Liver Cancer Diagnosis and Staging

Liver Cancer Diagnosis and Staging

Dr. Kennedy
Often liver cancer does not present symptoms until the later stages of the disease. However, when liver cancer symptoms do occur, they may include the following:

  • Abdominal pain (on upper right side) and/or swelling
  • Fatigue
  • Weakness
  • Yellowing of the skin and eyes (jaundice)
  • Darkened urine
  • Nausea/vomiting
  • Unexplained weight loss
  • Loss of appetite
  • Fever
  • Feeling very full after a small meal
  • Itchy skin
  • Enlarged veins that become visible through the skin

These symptoms may be attributed to a number of conditions other than liver cancer, so their presence is not specific (pathognomonic) to liver cander,


Liver cancer screening for those at high risk include people who have:

Hepatitis B and one or more of the following:

  • Asian male older than 40
  • Asian female older than 50
  • African and older than 20, have liver cirrhosis, or have a family history of liver cancer
  • Liver cirrhosis from alcohol use
  • Hepatitis C
  • An inherited form of hemochromatosis
  • Primary sclerosing cholangitis


If you experience any of the symptoms of liver cancer, your doctor will ask you about your medical history and perform a physical exam. Tests and procedures used to diagnose liver cancer include:

  • Ultrasound (ultrasonography). This test uses sound waves to produce a picture of internal organs, including the liver. Ultrasound is painless and usually takes less than 30 minutes. While you lie on a bed or examining table, a wand-shaped device (transducer) is placed on your body. It emits sound waves that are reflected from your liver and transformed into a computer image. Ultrasound provides information about the shape, texture and makeup of tumors.
  • Computerized tomography (CT) scan. This test uses X-rays to produce cross-sectional images of your body. You may also have a variation of the test — known as a CT angiogram — in which contrast dye is injected into an artery in your liver. X-rays then track the dye as it flows through the blood vessels in your liver. CT angiogram, which may take up to an hour to perform, can provide detailed information on the number and location of liver tumors, but a CT scan exposes you to more radiation than conventional X-rays do, and some people may experience an allergic reaction to the contrast dye.
  • Magnetic resonance imaging (MRI). MRI creates images using a magnetic field and radio waves. Sometimes a contrast dye also may be used. The test can take from 15 minutes to an hour. Newer MRIs can show images of the ducts that transport bile from the liver to the upper part of the small intestine (duodenum) as well as of the arteries and veins within the liver.
  • Liver biopsy. In this procedure, a sample of tissue is removed from your liver and examined under a microscope. Liver biopsy is considered the only definitive way to diagnose liver cancer. Your doctor may use a thin needle or a lighted instrument (laparoscope) to obtain the sample. Biopsy carries a risk of bleeding, bruising and infection.
  • Blood tests. Doctors sometimes use a blood test that checks for the presence of alpha-fetoprotein (AFP) — a type of protein found in small amounts in adults — to detect liver cancer. But the test isn’t perfect. Not all malignant liver tumors produce AFP, and those that do may be advanced by the time protein levels become elevated. In addition, other types of cancer and even some noncancerous liver diseases can raise AFP levels.


Staging tests help determine the size and location of cancer and whether it has spread. Liver cancer may be staged in different ways. One method uses the Roman numerals I through IV, with higher numbers indicating cancers that are more advanced. A stage I tumor is small and confined to one lobe of the liver. By stage IV, several tumors may exist in different lobes, or malignant cells may have spread to other parts of the body.

Doctors may also use the following stages to describe primary liver cancer in adults:

  • Localized resectable At this stage, the tumor is confined to one lobe of your liver and can be completely removed in an operation. The term “resectable” refers to a tumor that can be surgically removed.
  • Localized unresectable The cancer is found in only one part of your liver, but can’t be completely removed, either because the noncancerous portion of your liver isn’t healthy or because the cancer is located near your liver’s main arteries, veins and bile ducts.
  • Advanced This stage of cancer has spread throughout the liver or to other parts of your body, particularly the bones or lungs. You’re more likely to have advanced cancer if you also have cirrhosis or chronic hepatitis.
  • Recurrent This means the cancer has returned to your liver or to another part of your body after being treated.

    Stages of primary cancer in children

    Doctors use the following stages to describe childhood liver cancer:

    • Stage I At this stage, the cancer can be removed with surgery.
    • Stage II Most stage II liver cancers can be removed with an operation, but microscopic amounts of cancer remain in the liver after surgery.
    • Stage III At this stage, some of the cancer may be surgically removed, but some will remain in the lymph nodes or abdomen.
    • Stage IV This stage of cancer has spread to other parts of the body.
    • Recurrent This means the cancer has returned after it has been treated. It may recur in the liver or in another part of the body.

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