Liver Cancer Testing Guidelines

Liver cancer diagnosis and death rates have continued to rise in the United States since the 1980s. 

The liver performs many essential functions, including breaking down, metabolizing and storing nutrients, producing blood clotting agents, delivering bile for breaking down fats and processing alcohol, medications and toxic wastes. We cannot survive without our livers. 

Because of the liver’s many duties, it consists of many different types of cells that are susceptible to both cancerous and noncancerous tumors.   

There are no preventive regular screening guidelines for people with an average risk for liver cancer. The liver’s location behind the ribcage makes it difficult to identify issues early when they are  most treatable.

Some common symptoms of liver issues include:

  • Yellowing of the skin or eyes
  • Nausea or vomiting
  • Loss of appetite or feeling full after small meals
  • Pain in the stomach or around the right shoulder blade
  • Swelling in the abdomen

It is essential to share any abnormal symptoms with your primary care provider. If liver cancer is suspected, your primary care provider can order the appropriate diagnostic screening tests. Keep in mind, there are many conditions besides cancer that can cause a reaction in your liver.

Liver Cancer Risk Factors

Several risk factors can increase your likelihood of developing liver cancer.

  • Chronic viral infections – Chronic hepatitis infection with hepatitis B virus or hepatitis C virus significantly increases the risk of liver cancer. These infections are the leading causes of liver cancer worldwide.
  • Non-alcoholic fatty liver disease – This condition is characterized by the accumulation of fat in the liver without excessive alcohol consumption. Non-alcoholic steatohepatitis, a progressive form of non-alcoholic fatty liver disease, can increase the risk of liver cancer.
  • Cirrhosis – Cirrhosis is a late stage of liver scarring, often caused by long-term liver damage from various conditions such as chronic viral hepatitis, excessive alcohol consumption, non-alcoholic fatty liver disease or autoimmune liver diseases.
  • Heavy alcohol consumption – Excessive and prolonged alcohol consumption can cause liver damage and inflammation, leading to an increased risk of liver cancer.
  • Aflatoxin exposure – Aflatoxins are toxins produced by certain molds that can contaminate crops like peanuts, corn and soybeans in warm and humid regions. Eating foods contaminated with aflatoxins over a long period can increase the risk of liver cancer.
  • Obesity – Obesity and excessive body fat increase the risk of liver cancer, particularly if you also suffer from non-alcoholic fatter liver disease and non-alcoholic steatohepatitis.
  • Diabetes – If you have diabetes, especially Type 2 diabetes, you have an increased risk of developing liver cancer.
  • Inherited liver diseases – Certain inherited liver diseases, including hereditary hemochromatosis, Wilson disease, alpha-1 antitrypsin deficiency and others, can put you at a higher risk for liver cancer.
  • Tobacco – Smoking tobacco has been linked to an increased risk of liver cancer.
  • Gender and age – Men tend to have a higher risk of liver cancer than women. Additionally, the risk of liver cancer increases with age.

Having one or more of these risk factors does not guarantee that you will develop liver cancer. 

Diagnostic Tests for Liver Cancer

There are several tests to diagnose issues with your liver.

  • Ultrasound – High-energy waves are bounced off the liver to produce an image that looks for tumors or damaged areas.
  • CT scan – A common imaging test that takes several pictures of the liver. Typically, a dye is used to help get clearer images of any tumors or damaged areas.
  • Alpha-fetoprotein tumor marker (AFP) – Measuring the level of this protein is a common way to detect liver cancer. However, there are other conditions and circumstances that can raise your AFP levels, including pregnancy, hepatitis and other cancers.
  • Liver biopsy – A biopsy involves taking a sample of the suspected tumor or area.

What to Expect During a Biopsy

A liver biopsy is a routine procedure. You lie on your back with your right arm above your head or on your left side. Your liver will be located and marked at the site of the biopsy. An ultrasound, MRI or CT scan may be used to locate a specific spot in the liver. 

You will be asked to hold your breath and lie still while the doctor inserts the biopsy needle into the liver. The procedure only takes a few minutes. 

It is common to feel pressure as the needle is pressed into the liver. You may also have discomfort in the shoulder due to irritation of the adjacent nearby nerve . The sample of liver tissue will be removed.

Arrangements for a follow-up appointment to discuss the biopsy results will be made upon discharge.

Get Started

The most appropriate screening test depends on various factors, including individual risk, personal preferences and your primary care provider’s recommendation.

Talk to your primary care provider to schedule liver testing.