Once your doctor knows you have liver cancer, you may need other tests to see whether the cancer has spread outside of the liver. This allows doctors to determine the stage of the cancer and to design an effective treatment plan. After being diagnosed with liver cancer, you may need one or more of the following tests:
Intraoperative ultrasound (IOU). This test helps show tumors deep inside the liver. An IOU is an ultrasound done at the time of surgery or laparoscopy.
Computed tomography (CT). A CT scan is a detailed cross-sectional X-ray that can help identify different types of liver tumors. This scan can provide the size, shape, and position of the tumor in the liver and help determine the stage of the cancer.
Magnetic resonance imaging (MRI). MRI scans using contrast are also very useful for evaluating liver cancer and may be taken in sets over a few minutes as the contrast travels through the liver. With this type of imaging, they can sometimes tell if a tumor is benign or malignant and also if the cancer has spread to other parts of the body.
Your doctor may also take some samples of your blood for testing:
Alpha-fetoprotein (AFP) blood test. AFP is a protein in the blood that typically decreases right after birth. AFP levels are higher in people with certain types of liver cancer. Comparing your AFP levels before and after treatment can show whether the cancer is gone or is starting to come back. Certain rare cancers of the ovaries and testicles can also give a person a high level of AFP. AFP levels can also be elevated in other diseases of the liver besides liver cancer. This test is not always accurate and should be used with other tests to evaluate liver cancer.
Liver function tests. These tests check liver function and can reveal liver irritation and inflammation. If the tests show that your liver has been damaged, your doctor may do other tests to see whether you have cancer. Included in this test are serum bilirubin and serum albumin levels, which are used in some of the cancer staging models.
Prothrombin time (PT)/International normalized ratio (INR). A damaged liver may not be able to produce certain proteins that help the blood clot. These tests help your doctor know if your liver is producing the proper amount of clotting factors.
The following are some of the different systems used for staging liver cancer.
The Barcelona clinic liver cancer (BCLC) staging. This system uses an algorithmic approach for staging classification considering the extent of the primary lesion, presence of symptoms, vascular invasion, spread outside the liver, and Okuda stage.
Okuda staging. This system uses the tumor size and 3 levels of the severity of cirrhosis including ascites, serum albumin level, and bilirubin level.
The cancer of the liver Italian program (CLIP) score. This is one of the newer prognostic scoring systems for liver cancer. It evaluates macroscopic tumor morphology, serum alpha-fetoprotein levels, and the presence or absence of portal vein thrombosis.
The model for end-stage liver disease (MELD). This is a scoring system that uses serum bilirubin, creatinine, and international normalized ratio (INR) levels to predict 3 month survival of end-stage liver disease.
The Child-Pugh score. This score is a measure of liver function in people with cirrhosis. This score also measures blood levels of bilirubin, albumin, and prothrombin time (PT). This system also asks if there is ascites or decreased brain function.