Diagnosing Liver Cancer & Liver Metastases

Our team includes hepatologists, who specialize in liver diseases, as well as medical oncologists, oncologic surgeons, interventional radiologists, radiation oncologists, nurses, social workers, and rehabilitative and palliative medicine specialists.

Most cancers that start in the liver are hepatocellular, meaning they form in the hepatocytes, or liver cells. This cancer is called hepatocellular carcinoma. Other cancers can spread to the liver, typically from the colon and other gastrointestinal organs, but also from other organs such as the kidneys. This is known as metastatic, or secondary, liver cancer.

Treatment for liver cancer is most effective when the condition is diagnosed early. Many people with these types of cancer receive a diagnosis when the disease is advanced because early symptoms may be absent or vague and therefore go unnoticed. For this reason, Perlmutter Cancer Center doctors recommend that people at high risk be screened regularly for liver cancer and liver metastases.

Ongoing communication between you and your doctors, in addition to your personal preferences, guide all treatment decisions.

Symptoms of liver cancer and liver metastases include a loss of appetite, unexplained weight loss, fever, fatigue, weakness, nausea, dark urine, and jaundice, which is yellowing of the skin or eyes. These symptoms are similar to those associated with other liver conditions, such as cirrhosis, fatty liver disease, or hepatitis B or C.

If liver cancer is advanced, signs and symptoms may also include abdominal pain and internal bleeding.

To diagnose liver cancer or liver metastases, your doctor asks about your medical history and conducts a physical exam. He or she may also perform several blood and imaging tests.

Your doctor may draw blood to determine whether you have high levels of alpha-fetoprotein, which can be a sign of liver cancer. High levels of this protein can indicate if other forms of liver disease are present. For this reason, your doctor may also perform imaging tests, such an ultrasound or CT or MRI scan, to see whether you have a tumor.

Your doctor may test your blood for the presence of tumor markers. If you have a history of other cancers, particularly colon cancer, your doctor may test the blood for CEA, a substance that is made by cancer and therefore a tumor marker. CT or MRI scans may be performed to check the liver for cancer.

Doctors may also use blood tests to measure liver function. These tests can reveal elevated levels of enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as well as high levels of bilirubin—a substance found in bile that is produced by the liver. Results of these tests can help doctors diagnose fatty liver disease, hepatitis B or C, or cirrhosis and determine how severe they are.

These conditions may need to be managed in addition to cancer.

An ultrasound uses sound waves to create images of structures in the body on a computer monitor. This test may give your doctor a first look at a liver tumor and help determine whether further scans are necessary.

If an ultrasound reveals a suspicious tumor in the liver, your doctor may order a CT scan. A contrast agent, an iodine-based dye, is injected into a vein to enhance the CT images, and a specialist takes X-rays of the liver as the contrast agent moves through the blood vessels, highlighting any tumors. These X-ray images are sent to a computer to create cross-sectional images of the liver from different angles. A CT scan may indicate whether cancer has spread to other organs in the abdomen or chest.

Your doctor may also order an MRI scan, which uses a magnetic field and radio waves to create images of structures in the body from different angles. A contrast agent called gadolinium is injected into a vein before the scan to enhance images of the blood vessels and other body structures.

An MRI scan may reveal whether you have a liver tumor.