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Diagnosis

How Is Liver Cancer Diagnosed?

Liver cancer can be difficult to diagnose early, as symptoms frequently do not develop until the later stages of the disease. Patients experiencing any of the symptoms of liver cancer, or those who have cirrhosis and notice it getting unexpectedly worse, should see their physician.

Physical Exam

The physician feels the abdomen for any unusual lumps or changes in the sizes and shapes of the liver, spleen, and surrounding organs. The physician also checks the abdomen for an abnormal buildup of fluid called ascites. He or she may also examine the skin and eyes for jaundice (a condition which may cause them to take on a yellowish appearance).

Imaging Tests

Several types of imaging tests and procedures are used to diagnose liver cancer. A physician may request on or more of the following:

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Ultrasound, CT, and MRI are the imaging tests most commonly used to diagnose liver cancer. Physicians are less likely to perform the following tests:

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Staging

Staging is used to determine the extent of the cancer and treatment options. There are several different staging systems in place for liver cancer. Some staging systems, such as the American Joint Committee on Cancer’s TNM system, look only at how widespread the cancer is. Other systems also take liver function into account.

Physicians frequently categorize liver cancers by whether they can be resected (surgically removed) or not. This helps physicians determine the best treatment options for patients.

A liver cancer can potentially be placed into one of five categories:

  • A liver cancer is potentially resectable if surgery can be used to remove the cancer, and the health of the patient permits it.
  • It is potentially transplantable if the surgeon is able to perform a liver transplant.
  • It is unresectable if the surgeon cannot remove the cancer, but it has not spread beyond the liver.
  • The cancer is inoperable with only local disease if surgery could be used to remove the cancer, but the health of the patient does not permit it.
  • It is metastatic if the cancer has metastasized (spread) beyond the liver. (American Cancer Society 2015)

Liver function is key to determining the best treatment options for patients. A system called the Child-Pugh score helps physicians determine how well the liver is functioning based on the measures of different substances in the blood, fluid in the belly, and brain function.

Patients are encouraged to discuss cancer staging and treatment options with their physicians.

Gastroenterology/Hepatobiliary Tumor Board

The results of the diagnostic tests are discussed at the Gastroenterology/Hepatobiliary Tumor Board. During this weekly meeting, the entire multidisciplinary team comes together to discuss new cases and develop individualized treatment plans for each patient.

References

American Cancer Society. 2015. Liver Cancer Overview. PDF. http://www.cancer.org/acs/groups/cid/documents/webcontent/003058-pdf.pdf

National Cancer Institute. 2009. What You Need To Know Aboutâ„¢ Liver Cancer. PDF. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. http://www.cancer.gov/publications/patient-education/liver.pdf