Diagnosing Hepatocellular Carcinoma
Symptoms of hepatocellular carcinoma
Many people with hepatocellular carcinoma (HCC) have no symptoms until the disease becomes advanced.
Common symptoms include:
- Abdominal pain
- Abdominal swelling or mass
- Fluid in the abdomen
- Weight loss
Testing for hepatocellular carcinoma
In addition to a physical exam, your doctor may order the following tests to help diagnose HCC:
Imaging studies — such as CT scans, MRI scans, or abdominal ultrasounds — can show:
- The size and location of the tumor(s).
- Whether the cancer has spread beyond the liver.
- Any blood clots in the major branches of the portal and hepatic veins.
- Any enlarged lymph nodes.
- Evidence of cirrhosis and its complications.
- The vasculature structure surrounding the lesion.
A bone scan may also be performed to check for the presence of cancer in the bone.
Blood tests will evaluate:
- Platelet count, which can detect cancer in its early stages. A white cell count below the normal range can be a sign of an enlarged spleen and/or an increase in the blood pressure within the liver’s blood vessels, indicating blockage by a tumor.
- Liver function, specifically:
- albumin level
- blood creatinine level
- prothrombin time
- transaminase levels (ALT, AST, GGTP)
- Tumor “markers,” such as alpha-fetoprotein (AFP)
Blood tests also help doctors determine your general health and how well your liver works, including whether you have been exposed, in the past, to hepatitis B or hepatitis C, and whether the hepatitis is active.
A liver biopsy is the removal of a sample of tissue for testing to prove or disprove the existence of HCC.
In addition to a biopsy of the tumor:
- A biopsy will be performed on tissue from the nontumorous part of the liver to help determine the presence or degree of cirrhosis.
- A core-needle biopsy is usually necessary to evaluate the make-up of the tumor.
If the CT scan suggests thrombosis (clotting), you may need a needle-aspiration biopsy of the portal vein. The portal vein drains blood from the gastrointestinal tract and spleen to the liver.
This type of biopsy helps doctors determine whether the tumor is actually invading the portal vein. Invasion of the portal vein by a tumor has major consequences for the long-term outcome of liver transplantation for HCC.