How primary liver cancer is diagnosed This information is an extract from the booklet Understanding primary liver cancer (hepatocellular carcinoma or hepatoma). You may find the full booklet helpful. We can send you a copy free – see page 6.

Contents          

At the hospital Surveillance Blood tests Liver ultrasound scan Abdominal CT scan (computerised tomography scan) MRI (magnetic resonance imaging) scan Liver biopsy Laparoscopy Waiting for test results Hepatic angiogram

Usually, you begin by seeing your GP, who will examine you. They may arrange some blood tests to check your general health, and other tests to help find out what is causing your symptoms. If your GP isn’t sure what the problem is or thinks that cancer may be present, you’ll be referred to a hospital for specialist advice. If your GP suspects you have cancer, you should be seen at the hospital within two weeks.

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How primary liver cancer is diagnosed

At the hospital The specialist will ask you about your symptoms and your general health. You’ll also be asked if you have any other health problems. The doctor will examine you by feeling your tummy (abdomen). You may also have a blood test and a chest x-ray. Several tests may be used to diagnose primary liver cancer. The tests may also show the stage of the cancer and whether or not it has spread to other parts of the body. These tests help your doctor decide on the best way to treat the cancer. It can help to have a relative or friend with you when you go for any tests or when you get your results.

Surveillance If you are known to have liver cirrhosis already, you should have regular blood tests and ultrasound scans to monitor your liver. This means that any cell changes will be found early and your doctor can begin treatment as quickly as possible.

Blood tests As well as blood tests to check your general health, you’ll have other blood tests called liver function tests (LFTs), which check how well your liver is working. Another blood test checks the amount of a chemical called alpha-fetoprotein (AFP) in your blood. The amount of AFP in the blood can be higher than normal in people with hepatocellular carcinoma (HCC). The doctors may monitor the level of AFP before and after treatment, as it can show how well it’s working.

Liver ultrasound scan A liver ultrasound scan uses sound waves to make up a picture of the liver. This test is painless and only takes a few minutes. It’s done in the hospital scanning department. You’ll be

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How primary liver cancer is diagnosed

asked not to eat anything for at least four hours before your appointment. Once you are lying comfortably on your back, a gel is spread on to your abdomen. A small device like a microphone, which produces the sound waves, is passed over the area. The sound waves are then converted into a picture by a computer.

Abdominal CT scan (computerised tomography scan) A CT scan takes a series of x-rays of the abdomen, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

Someone having a CT scan You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

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How primary liver cancer is diagnosed

You’ll probably be able to go home as soon as the scan is over.

MRI (magnetic resonance imaging) scan This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins. You should also tell your doctor if you’ve ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it’s likely that you won’t be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Liver biopsy The only way to be sure of the diagnosis is to take some cells or a small piece of tissue from the affected area to look at under a microscope. This is called a biopsy. A biopsy isn’t always necessary – some doctors use the scan results to make their diagnosis. Sometimes the diagnosis is confirmed after an operation to remove the tumour. After the area has been numbed using a local anaesthetic injection, a fine needle is passed into the tumour through the skin. A CT scan or ultrasound may be used at the same time to make sure the biopsy is taken from the right place. You’ll need to stay in hospital for a couple of hours after a liver biopsy, and possibly overnight. This is because there’s a risk of bleeding afterwards.

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How primary liver cancer is diagnosed

If your cancer hasn’t already spread and there’s a chance your tumour can be removed, you may not have a biopsy. This is because there is a small risk that the cancer can spread along the pathway of the needle when the biopsy needle is removed.

Laparoscopy A laparoscopy is a small operation that allows the doctors to look at the liver and other internal organs in the area. It’s done under a general anaesthetic and will mean a short stay in hospital. The doctor makes a small cut (incision) in your abdomen and inserts a thin tube with a light and a camera at the end of it (laparoscope). Using the laparoscope, the doctor is able to look at the liver and can take a small sample (biopsy) for examination under a microscope. During the operation, carbon dioxide gas is passed into the abdominal cavity, which can cause uncomfortable wind and/or shoulder pains for several days afterwards. The pain is often eased by walking about or taking sips of peppermint water. After the laparoscopy you’ll have one or two stitches in your abdomen.

Waiting for test results It may take 1–2 weeks for the results of your tests to be ready. Waiting for your results can be a difficult time. It may help to talk things over with a relative or close friend. You may want to contact our cancer support specialists on 0808 808 00 00 or a support organisation. If the tests described here show that you have primary liver cancer, your doctor may need to arrange some further tests. These will tell the doctor more about the cancer and show whether or not it has spread. You may have the following test:

Hepatic angiogram This test allows the doctors to see how the tumour is affecting the main blood vessels around the liver. A fine tube is inserted into an artery in your groin and a dye is injected through the Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk

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How primary liver cancer is diagnosed

tube. The dye circulates the arteries and makes them show up on an x-ray. An angiogram is carried out in a room within the x-ray department. Sometimes, an MRI scan (see page 4) can be used to show up the blood vessels of the liver, which means that an angiogram will not be necessary.

More information and support If you have any questions about cancer, ask Macmillan. If you need support, ask Macmillan. Or if you just want someone to talk to, ask Macmillan. Our cancer support specialists are here for everyone living with cancer, whatever you need. Call free on 0808 808 00 00, Monday–Friday, 9am–8pm www.macmillan.org.uk To order a copy of Understanding primary liver cancer (hepatocellular carcinoma or hepatoma), visit be.macmillan.org.uk We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. © Macmillan Cancer Support 2012. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ

REVISED IN FEBRUARY 2012

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