Diagnosis & Staging
Memorial Sloan Kettering doctors use a variety of approaches to diagnose and determine the extent (stage) of liver cancer. We may use blood tests, diagnostic imaging, or a biopsy—alone or in combination.
To diagnose liver cancer, we may order a test to measure the level of a protein produced by the liver called alpha fetoprotein (AFP). An elevated level of AFP in your blood may indicate that you have hepatocellular carcinoma, at which point your doctor may order additional blood tests to measure liver function and determine whether surgery or other treatments are appropriate.
Imaging tests can help to assess the exact location of a liver tumor and determine the condition of the organ and surrounding tissues and blood vessels. By revealing the precise size and density of a tumor, for example, these tests can help guide surgeons and interventional radiologists during therapeutic procedures.
The imaging techniques our doctors commonly use are a magnetic resonance imaging (MRI) and a triphasic computed tomography (CT) scan. These techniques provide detailed cross-sectional images of the liver, gallbladder, bile ducts, nearby lymph nodes, and other internal organs during different phases of blood flow through the liver.
Ultrasound tests are also used to distinguish a benign (noncancerous) tumor from a cancerous mass. We use a special kind of ultrasound, known as Doppler ultrasound, to look at the portal and hepatic veins and determine whether the tumor has invaded these structures and may have caused a blood clot.
Your doctor may also recommend a biopsy to learn more about the extent of your tumor and the types of cells it contains. While most liver biopsies are guided by ultrasound or CT imaging, at Memorial Sloan Kettering we also have a unique interventional MRI and interventional PET/CT to assist us in challenging cases.
To get more information about the extent of the tumor and the types of cells involved, your doctor may order a fine-needle aspiration biopsy, in which a thin needle is inserted into the liver to obtain a small tissue sample for microscopic examination by a pathologist. Or your doctor may order a core biopsy, which uses a slightly larger needle.
For people with suspected fibrolamellar-hepatocellular liver cancer, a biopsy is the most important diagnostic tool. A biopsy may also help in determining if you have a combination of hepatocellular carcinoma and cholangiocarcinoma, and results can help guide the best choice of therapy based on what the pathologist finds.
A laparoscopy procedure may be recommended to get tissue samples for a biopsy and is also sometimes used to avoid the need for exploratory surgery. In this procedure, a surgeon passes a thin, lighted tube with a camera on its tip through a small incision in the abdominal wall to view the liver and surrounding organs.
Our pathologists will likely conduct laboratory tests on the biopsy tissue to identify the genetic makeup of your tumor. Having this information can help in selecting the most effective treatment approach.
In examining a small sample of the tumor removed during a biopsy or surgery, we look for specific mutations in a number of genes. Tumors containing mutations in the genes KRAS and BRAF, for example, do not respond well to a class of drugs called epidermal growth factor receptor (EGFR) inhibitors, so our doctors know to start treatment with a different approach.
Our researchers are evaluating a variety of drugs, including new and experimental drugs, for their potential effectiveness in treating tumors with these and other mutations.
Staging Liver Cancer
If your doctors have determined that you have liver cancer, you may need additional tests to assess the extent (stage) of the tumor and the presence of other liver conditions, such as hepatitis, cirrhosis, or diabetes—all of which can affect the choice and outcome of the best treatment for you.
Based on information from these tests, our doctors will classify your particular case into one of the following stages:
- A tumor is found in one area of the liver and can be removed.
- A tumor is found in one area but cannot be completely removed safely.
- Cancer has spread throughout the liver and/or to other parts of the body.
- Cancer has reoccurred in the liver or in another part of the body after it was eliminated with initial treatment.
- Extensive liver cirrhosis or liver failure prevents surgical treatment of the tumor.
Depending on the stage of the disease and other factors, such as the extent of cirrhosis and liver failure, your treatment team will determine the most appropriate therapy for you.
Investigative Staging Techniques
Researchers at Memorial Sloan Kettering are evaluating novel methods of diagnosing and staging primary liver tumors. Studies are under way to determine the potential value of imaging techniques such as the following:
- Volumetric CT, which produces visual representations in three dimensions.
- Dynamic contrast-enhanced MRI, which uses rapid imaging and injected contrast material to make specific organs, blood vessels, or tumors easier to see. This is combined with ultrasound imaging.
- Nuclear imaging, which produces images of different parts of the body following administration of small amounts of radioactive tracers.