less than 1 minute. It is typically not painful, and few people have complications from the procedure.

    Before the biopsy, your doctor will test your blood to make sure it clots normally. This decreases the risk of bleeding after the procedure. Sometimes, your doctor might perform a laparoscopy and biopsy to look at the non-cancerous part of the liver to find out if you have cirrhosis, which will help determine the best treatment options.

    • When the AFP blood test, CT scan, or MRI strongly indicates HCC and other test results are typical of HCC, a biopsy may not be needed. Also, most surgeons will recommend that a biopsy be done as part of surgery if all or part of the liver is being removed rather than as a separate procedure beforehand. See the Types of Treatment section for more information about surgery for liver cancer.

      It is also important to note that with newer imaging methods, very small masses are easier to find. However, it is not always possible to identify what a very small mass is and whether it is cancer. In these instances, especially when the mass is 1 centimeter or smaller in size, the doctor may recommend a “watch and wait” approach. This is also called active surveillance or watchful waiting. This means that the scans are repeated in 3 to 6 months. If the later scan shows that the size hasn’t changed, the surveillance approach is continued. If it grows, the doctor will then do a biopsy.

  • Biomarker testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Types of Treatment).

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is HCC, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.