Liver Cancer Diagnosis.

About 13,000 new cases of primary liver cancer are diagnosed each year and there are about 10,000 deaths annually from the disease. In the United States, men are more likely to develop the disease than women.

In its early stages, liver cancer often produces no obvious symptoms. As the disease progresses, likely symptoms include weight loss, malaise, loss of appetite, abdominal swelling, and pain. Fever is not uncommon; some patients also may develop jaundice. Ascites, a buildup of fluid in the abdominal cavity, is another relatively common development. These symptoms occurring in a person who has had cirrhosis or other liver disease raise a possibility of cancer. In some instances, signs of metastases to other parts of the body, such as bone pain, cough from lung involvement, or gastrointestinal bleeding, are the symptoms that prompt the patient to see a physician.

When the physician examines the patient with liver cancer, an enlarged, painful liver is the most common finding. The tumor may take the form of a single mass or a number of small nodules. At this point it is important to determine whether the problem is a primary or secondary liver cancer or a benign tumor. A number of tests may be performed to arrive at a precise diagnosis and, if it is cancer, to determine the extent of liver damage and whether it has spread to other parts of the body. Initial studies will include liver function tests, which measure the blood levels of bilirubin, the chemical by-product by the breakdown of old red blood cells by the liver, and of enzymes normally present in liver cells but which may enter the bloodstream in increased concentrations if the liver is diseased. Anemia is a common finding, as are a number of other abnormalities that can be detected by blood tests. But none of these tests provides a definite diagnosis.

At one time, researchers thought that testing the blood for elevated levels of a substance called alphafetoprotein (AFP) might provide a useful screening examination, especially for high risk groups such as people with cirrhosis. However, a number of diseases, including cancers of the testes, stomach, pancreas, and lungs, as well as pregnancy, can produce elevated levels of AFP. Also, further studies have found that about 30 percent of Americans with liver cancer will not have an elevated AFP. Nevertheless, a high blood level of AFP in an adult man with other symptoms of liver cancer strongly suggests a positive diagnosis.

Although cancer is the most common cause of a mass in the liver, other possibilities include benign tumors, abscesses, abnormal growths of the bile ducts, and cysts, either fluid-filled or from parasites. A number of examinations are available to help establish a diagnosis of liver masses. Liver scans using a radioactive contrast substance may be performed, but abnormal findings may be difficult to distinguish from those of cirrhosis. In angiography of the liver, a catheter is threaded into the hepatic artery and an opaque substance that makes the blood vessels of the liver visible on X rays is injected through it.
This examination, which takes up to three hours to perform and requires overnight hospitalization, is one of the most useful tests in confirming the presence of a liver tumor. Clusters of small new blood vessels that develop in the tumor, or distortions of normal vessels can be seen on the angiograms, the X rays taken during the examination. In addition, angiography can provide highly useful information about the nature of the tumor, indicating whether it is a primary or secondary liver cancer or benign, and whether it can be surgically removed.

Other diagnostic tests that may be performed include bone scans, chest X rays, and CT and ultrasound examinations. A biopsy will provide a definite diagnosis, but potential bleeding problems may rule out taking a tissue sample via a needle inserted through the overlying abdominal wall. Instead, abdominal exploratory surgery is called for, or laparoscopy, an examination in which a flexible tube (a laparoscope) is inserted into the abdominal cavity through a small incision. This allows the examining physician to view the liver and other abdominal organs directly and also to take a small sample of tissue for later microscopic study.