Liver Cancer Diagnosis

A liver cancer diagnosis usually starts with a physical examination. The doctor feels for hard lumps in the abdomen. An organ affected by a tumor often feels enlarged and hard to the touch. The patient may feel some pain during the physical exam, as the liver may be tender. If the doctor listens to the blood vessels surrounding the liver, he may hear sounds that indicate the tumor is putting pressure on the vessels.

A personal history is also taken. The doctor looks for lifestyle risk factors such as alcohol abuse or IV drug use, health concerns such as hepatitis infections and any family history of liver-related disorders.

The Alpha-Fetoprotein Blood Test

The next stage in the diagnosis is a blood test known as an AFP (alpha-fetoprotein) test. Between 50 and 75 percent of people suffering from primary hepatic cancer have high levels of alpha-fetoprotein in their blood.

An AFP test measures the amount of the protein present in the blood stream. Although the AFP test indicates the possibility of hepatic cancer, it cannot confirm the diagnosis. Other conditions, most notably cirrhosis, chronic hepatitis infections and several other cancers also produce high levels of AFP.

In addition to the AFP blood test, other tests that measure enzyme, bilirubin and protein levels can identify possible liver dysfunction. None of these tests, however, can be used alone to diagnose hepatic cancer.

Diagnostic Imaging: CT Scans, MRIs and the Liver Scan

Diagnostic scanners can identify a potential tumor as small as an inch across. If your AFP blood test indicates the possibility of hepatoma, you may be sent for a liver scan, computed tomography (CT) scan, ultrasound or magnetic resonance imaging (MRI):

  • CT scan – Multiple X-rays are used to create a computerized 3D image of the internal organs.
  • Ultrasound – High frequency sound waves create an image of the internal organs on a monitor.
  • MRI – Powerful magnets and radio signals create an image of the internal organs on a computer.
  • Liver scan – Radioactive isotopes are injected into the bloodstream. A scanner detects these isotopes and produces a picture of their location. Under normal conditions, the isotopes would be evenly spread throughout the organ.

Although diagnostic images are helpful, they can’t always distinguish a hepatoma and other abnormal tissue masses such as the nodular fibers generated by cirrhosis. Nor can a malignant tumor be differentiated from a benign growth. The scan can, however, indicate the ideal location for a liver biopsy, which can then be analyzed microscopically.

If a tumor is detected, a chest X-ray may be ordered. This confirms whether the tumor is indeed a primary cancer or whether it has metastasized from another location such as the lungs.

Liver Biopsy

A liver biopsy remains the best way to confirm diagnosis of hepatoma. A long narrow needle is inserted into the liver and a small sample of tissue is removed. This sample is then examined for tumor cells. The procedure is generally very safe. In fewer than 0.5 percent of cases, a fatal hemorrhage can result, as some tumors are connected to multiple blood vessels.


American Cancer Society. (updated 2005). What is liver cancer?

Frey, R. J. (2005). Liver cancer. Gale Encyclopedia of Medicine.

National Library of Medicine. (updated 2004). Hepatocellular carcinoma. MedlinePlus Medical Encyclopedia.

National Library of Medicine. (updated 2005). Liver scan. MedlinePlus Medical Encyclopedia.