Liver Cancer Investigations: Tests for Diagnosis

If a person is suspected to have liver cancer due to the presence of signs and symptoms, some investigations are required to confirm the diagnosis of the disease. Further, these investigations can help in determining the extent of locoregional invasion or spread of the disease to other body parts, which in turn help in choosing an appropriate treatment option.

Following are some commonly used diagnostic tools for liver cancer:

  1. Ultrasound: This is a test recommended to be used for screening of high-risk individuals. In this technique, a transducer is used which directs very high-frequency sound waves towards the tissue to be examined. The sound waves are reflected off the internal structures depending on their ability to reflect these waves.

    The reflected sound waves are collected by a special detector (fixed near the transducer) to produce a real-time image of the internal tissues on a computer screen. This helps the doctor to examine the liver tissue for any abnormality. This test can detect solid tumor masses (cancerous) within the liver of high-risk patients, which can be further evaluated with the help of other diagnostic tools. This technique can sometimes be used to guide a biopsy needle to collect biopsy samples from the affected area to establish the diagnosis of liver cancer.

  2. Blood Tests: Blood tests cannot confirm liver cancer themselves but these tests can provide certain important information that can provide direction to the diagnostic workup of liver cancer. Following are commonly employed blood test for this purpose:

    Alpha-fetoprotein (AFP): This is another test recommended to be used for screening of high-risk individuals. AFP is glycoprotein generally produced by the immature liver cells of a fetus. The level of AFP decreases significantly after birth and approaches to normal by 1 year of birth.

    Abnormally high level of AFP in adults is usually associated with liver disease, liver cancer, or some other conditions. Thus, in the high-risk individuals, abnormally high level of AFP may signal the development of liver cancer.

    Monitoring of AFP level can be helpful in assessing the efficacy of the treatment/surgery (that should bring down the AFP level in patients with high AFP levels detected before treatment start) and to assess disease progression/recurrence.

    Liver function tests (LFTs): These are a group of blood tests which give an estimate of overall liver functionality as a function of the blood levels of certain substances. These tests include prothrombin time (PT), albumin, bilirubin (direct and indirect), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and others. These tests are employed for the assessment of suitability for liver resection.

  3. Imaging Tests: These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.

    Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area. Triple-phase CT scan is used if there is a suspicion of hepatocellular cancer. Contrast enhancement in the arterial phase and washout in the delayed venous phase may be suggestive of hepatocellular cancer.

    Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, a strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.

    Positron emission tomography (PET) scan: This technique uses a radioactive substance (e.g.fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells. The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose the spread of disease to distant body parts. It is usually combined with a CT scan (PET/CT).

    Bone Scan: This test is performed for patients with symptoms suggesting the spread of disease to bones, for example, pain in bones and an elevated serum level of alkaline phosphatase. In this test, a radioactive material is first injected into the vein of the patient, which gets accumulated in the areas of bones affected by the disease and such areas are then detected with the help of radioactivity detectors.

  4. Laboratory Tests for Biopsy Samples: Biopsy samples contain a small number of cells or a tiny piece of tissue collected from the affected area with the help of a biopsy needle or other biopsy instrument. These samples provide very useful information about the cancer cells such as the type of cancer, the severity of cancerous changes involved, and the presence of specific defective genes or proteins. Biopsy is not always required in hepatocellular cancer, as in some cases imaging and tumor markers may be sufficient for diagnosis.

In the next section, you will read about the staging of liver cancer.

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