Liver Cancer

Diagnosis

Whether you're being seen for the first time or seeking a second opinion, a thorough evaluation is essential for determining the most beneficial course of treatment. Mayo Clinic doctors diagnose primary liver cancer using blood tests, advanced cytology procedures and diagnostic imaging performed by radiologists who specialize in liver diseases.

Blood tests

Mayo Clinic physicians use a biomarker test in conjunction with ultrasound imaging to help screen high-risk people for signs of liver cancer. The test used most often measures the blood level of a substance produced by some tumors called alpha-fetoprotein (AFP). Not all malignant tumors make AFP, however, and certain conditions, including pregnancy, viral hepatitis and some types of cancer can increase AFP levels. Mayo researchers are actively involved in studies of other blood tests for the early detection of primary liver cancer.

During your evaluation at Mayo, you will also have blood tests that check your overall liver function. Because people with pre-existing cirrhosis or other liver problems may not be candidates for surgery, these tests are essential for determining the most appropriate treatment options.

Diagnostic imaging tests

In the last few decades, imaging tests have become increasingly sophisticated, allowing doctors to view the body at the cellular and molecular level with much greater speed and accuracy. These enhanced capabilities are particularly important for imaging the liver, which is a large, complex organ, partially covered by the rib cage and surrounded by major blood vessels.

Some of the advanced imaging technologies used at Mayo Clinic include:

• Triphasic helical CT scans: These scans generate high-resolution images of your liver in less than 20 seconds, or a single held breath. Triphasic CT scans produce images during three different phases of blood flow through your liver, making it easier to detect tumors that have spread into the bile ducts, nearby lymph nodes or other organs.
• Magnetic resonance cholangiopancreatography: Mayo Clinic radiologists have great expertise in magnetic resonance colangiopancreatography, which uses magnetic fields and radio waves to produce detailed images of your liver and bile ducts. This noninvasive test is especially helpful for diagnosing bile duct obstructions and staging liver tumors.
• Magnetic resonance elastography (MR elastography): Developed at Mayo Clinic, magnetic resonance elastrography is a groundbreaking technology that uses sound waves to measure the hardness or elasticity of your liver. This helps detect fibrosis — scarring of liver tissue that can lead to cirrhosis, a major risk factor for liver cancer. MR elastography produces color-coded images called elastograms that indicate how internal organs and tissues would feel to the touch. A healthy liver is very soft, whereas a liver with cirrhosis can be extremely hard.
  
  Mayo Clinic physicians also use MR elastography to distinguish between benign and cancerous liver masses. In both cases, the test can often replace liver biopsies.
• Ultrasound: This painless, noninvasive test uses sound waves to produce images of your liver. Ultrasound is excellent at providing information about the shape, texture and location of tumors and can help distinguish a cancerous mass from a benign one. It's also used in conjunction with the alpha-fetoprotein test to screen people at high risk of liver cancer, including those with cirrhosis, hepatitis B, hepatitis C or alcoholic fatty liver disease.
• Endoscopic ultrasound (EUS): Physicians at Mayo Clinic have offered endoscopic ultrasound since 1989 and perform more than 3,000 EUS procedures every year. During the test, a tiny ultrasound probe is placed into your body through a thin, lighted tube called an endoscope. The probe helps guide the removal of a sampling of cells from the liver and nearby lymph nodes using a thin, hollow needle (fine-needle aspiration).
  
  EUS combined with fine-needle aspiration is an effective and minimally invasive alternative to surgical biopsies. It may also help detect metastasized cancers that can't be found using other methods.
• Cytology: Mayo Clinic researchers pioneered the fluorescence in situ hybridization (FISH) test, which uses a mix of fluorescent-labeled probes to detect cancer by analyzing DNA sequences in cells — a method that is twice as sensitive as other types of cell analysis. Mayo pathologists routinely use FISH to diagnose cancer in biliary strictures — abnormal narrowing in the common bile duct — and is particularly beneficial for patients with primary sclerosing cholangitis.