When you are having tests for a possible cancer, there are two important things to find out. Firstly, your doctor needs to discover what type of cancer it is. This is very important, as different types of cancer respond to different treatments. Secondly, they need to find out how far the cancer has grown and whether it has spread. There is more about this in the section on staging HCC.
You are likely to have various tests to diagnose HCC (hepatocellular cancer). Usually, you see your GP first, who will ask about your general health and symptoms. They may examine you and listen to your chest. They may ask you to have:
- a full blood count (FBC) to measure your red blood cell, white blood cell and platelet levels
- a liver blood test
A liver blood test used to be called a liver function test. It looks for ‘markers’ in the blood that indicate a problem with the liver. It also measures blood levels of proteins and liver enzymes.
Seeing a specialist
Any abnormal results in your blood tests may suggest a problem with the liver. Your GP will refer you to a hospital specialist for further investigations. The specialist will ask about your medical history and arrange some tests.
You may have any of the following tests to diagnose HCC. There’s also information below on what happens after your tests.
If you haven’t had a full blood count and liver test, your specialist will arrange these. You may also have a U&E blood test (also called ‘electrolytes’) and a clotting screen. The U&E test checks levels of a number of important substances in your blood and is a test of general health. The clotting screen is to make sure your blood can clot normally – liver conditions can sometimes affect blood clotting.
Your blood may also be tested for a chemical called alpha-fetoprotein (AFP). It is sometimes made by HCC liver cancer cells. Not everyone with HCC has AFP in their blood. And a raised AFP level doesn’t always mean you have liver cancer.
If there is anything abnormal on your liver ultrasound scan, your specialist may arrange an MRI scan. MRI stands for magnetic resonance imaging. It uses magnets and radio waves to produce images of the inside of the body. MRI scans show soft tissues more clearly than CT scans.
MRIs are painless and take about 30 minutes. But they are very noisy, so you may have headphones or earplugs and can bring your own music to listen to. There is more about having an MRI scan in the information on general liver cancer tests.
Your specialist may suggest a CT scan of your tummy (abdomen) and chest. This is to further assess a possible liver cancer and to check for any sign of cancer spread to the chest.
CT stands for computerised tomography. A CT scan takes a series of X-rays in cross section and builds them into a 3D image. It’s completely painless and takes about half an hour.
A biopsy is a small sample of tissue. You don’t always need this to diagnose HCC. Often, the pictures of the scan are so typical of a liver tumour that the diagnosis is certain without one. Or, if it looks likely that the tumour(s) can be removed, your doctor may wait until the surgery to have the tumour examined.
If you do need a biopsy, your doctor can put a fine needle through the skin and into the abnormal area of the liver. This is called a percutaneous (per-kew-tane-ee-us) biopsy, which just means biopsy through the skin.
The doctor will inject some local anaesthetic first, to numb the area. They may use an ultrasound or CT scan to ‘guide’ the needle and make sure they take biopsies from exactly where they want to. The tissue samples then go to a medical laboratory, to be examined for signs of cancer. You’ll have a small dressing over the needle site.
After this test, the doctor will want you to stay in bed for 6 hours, as there is a risk of bleeding. You may need to stay in hospital overnight.
If you have a long term liver condition, such as cirrhosis or hepatitis B or C, you may already have regular blood and ultrasound tests. The aim of these is to pick up any cancer that develops as quickly as possible so you can have treatment while the cancer is still at an early stage. This is called ‘surveillance’. There is more about it in our general liver cancer section.
After your tests
Waiting for test results can be nerve wracking. It could take a week or two and that may seem like forever. There’s no right or wrong way to deal with this situation. Many people try to carry on as normal – others find their concentration is too poor. Try not to bottle up how you are feeling. If you don’t feel you can talk to relatives or friends, a counsellor may help.
In the meantime, be reassured that you haven’t been forgotten – work on your case is going on. Scan reports have to be made and sent to your specialist for review.
If you’ve had biopsies taken, the sample may need to be ‘stained’ and that takes a few days.
It means that a dye is put onto the sample that helps to show up the cells more clearly under a microscope.
A team of specialists will need to look at your results to decide the best course of action. This is called a ‘multi-disciplinary team’ or MDT for short. It will include a surgeon, medical cancer specialist, specialist nurse, pathologist (specialist in studying cells and biopsies) and a radiologist (an expert in reading scans and X-rays). Once they’ve met and discussed how best to treat you, you will have an appointment to go through your diagnosis and any planned treatment.
When you go to get your results, it’s a good idea to take someone with you. This isn’t only for moral support. It’s so that there are two of you to remember what’s been said. Your relative or friend could take notes for you and remind you of any questions you particularly wanted to ask. The next page in this section has some suggestions for useful questions for your doctor.
Content last reviewed: October 2022
Next review date: October 2025