To diagnose hepatocellular carcinoma, a healthcare professional might do a physical exam and ask questions about your health history. Other tests and procedures might include imaging tests, blood tests and removing some cells for testing.

Imaging tests

Imaging tests make pictures of the body. They can show the location and size of a hepatocellular carcinoma. Tests might include:

• Ultrasound.
• Computerized tomography (CT) scan.
• Magnetic resonance imaging (MRI) scan.
• Positron emission tomography (PET) scan.

Liver function tests

Blood tests can give your healthcare team clues about what's causing your symptoms. These might include tests that measure how well the liver is working, such as:

• Alanine transaminase (ALT) test.
• Aspartate transaminase (AST) test.
• Alkaline phosphatase (ALP) test.
• Albumin test.
• Bilirubin test.
• Prothrombin time (PT) test.

Tumor marker test

Tumor marker tests look for chemicals made by the cancer cells. The alpha-fetoprotein (AFP) blood test is a tumor marker test used for hepatocellular carcinoma.

AFP is a protein made by liver cells as a baby grows in the womb. Blood levels of AFP drop soon after birth. For most people, a high level of AFP in the blood isn't typical, except during pregnancy.

When liver cells are injured, they may make AFP as they try to repair themselves. This raises AFP levels in the blood. For most people with hepatocellular carcinoma, the cancer causes very high AFP levels. Having high AFP doesn't mean someone has cancer, though. There are other things that can cause it, such as pregnancy, acute liver injury and liver fibrosis.

Healthcare teams may use AFP test results along with other results to decide whether a growth in the liver might be cancer. They might track AFP levels over time to see whether treatment is working.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For hepatocellular carcinoma, the biopsy uses a needle to get the tissue sample. During a liver biopsy, a healthcare professional puts a needle through the skin and into the cancer. The health professional uses the needle to draw out a sample of cells from the liver.

The sample is tested in a lab to see if it is cancer. Other special tests give more details about the cancer cells. Your healthcare team uses this information to make a treatment plan.

Not everyone needs a biopsy to diagnose hepatocellular carcinoma. Sometimes healthcare teams make the diagnosis using the results of other tests.