Making the Diagnosis
To make the diagnosis, a thorough medical history must be taken, followed by a physical
examination. Your doctor may then recommend some of the following tests:
- blood tests to check liver enzyme levels
- abdominal ultrasound to check liver size and to look for any
tumors or abnormalities
- magnetic resonance imaging (MRI) of the abdomen
- computed tomography (CT) scan of the abdomen
- laparoscopy - through a small incision, the doctor inserts a small,
thin tube called a laparoscope, which allows viewing of the liver and
surrounding organs
- biopsy - using a laparoscope, a small piece of tissue is taken from
the liver for microscopic examination
- angiography - a dye is injected into the veins and its progress through
the liver is tracked by X-ray
- chest X-rays to see if the cancer has spread
Once cancer has been diagnosed, you doctor will need to "stage" or classify
the tumors in order to recommend the proper treatment.
The classifications
are done by the TNM system:
- T refers to the size of the tumor and can be listed anywhere from
T1 to T4 according to the size, and extent of spread to surrounding tissue. (T1 is the
smallest.) TX is used to classify a tumor that cannot be observed well enough
to categorize.
- N refers to whether or not the cancer has spread to the lymph nodes.
N1 means that the tumor has spread and NX means that the doctors can't access
the lymph nodes to check.
- M refers to whether or not the cancer has spread to other organs
in the body. M0 means that the tumor hasn't spread, M1 means it has. MX indicates
that it can't be determined whether it has spread or not.
Some doctors stage liver cancer according to the following categories:
- localized resectable: the cancer is contained to one spot in the
liver, and because it hasn't spread, it can be removed (generally T1-2, N0, M0 tumors)
- localized unresectable: the cancer is still confined to one part
of the liver but can't be removed
- advanced: the cancer has spread through the liver and perhaps to
other parts of the body
- recurrent: the cancer has returned some time after treatment
A variety of other classifications are used in some centers to help predict overall prognosis as well as to determine the ability to undergo surgery.