Your doctor may find liver cancer during a routine visit with imaging, even if you don’t have symptoms. If you’re having symptoms of liver cancer, your doctor will ask you about these things:
Your health history
Your family’s history of cancer
Your other risk factors for liver disease or cancer
Details about your symptoms, and how long you've had them
The doctor then performs a physical exam to look for signs of liver cancer. These signs may include yellowing of the skin and eyes, called jaundice, and an enlarged liver. The doctor may order tests to determine whether you have liver cancer. Blood tests, such as liver enzyme and liver function tests or tests for alpha fetoprotein, AFP-L3 percentage, and des-gamma carboxyprothrombin (DCP), may point toward liver cancer or other liver problems, although they can't be used to diagnose liver cancer on their own.
Imaging tests may also be done to look for liver cancer. These tests may also help determine the stage (extent) of the cancer. You may have one or more of these tests:
Ultrasound. This test is very helpful in seeing whether a liver tumor is a cyst, a fluid-filled sac that is probably not cancer, or a solid mass that is more likely to be cancer. An ultrasound uses sound waves to look for abnormalities in the liver. The sound waves bounce off body parts and send back a series of signals. A computer then looks at these signals and creates an image of your body.
MRI (magnetic resonance imaging) with contrast. This test gives the best information about normal and abnormal details of the liver. An MRI uses magnets and radio waves to take pictures of the inside of the body. MRIs can show more detail than other imaging tests.
CT scan (computed tomography). A CT scan uses an X-ray beam to take pictures of the body from many angles. A computer then combines these pictures, giving the doctor a very detailed cross-section picture of the body.
If one of these tests shows something in the liver that looks like it might be cancer, the doctor may take a small sample of liver tissue. This is called a biopsy. A doctor who specializes in looking at cells, called a pathologist, looks at the sample under a microscope to tell whether cancer is present. Some specific ways to get a biopsy are:
FNA (fine needle aspiration) biopsy, which uses a thin, hollow needle placed through the skin to get a small sample
Core needle biopsy, which uses a slightly larger needle to get a sample
A biopsy may be taken during a CT or ultrasound of the liver, during a laparoscopy, or during surgery to treat the tumor