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In its early stages, liver cancer has few, if any, signs or symptoms. That's why people at higher than average risk of developing liver cancer should undergo regular liver cancer screening tests.
Liver cancer is on the rise in the United States, says Eugene R. Schiff, MD, director of the Center for Liver Disease at the University of Miami Medical Center. Two conditions, says Dr. Schiff, are largely behind the increase: hepatitis B and hepatitis C. Both infections can lead to chronic liver disease, or cirrhosis, he explains, and about 3 percent of patients with chronic liver disease will develop liver cancer.
Liver Cancer: Screening Those at Risk
Early diagnosis and treatment of liver cancer can mean the difference between life and death. That’s why the Hepatitis B Foundation, among other organizations, recommends that people who are at high risk of liver cancer be screened for the disease at least every six months. People at higher than average risk of liver cancer include:
Additionally, Schiff says that all people with cirrhosis, due to any cause, should consider regular screening for liver cancer.
An ultrasound exam every six months is “the mainstay of screening” for liver cancer, says Schiff. During an ultrasound exam, a technician moves an instrument called a transducer over your abdomen, where your liver is located. The transducer sends sound waves through your body, which bounce off the organs and create echoes. A computer uses the echoes to create images visible on a monitor. These ultrasound images can reveal tumors growing in the liver.
Ultrasound exams are often performed in conjunction with a blood test for alpha-fetoprotein (AFP). AFP is a protein that is present in fetal blood, but usually goes away after birth. Its presence in adult blood can be a warning sign for certain cancers, including liver cancer.
Some experts point out that AFP testing is not always accurate, but “everybody agrees it’s helpful,” Schiff says. Finding both AFP in the blood and a liver mass on ultrasound is strong evidence of a liver tumor and should prompt further tests, he says. Whenever someone has an elevated AFP level, however, Schiff recommends further testing, even if the ultrasound results are normal.
Liver Cancer Screening: Additional Imaging Studies
If doctors find signs of liver cancer in screening exams, they may suggest more detailed diagnostic tests, including:
Liver Cancer Screening: Liver Biopsy
Sometimes the combination of finding a visible mass on an imaging study and a very high level of AFP is enough for doctors to make a diagnosis of liver cancer. Even so, most people undergo a tissue biopsy to confirm the diagnosis. During a liver biopsy, a surgeon removes all or part of the mass in your liver. The surgeon then sends a sample of the tissue to a pathologist, who studies the sample under a microscope to determine if cancer cells are present.
Depending on your particular situation, doctors may recommend different types of biopsies, including:
Liver Cancer Screening: Additional Tests
Your doctor may also order blood and urine tests, such as liver function tests, kidney function tests, a complete blood count, and blood clotting tests, in order to evaluate how well your liver and other organs are working. The tests can help your doctor determine your ability to withstand surgery or other cancer treatments, such as chemotherapy and radiation.
If you have hepatitis B, hepatitis C, cirrhosis, or a family history of liver cancer, talk to your doctor about how often you should undergo cancer screening.