For many people, the first stage of diagnosing liver cancer is a consultation with a GP, although people at risk are usually tested regularly for the condition.
If you visit your GP, they'll ask about your symptoms, when they started, and when they're noticeable. They'll also examine you.
If they feel you need further tests, you'll be referred to a hospital specialist. Some of the tests you may have are described below.
Surveillance for liver cancer
If you're in a high-risk group for developing liver cancer, such as having a history of liver disease, regular screening – known as surveillance – is often recommended. This is because the earlier the cancer is diagnosed, the greater the chance there is of curing it.
Surveillance is usually carried out every 6 months and often involves:
- ultrasound scans – high-frequency sound waves are used to create an image of your liver, which can highlight any abnormalities
- blood tests – your blood is tested for a protein called alphafetoprotein (AFP), which is found in some people with liver cancer
Surveillance is usually recommended if you have cirrhosis (scarring of the liver), although there are other factors that can also affect your risk of liver cancer.
The potential benefits of surveillance should be discussed with you before you enter any screening programme.
The tests above can also be used to look for liver cancer in people who are not being routinely screened.
If these initial tests suggest there's a chance you could have liver cancer, one or more further tests will usually be recommended to confirm the diagnosis.
The further tests include:
- CT scans – a series of X-rays of your liver are taken to give a more detailed 3-dimensional image
- MRI scans – use a strong magnetic field and radio waves to build up a picture of the inside of your liver
- biopsy – a needle is inserted into your abdomen (tummy) to remove a small sample of liver tissue, which is then tested in a laboratory for cancerous cells
- laparoscopy – a small incision is made in your abdomen under general anaesthetic (where you are asleep) and a flexible camera called an endoscope is used to examine your liver
After these tests have been carried out, it's usually possible to confirm a diagnosis of liver cancer and determine the condition's "stage".
Staging liver cancer
Staging is a term used to describe how far a particular cancer has spread. There are a number of different systems used to stage liver cancer.
Many liver cancer specialists use combination staging systems that include features of both the cancer and the underlying liver function to stage a person's condition.
This is because the length of time a person lives and how well they tolerate potential treatments will be determined not only by how advanced their cancer is, but also by their level of health and how good their underlying liver function is.
In the UK, liver cancer specialists normally use a staging system called the Barcelona Clinic Liver Cancer (BCLC) staging system.
The BCLC staging system is based on how well your liver is working, how far the cancer has spread and your overall health.
There are 5 stages:
- stage 0 – the tumour is less than 2cm in diameter and the person is very well and has normal liver function
- stage A – a single tumour of any size has developed, or there are 3 or fewer smaller tumours less than 3cm in diameter and the person is very well and their liver is working well
- stage B – there are multiple tumours in the liver, but the person is well and their liver function is working well
- stage C – the cancer has spread into blood vessels, lymph nodes or other body organs, or the person is not feeling very well and is less active but their liver is still working well
- stage D – the person has severe liver damage or they are not well and need assistance from a carer(s)
Read more about staging primary liver cancer on the Cancer Research UK website.