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Liver Cancer 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:


Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging method that uses high-frequency sound waves to produce images of structures within the body. The images can provide valuable information for diagnosing and treating a variety of diseases and conditions. Most ultrasound examinations are done using a sonar device outside the body, though some ultrasound examinations involve placing a device inside the body.

Computed Tomography (CT) Scan

CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut. Doctors order CT scans when they want to see a two-dimensional image of the body to look for tumors and examine lymph nodes and bone abnormalities. If contrast dye is used to improve the computer image, the patient may need to avoid eating or drinking for 4 to 6 hours before the test. Patients should tell their provider before the test if they have any allergies or kidney problems.

Magnetic Resonance Imaging (MRI)

This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be asked to drink a contrast solution for better imaging, and you will most likely lie on a moving table as pictures are taken. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT. MRI may not be recommended if you have a pacemaker or other metal implant.


You will receive an intravenous sedative and pain medication. Once comfortable, the physician will then examine the area using an endoscope—a lighted tube with a small camera at the end. The physician will be able to view any abnormalities and take a tissue samples (biopsies) if necessary.

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


An angiography is an imaging test that uses x-rays to view the body’s blood vessels.

Bone Scans

Bone scans involve a low dose of radioactive material that is injected into a vein. Bone attracts this material. Concentrated areas show up on the scan and are referred to as "hot spots." Hot spots may be indicative of a variety of diseases and conditions.

Blood Tests

A common tool for disease screening, blood tests provide information about many substances in the body, such as blood cells, hormones, minerals, and proteins.


Any suspicious mass of tissue or tumor is subject to a biopsy, or removal of cells from the mass. This is the only technique that can confirm the presence of cancer cells. The doctor will use a general or local anesthetic depending on the location of the mass, and then remove a sample of tissue to send to the lab. The sample is sent to a pathologist, a physician who is an expert at identifying diseased cells in tissue samples. Very often, a few stiches are used to help the area heal, and tenderness is felt for a short period of time.

Liver Cancer 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.


American Cancer Society. 2015. Liver Cancer Overview. PDF.

National Cancer Institute. 2009. What You Need To Know About™ Liver Cancer. PDF. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services.