A test that measures the level of a protein produced by the liver called alpha fetoprotein (AFP) can indicate that you have fibrolamellar-hepatocellular carcinoma (FLL-HCC).

Imaging tests help us learn about the exact location of your tumor and assess the condition of the organ and surrounding tissues and blood vessels. These tests also help guide our surgeons and interventional radiologists during procedures.

We commonly use CT scans and MRI to create detailed images that include the insides of areas of the liver, gallbladder, bile ducts, nearby lymph nodes, and other internal organs.

We can also use ultrasound tests to determine if the cancer is benign (noncancerous) or malignant (cancerous). A special kind of Doppler ultrasound can help us examine the veins where blood travels from your gastrointestinal tract and spleen to your liver. We can then see if the tumor has invaded these areas and caused a blood clot.

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. At most institutions, liver biopsies are guided by ultrasound or CT imaging. At MSK, we also have a unique interventional MRI and interventional PET/CT unit that uses minimally invasive techniques to help us in diagnose challenging cases.

To get more information about the extent of your tumor and the types of cells involved, we may do a 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.

Your MSK doctors 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 in the abdomen to inspect the liver and other organs.

To examine you for fibrolamellar-hepatocellular carcinoma, a biopsy is crucial because we learn about what cells are involved in the cancer. A biopsy can also help us determine if you have a combination of FLL-HCC carcinoma and another type of liver cancer called cholangiocarcinoma. This can guide us to the most effective therapy for you.

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.

We’ll look for specific mutations in a number of genes. We know that tumors containing mutations in the genes KRAS and BRAF don’t respond well to a class of drugs called epidermal growth factor receptor inhibitors, for example, so our doctors know to start treatment with a different approach.