Liver cancer

A device like a microphone is passed over your tummy area to give high-frequency sound waves. These create an image of your liver, which can show up any abnormality.

A series of X-rays that give a detailed picture of your liver. 

Read more about CT scans.

A scan that uses magnetic energy to build up a picture of the inside of your liver. During the scan you will lie inside a tunnel-like machine. 

Read more about MRI scans.

Usually liver cancer is diagnosed from a CT scan or from a sample of cells taken during another surgery. Taking a biopsy may be necessary to diagnose primary liver cancer for someone who does not have liver disease. Or your team may do a biopsy to find out more about how well your liver is working. A liver biopsy involves taking a sample of the liver using a long thin needle, guided to the right place by a CT or ultrasound scan. You will stay in hospital overnight after this test. 

Read more about liver biopsy.

Blood tests can check how well your liver and kidneys are working.

This test is done under general anaesthetic. Your doctor will make a small cut in your tummy (abdomen) and put in a small, thin flexible tube with a camera attached to it. This lets your doctor look for any abnormal changes in your liver and other nearby organs. A sample of cells (biopsy) can be taken at this time. 

Read more about laparoscopy.

A special type of X-ray to give a picture of the tissues inside your body. 

Read more about CT scans.

This is a scan that uses magnetic energy to build up a picture of the tissues inside your body. During the scan you will lie inside a tunnel-like machine. 

Read more about MRI scans.

A radioactive injection that will show up any cancer spread to other parts of your body on a CT scan picture. 

Read more about PET scans.

The BCLC staging system is used to stage HCC. it looks at liver function as well as the size and number of tumours. It has 5 stages:

Stage 0: Small tumour less than 2cm. The person is well and has normal liver function.

Stage A: One tumour less than 5cms, or 2-3 smaller tumours. The person is well and has normal liver function.

Stage B: There are many tumours in the liver. The person is well and has normal liver function.

Stage C: The size and number of tumours may vary but the cancer may have spread to nearby blood vessels and/or lymph nodes. It may also have travelled to other parts of the body. 

Stage D: There is severe damage to the liver. The person is not well at all and the cancer has spread beyond the liver.

Sometimes your doctor might describe your cancer as a stage number from 1-4. A higher number, such as stage 4, means a more advanced cancer. Some stages are further divided into stage A and B. 

The Child-Pugh system has 3 classes that describe how well your liver is working (liver function), in people who have liver cirrhosis. The system considers your blood test results, if there is fluid in your abdomen (ascites) and your brain function.

Class A: The liver is working normally

Class B: Mild to moderate liver damage

Class C: Severe liver damage

To decide the class, you will have tests such as blood tests, brain function tests and a check for fluid in your abdomen (tummy area). Based on the results, you will get a score that tells the doctor how well your liver is working (class A, B or C).

This refers to the size of the tumour (T), if the cancer has spread to your lymph nodes (N), and if the cancer has spread to other parts of your body (M for metastasis). Your doctor often uses the TNM information to give your cancer a number stage – from 0 to 4.  A higher number, such as stage 4, means a more advanced cancer.

In general, the lower the number, the less the cancer has spread. Some stages are further divided into stage A and B.

(Based on the Eastern Co-operative Oncology Group (ECOG)/WHO system)

Performance status (PS) is a scale to rate how well and physically fit you are:

• PS 0: you are fully active and can do much the same as you did before your diagnosis. 
• PS 1: you cannot do heavy physical work, but can do everything else.
• PS 2: you are up and about more than half the day. You can look after yourself, but you can’t work.
• PS 3: you are in bed or a chair for more than half the day. You can look after yourself to some extent but need help.
• PS 4: you are in bed or a chair all the time and need complete care