Diagnosing liver cancer

Tests

Liver cancer may be diagnosed using several tests. These include blood tests and imaging scans. It is becoming more common for a tissue sample to also be tested. This is called a biopsy.

Staging

The stage of a cancer describes how large it is, where it is and whether it has spread in the body. Knowing the stage of a liver cancer helps doctors plan the best treatment for you.

Primary liver cancer is staged using a method called the Barcelona Clinic Liver Cancer (BCLC) staging system. The system has 5 stages: 0 (very early); A (early); B (intermediate); C (advanced); D (end-stage).

To work out a cancer's stage, your doctor will consider:

• the size of the tumour
• the number of tumours
• whether the cancer has spread to blood vessels, lymph nodes or other organs
• how well you are functioning in daily life and how active you are
• how well the liver is working (using a Child-Pugh score).

The Child-Pugh score records how well the liver is working. In this system, liver function is ranked as: A (some damage but is working normally); B (moderate damage, affecting how well the liver is working); or C (very damaged and not working well). A severely damaged liver may not be able to cope with some types of cancer treatment.

The doctor may also check for portal hypertension. Cirrhosis can sometimes increase the blood pressure in the portal vein, which carries blood from the digestive organs to the liver. This can affect how the cancer can be treated (e.g. surgery may not be an option in people with portal hypertension).

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of a disease. To work out your prognosis, your doctor will consider:

• test results
• the type of liver cancer, its stage and how fast it is growing
• whether you have cirrhosis and how well the liver is working
• how well you respond to treatment
• other factors such as your age, fitness and overall health.

Discussing your prognosis and thinking about the future can be challenging and stressful. It is important to know that although the statistics for primary liver cancer can be frightening, they are based on an average of many cases and may not apply to your situation. Talk to your doctor about how to interpret any statistics that you come across.

The prognosis for liver cancer tends to be better when the cancer is still in the early stages, but liver cancer is often found later. Surgery to remove the cancer (liver resection) or a liver transplant may be an option for some people with primary liver cancer. Other treatments for liver cancer can significantly improve survival and can relieve symptoms to improve quality of life.