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Physical Examination

Patients who present with symptoms suggestive of liver undergo a thorough medical history and physical examination. During the physical exam, the doctor will carefully evaluate the patient for the following symptoms:

• Hepatomegaly - enlargement of the liver
• Splenomegaly - enlargement of the spleen
• Ascites - abnormal accumulation of fluid in the abdomen
• Jaundice - a yellowish-green complexion of the skin and eyes caused by the accumulation of bilirubin in the liver

Alpha-Fetoprotein

Measuring the levels of alpha-fetoprotein in the blood is the most commonly used laboratory test for the detection of liver cancer. Patients with liver cancer often have elevated levels of alpha-fetoprotein in their bloodstream that can be measured with a special blood test. The normal level of alpha-fetoprotein in adults is 20 ng/ml. In general, elevated levels of alpha-fetoprotein of 400 ng/ml or higher strongly suggests the presence of liver cancer. Monitoring changes in alpha-fetoprotein levels is also useful in helping doctors determine the effectiveness of various treatments for liver cancer.

Diagnostic Imaging

Radiological imaging is a very useful tool for helping to establish the diagnosis of liver cancer and also plays an important role in staging the extent of spread of the disease. Several imaging modalities may be used for liver cancer including:

• Ultrasound - This is a non-invasive diagnostic imaging technique which uses high-frequency sound waves to create images of blood vessels, tissues, and organs. Ultrasound can be used to visualize a solid tumor in the liver, however, it cannot differentiate hepatocellular carcinoma from other types of liver tumors.

• Computed tomography (CT scan) - This is a diagnostic imaging procedure that uses special x-ray equipment to obtain cross-sectional pictures of the body. Using this technique, doctors can obtain very detailed images of organs, bones, blood vessels, and other tissues. The CT scan is very useful in helping doctors determine if a patient's liver tumor is hepatocellular carcinoma or another type of solid liver tumor.

• Magnetic resonance imaging (MRI) - This is a diagnostic imaging procedure that uses magnetic fields and radio-waves to produce detailed images of organs and tissues. In patients with liver tumors, MRI is very useful in helping doctors determine if the tumor is malignant or benign.

• Angiography - This is a diagnostic imaging procedure that is performed to visualize blood vessels after injecting them with a dye that enables the blood vessels to be seen on an X-ray. Angiography is very useful in helping surgeons determine if the tumor in the liver is resectable (can be surgically removed).

Liver Biopsy

In some cases, patients with suspected liver cancer may require a biopsy of the liver to confirm the diagnosis. This procedure is usually performed for patients with symptoms suggestive of liver cancer who either do not have elevated levels of alpha-fetoprotein in the blood or where the diagnosis of liver cancer cannot be made on the basis of imaging studies. During a liver biopsy, a piece of liver tissue is removed and the tissue is then examined under a microscope for the presence of cancer cells. Various techniques can be used to perform a liver biopsy including: