Your Diagnosis

Working with Your Doctors

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When you go to your doctor with symptoms that may signal liver cancer, he or she may perform one or more tests or refer you to one or more specialists to determine what’s wrong.

From diagnosis through treatment, you may work with a number of different kinds of doctors. For instance, you may work with a hepatologist, who specializes in the treatment of liver diseases, a surgeon, who would perform any surgical procedures you may need, and a radiologist, who uses imaging technology and radiation to diagnose and treat diseases. If your doctor refers you to a specialist, don’t be afraid to ask questions about his or her role in your diagnosis or treatment.

If you know of a doctor or treatment center that you would like to consult about your symptoms, you may ask your doctor for a referral.

The most frequently used tools to diagnose liver cancer are blood tests, imaging, biopsies, or a combination of these tests.

Learn about:

Basic diagnostic techniques

  • Physical exam. During a physical exam, your doctor feels your abdomen to check your liver, spleen, and nearby organs for any lumps or changes in their shape or size. He or she will also check for ascites — an abnormal buildup of fluid in the abdomen — and may examine your eyes and skin for signs of jaundice. Since it is difficult to feel small tumors through a physical exam, your doctor will likely perform additional tests.

  • Blood tests. Your doctor may administer one or more blood tests to see whether your liver is functioning normally or if there is some abnormality.

    Words to Know

    A tumor marker, or biomarker, is a substance produced by a tumor. Tumor markers can be found in the blood, in tissues, or in other body fluids. High levels of a tumor marker, such as AFP, may be a sign of cancer.

    One of these tests for the amount of a protein called alpha-fetoprotein (AFP), or fetal alpha globulin, in your blood. AFP is produced in the liver and yolk sac of fetuses — and so may be present in the blood of pregnant women — but the amount produced declines dramatically after birth. High levels of AFP may be a sign of liver cancer, or another type of cancer.

    While AFP is currently the most reliable tumor marker for liver cancer, there are risks associated with depending on it as a diagnostic tool because other conditions may cause it to rise. For instance, not all liver tumors raise levels of AFP, so even if your AFP count is normal, there may still be a cancerous tumor in your liver. Other times, AFP levels are only detectable after the tumor has grown too large to be removed. AFP may also be a sign of some non-cancerous liver diseases. Other tumor markers for liver cancer are currently being studied.

Imaging tests

  • Computed tomography (CT) scan. A CT scanner is a high-beam x-ray machine that takes a series of detailed pictures of cross-sections of your body and then feeds them into a computer. The x-rays it uses are thinner and more focused than those used in a traditional x-ray and make the pictures clearer. To check for signs of liver cancer, your doctor will use the CT scanner to take pictures of your liver, other organs, and blood vessels in your abdomen. During the procedure, you may receive an injection of special dye so that your liver will show up clearly in the pictures. You generally must remain still for the 15 to 30 minutes needed to perform the test.

  • Magnetic resonance imaging (MRI). MRIs create detailed pictures of areas inside the body using a powerful magnetic field to take pictures of cross-sections of your body rather the using radiation as a CT scan does. Similar to CT scans, the images are displayed on a computer monitor and can also be printed. In some cases, MRIs can make it possible to distinguish between cancerous and non-cancerous tumors, which can make them especially helpful. Similar to CT scans, MRIs are non-invasive, though these tests usually take longer.

  • Ultrasound. An ultrasound device is a wand that your doctor moves over your body, while you lie on a table, to take pictures of your liver. The device uses sound waves that produce a pattern of echoes as they bounce off internal organs. The echoes create a picture, known as a sonogram, of your liver and other organs in the abdomen. Ultrasound tests can help your doctor detect where any tumors are located because tumors may produce echoes that are different from the echoes made by healthy tissues. These tests can make it possible to discern cysts from a tumor, but not a cancerous tumor from a non-cancerous tumor.

  • Angiogram. For this procedure, your doctor injects dye into one of your arteries so that blood vessels in your liver show up on an x-ray. This test can reveal a tumor in the liver and help doctors determine whether it can be removed.

    Words to Know

    Under local anaesthesia or regional anaesthesia only the area directly affected by an operation is numbed so that you may be awake during the procedure. Under general anaesthesia, you are unconscious for the duration of the operation.

    IV, which stands for intravenous line, is a narrow plastic tube inserted into a vein in your arm.

    An angiogram may be done in different ways. One method is to inject the dye into a narrow, hollow tube called a catheter, which is inserted into an artery that runs from your inner thigh to your liver. You will receive local anaesthesia in the skin surrounding the insertion site. X-rays are then taken of your abdomen.

    CT angiograms are done using a CT scan, and MRI angiograms use MRI scanners. In these cases, you may need to be hooked up to an IV so that the contrast dye can be inserted into one of your arteries.

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