Diagnosis & staging
Primary liver cancer is very different from
cancer that has spread to the liver from somewhere else in your body (secondary
or metastatic liver cancer). For more information: Secondary Liver Cancer
The liver is on the upper right side of your abdomen. It can weight up to 1.8kg (4 pounds).
The liver does many things in your body:
- Removes toxins from your blood.
- Makes bile and enzymes to help with digestion.
- Makes proteins that help the blood clot.
- Controls the level of cholesterol in the body.
- Stores glycogen (sugar) which your body uses for energy.
There are usually no symptoms in the early stages of liver cancer.
Common symptoms in people with later stage liver cancer include:
- Unexplained weight loss.
- Loss of appetite.
- Pain and swelling in your abdomen.
- Fever.
- Jaundice (when your skin and the whites of your eyes turn yellow).
- Fatigue.
- Weakness.
- If the cancer has spread to other parts of your body (metastasis), you may have bone pain, a cough or gastrointestinal bleeding.
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Liver cancer is usually not diagnosed until it is in an advanced stage.
Tests that may help diagnose liver cancer include:
- Liver function test (blood tests)
- Imaging tests to see the tumour and if the cancer has spread:
- Liver scan
- Chest x-ray
- Bone scan
- Ultrasound
- CT (computed tomography) scan
- MRI (magnetic resonance imaging)
- PET (positron emission tomography)
- Angiography: a special dye is injected into a small tube that is put into your artery. X-ray pictures are then taken to see the arteries.
- Laparoscopy: A laparoscope is thin tube with a light and camera on it. It is put through a cut made in your abdomen. This procedure is done under general anesthetic.
- Abdominal exploratory surgery: when a surgeon looks in your abdomen to see if there is any cancer.
- A biopsy is usually only done for liver cancers that cannot be removed by surgery.
- Alpha-fetoprotein (AFP) blood test: This may be helpful but about 30% of people with liver cancer do not have high amounts of AFP in their blood.
For
more information on tests used to diagnose cancer, see BC Cancer Library screening and diagnosis pathfinder.
- 90% (90 out of 100) of liver cancers.
- 30-70% (30-70 out of 100) of people with this type of liver cancer have cirrhosis (scarring of the liver caused by liver disease).
- 7% (7 out of 100) of these cancers start in the liver's bile ducts (tubes that carry bile from the liver to the small intestine).
- An unusual type of hepatocellular carcinoma.
- Most common in young women [see note below, Statistics]
- Has a slightly better prognosis (how well your treatment is expected to work and how long you are expected live) than other hepatocellular carcinomas.
- Very rare.
- Linked to polyvinylchloride (PVCs) and other industrial toxins like PVCs.
Other names for liver cancer: primary carcinoma of the liver, hepatocellular cancer, and hepatoma.
Note: Available statistics do not have information about the inclusion of transgender and gender diverse participants. It is unknown how these statistics apply to transgender and gender diverse people. Patients are advised to speak with their primary care provider or specialists about their individual considerations and recommendations.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
Hepatocellular carcinoma staging is based on three things:
- Child-Pugh classification score: Measures damage to your liver caused by cirrhosis (scarring).
- Tumours: Number of tumours, size of tumours, if tumours are causing symptoms and where the cancer has spread to.
- Performance status: Measures how well you can do your normal daily activities. Called an ECOG (Eastern Cooperative Oncology Group) score.
- Stage 0 (very early stage)
- One tumour (cancer growth) that is 2 cm (1 inch) or smaller.
- Tumour has not grown into nearby large blood vessels.
- No symptoms.
- Child-Pugh A.
- ECOG 0.
- Stage A (early stage)
- Up to 3 tumours that are all smaller than 3 cm (just over 1 inch).
- Tumours have not grown into nearby large blood vessels.
- No symptoms.
- Child-Pugh A or B.
- ECOG score 0.
- Stage B (intermediate stage):
- More than 3 tumours or 1-3 tumours with at least 1 that is larger than 3 cm.
- Tumours have not grown into nearby large blood vessels.
- No symptoms.
- Child-Pugh A or B.
- ECOG score 0.
- Stage C (advanced stage):
- Tumour has grown into large blood vessels in the liver or cancer has spread to other parts of the body.
- Causing symptoms.
- Child-Pugh A or B.
- ECOG score 1 or 2.
- Stage D (end stage):
- Tumour may have grown into large blood vessels in the liver or cancer may have spread to other parts of the body.
- Causing symptoms.
- Child-Pugh C.
- ECOG 3 or 4.
For more information on staging, see About Cancer.
