To diagnose secondary liver cancer and figure out how far the cancer has spread, your doctors may recommend one or more of the following tests:
- blood tests
- imaging tests
We may test your blood for tumor markers. Tumor markers are substances that cancer cells produce, or that your body makes in response to tumors. We may also check your liver enzyme levels. Abnormally high enzyme levels can indicate there has been injury to cells in the liver.
At most institutions, liver biopsies are guided by ultrasound or CT imaging. At Memorial Sloan Kettering, we also have a unique interventional MRI and interventional PET/CT unit that uses minimally invasive techniques to help us diagnose difficult cases.
Imaging Tests for Liver Metastases
Imaging tests create high-quality, detailed pictures of the body. They can help us learn about the exact location of your tumor and the condition of the organ and surrounding tissues and blood vessels.
This information can help your team predict how the tumor might respond to different treatments. Imaging tests also help guide our surgeons and interventional radiologists during procedures.
To diagnose liver metastases, MSK doctors may use the following imaging tests alone or in combination:
- magnetic resonance imaging (MRI)
- triphasic computed tomography (CT) scan provides detailed cross-sectional images of the liver, gallbladder, bile ducts, nearby lymph nodes, and other internal organs as blood flows through the liver
- ultrasound test helps doctors tell the difference between a benign (noncancerous) tumor and a cancerous mass. MSK doctors use ultrasound to examine the portal and hepatic veins and see if the tumor has grown into these parts of the body. Ultrasound also allows us to see if the portal and hepatic veins contain a blood clot.
- positron emission tomography (PET) starts with an injection of radioactive sugar. Because cancer cells absorb sugar faster than normal cells, they are highlighted on the PET scan.
We may use PET in combination with CT scans to:
- get the exact location of the liver metastasis
- figure out how far the cancer has grown
- understand more about what the cancer is doing
Biopsy of Liver Metastases
A biopsy is an important part of your diagnosis because it lets us know how extensive your tumor is and what types of cells it contains.
A common approach to examine possible liver metastases is fine-needle aspiration biopsy. In this test, a doctor inserts a thin needle into the liver to get a small tissue sample for one of our pathologists to examine under a microscope. Or your doctor may order a core biopsy, for which we use a slightly larger needle.
We may recommend a laparoscopy to get tissue samples for a biopsy. Laparoscopy can sometimes eliminate the need for surgery to make a diagnosis. With laparoscopy, the surgeon passes a thin, lighted tube with a camera on its tip (a laparoscope) through a small incision (cut) in the abdomen to inspect the liver and other organs.
A pathologist examines the biopsy sample under a microscope to learn more about its characteristics and behavior. This information can help your treatment team build a plan of care customized to you.
Genetic Testing of Biopsy Tissue
Having information about the genetic makeup of your tumor can help us select the most effective therapies for you. Pathologists do this through laboratory tests they perform on liver tissue from a biopsy.
A pathologist will examine a small sample of the tumor removed during a biopsy or surgery for specific mutations in several genes.
Cancer staging is a way of describing how advanced a cancer is, or to what stage it has developed. Because liver metastases have already spread to the liver from somewhere else in the body, they are called stage IV cancer. This is the most advanced stage of a cancer.
Knowing the stage of a cancer helps our experts build a plan of care that fits your unique needs.