Often there are no early symptoms of liver cancer, because the liver is a very resilient organ that can continue to work well even when large parts of it are damaged. If you do notice symptoms, they may be similar to those seen in other liver conditions, and are often exactly the same as those in cirrhosis.
- A general feeling of poor health
- Loss of appetite
- Fatigue and weakness
- Nausea and vomiting
- Loss of weight
- Discomfort over the liver area (upper right hand section of the abdomen)
- Itchy skin
- Pale or grey poo
- Dark urine
- Loss of libido (sex drive).
- Jaundice (yellowing of skin or eyes, and often the first and only symptom of liver disease).
- Swelling of the abdomen, which may be due to a build-up of fluid (known as ‘ascites’) or the cancer itself.
Your GP will take your medical history and ask about your symptoms. They will also perform a detailed clinical examination. Your GP will then take some blood samples and may arrange for you to have an abdominal ultrasound scan.
If this first round of blood tests and the ultrasound indicate a tumour may be present, you will be sent to see a specialist doctor (surgeon or gastroenterologist/hepatologist) who may take more blood tests and arrange for special imaging tests of your liver to examine it more closely. You may be required to have a biopsy. if doctors are still unable to make a diagnosis after these tests.
If you have been diagnosed with cirrhosis, particularly if it’s related to hepatitis B or C, alcohol or haemochromatosis, you should receive regular ultrasound scans and blood tests (every six to 12 months) to monitor your liver. Early detection of any tumours will give the best opportunities for successful treatment. Surveillance may not be offered if you have alcohol-related cirrhosis and continue to drink, as the continued damage from alcohol would reduce the chances of any successful treatment.
A blood test provides information on the general health of your liver. If HCC is suspected, a protein found in the blood called alpha-fetoprotein (AFP) will also be measured. In around five to seven out of 10 people with HCC, AFP levels will rise as the disease progresses. However, a negative AFP blood test does not guarantee that someone does not have HCC. Likewise, AFP levels can be elevated for reasons other than HCC. AFP levels usually come down if a treatment is working, so it is a useful tool to measure how effective treatment is.
Ultrasound is a painless test that sends sound waves into the body. The echoes are picked up and used to build a picture of the condition of the liver, bile ducts and gallbladder. If the ultrasound highlights any areas of tissue that are concerning, you should be referred to a specialist liver unit for a CT or MRI scan. You should be seen by a specialist within two weeks.
A CT scanner gives detailed images of the inside of the body, including soft tissues such as muscles, organs and nerves, which an ordinary X-ray cannot. Images of the body from different angles are fed into a computer, which processes them as a series of cross sections (or ‘slices’). This provides a 3D image of the inside of your body and can show the size of the tumour, and if it has spread and is present in other organs.
An MRI scan uses strong magnetic fields and radio waves to create detailed images of the inside of the body. MRIs are commonly used where more detailed examination is required.
Hepatic angiography is an X-ray study of the blood vessels that supply the liver and may be needed if the diagnosis is still doubtful after a CT and MRI scan. It may also be used as part of some treatment techniques, such as chemoembolization. The procedure uses a catheter (a thin, flexible tube) that is placed into a blood vessel through a small cut in the groin. A dye is then injected through the catheter, which highlights the blood vessels in the tumour as well as those feeding the tumour. A hepatic angiogram is usually done under local anaesthetic and you are also likely to be given sedation. Because of this, you may be asked to stay in hospital overnight.
A laparoscopy may be performed to assess damage to your liver and bile ducts and also to look for tumours in the abdominal cavity. In this procedure a tiny camera (endoscope) with a light on the end of a flexible fibre optic tube is inserted into your side through a small cut in your skin (‘keyhole’) to take pictures of your liver. If needed, a biopsy of your liver can be taken at the same time. A laparoscopy is performed under a general anaesthetic so you might need to stay in hospital overnight.
Usually, a diagnosis can be made using imaging techniques but occasionally a biopsy may be required. During a liver biopsy, a tiny piece of the liver is carefully removed via a long needle and taken for study. Liver biopsies are often needed in patients who are to be considered for sorafenib, a drug used to treat primary liver cancer .
For more information on these and other tests, see our Liver disease tests explained publication.