Why and When to do Liver Cancer Test

The liver is a pyramid-shaped organ in our body that lies just below the right lung. It is largest organ inside the human body. This vital organ is divided into right and left lobes and performs a number of functions. It makes bile necessary to digest fat, makes various proteins used by the body for a number of other purposes, breaks down toxic materials in the blood that are later removed by the body as waste, helps in blood clotting and stores certain nutrients absorbed from the intestine. Thus liver is primary to the healthy functioning of the human body. When cancerous cells form in the liver, it is known as liver cancer. Primary liver cancer is the cancer that starts in the liver tissue; whereas cancer that starts in some other site and spreads to the liver is classified as the secondary liver cancer. Varied methods & techniques are available to treat liver cancer.

Diagnosis: 

After examining your health and learning about the family history, your doctor may tell you to go for one or more of the following tests for diagnosing liver cancer:

• Liver biopsy:

  Liver biopsy is done in order to remove a tissue sample from the suspected site in the liver. This tissue sample is analysed under the microscope to confirm the presence of cancerous cells.  Laparoscopic biopsy, needle biopsy and surgical biopsy are the different types of biopsies done.

• Blood tests:

  You may need to perform some blood tests like liver function tests (LFTs). Besides these, if a suspicion of liver cancer arises, doctors check the level of alphafetoprotein (AFP) in the blood. The level of AFP is usually found higher in people with primary level cancer; although there are cases of people with liver cancer having normal levels of AFP. Again the ratio of des-gamma-carboxy prothrombin is also checked.

• Ultrasound:

  Imaging tests are done to find suspicious sites that may be cancerous and also to know whether the cancer has spread. Ultrasound uses sound waves to create an image on a video screen. This test can show tumors in the liver and these tumors are later tested for cancer, if required.

• Computed Tomography (scan):

  During a CT scan for diagnosing liver tumors, cross-sectional images of the abdomen are taken. Information regarding the shape, size and location of the tumors in the liver or nearby blood vessels can be known which help the doctors plan certain treatments. Sometimes some contrast material may be used that aims to outline the intestine in order to avoid confusion regarding tumors. You may be given oral contrast or intraveneous (IV) contrast.

• Magnetic Resonance Imaging (MRI):

  The difference between CT scan and MRI is that the latter uses radio waves and strong magnets instead of X-rays used by the former. Through waves and magnetic rays, certain images of the inside of the liver are taken. Your doctor can provide you contrast material, if needed.

• Angiography:

  During an angiography, a contrast dye is injected into the bloodstream to know about the arteries supplying blood to a liver. This test is used for both surgical and non-surgical purposes.

Symptoms:

Liver cancer does not have any symptoms, of its own. However, the tumor causes some symptoms and these symptoms appear in the later stages of the cancer. Sometimes these symptoms may show up in the early stages also. The common symptoms are mentioned below:

• Loss of appetite
• Vomiting
• Abdominal pain
• Unexplained weight loss
• Fever, yellowing of the skin and eyes (due to jaundice)
• Itching
• Feeling full while eating
• Wasting (cachexia)
• Increased swelling of the belly and feet
• Feeling of a mass under the ribs on the right side

Sometimes some tumors in the liver build hormones that influence other organs. These hormones may cause certain signs like low blood sugar levels, high cholesterols levels, enlarged breasts, high counts of red blood cells and high levels of calcium in the blood. If you have any of the symptoms at any stage of your life, you must consult your doctor right away to avoid unnecessary complications.

Stages:

The stages of liver cancer tell the doctor how far the cancer has spread. Once the stage is determined, individualized treatment plans can be designed. There are different staging systems for this cancer; but all doctors across the globe do not follow the same system. The American Joint Committee on Cancer (AJCC) is the commonly accepted method for staging liver cancer. According to this system, the stages can be evaluated on the basis of three main factors like:

• Tumor (T): It stands for the size and number of the original tumor.
• Lymph Node (N): It describes if there is any cancer present in the nearby lymph nodes.
• Metastasis (M): It indicates whether the cancer has spread to other parts of the body like lungs, bones etc.

Besides these, the letter X and a number (0-4) are also assigned to these factors. For instance, T1, T2, T3 and so on; a higher number refers to increasing severity. And the letter X indicates that no information could be gathered. 

Usually, the size and number of the tumor (s) and whether the cancer has spread to blood vessels or lymph nodes are the important criteria for staging liver cancer. Here a brief description of the 4 stages of liver cancer is described:

• Stage 1

  In stage 1, there is only one tumor and there is no growth of cancerous cells in the blood vessels, any other organs of the body or lymph nodes.

• Stage 2:

  In this stage, there is a single tumor and it has started growing into the blood vessels. Again there may also be more than one tumor which are less than 5cm and have not grown into the blood vessels. In either of the case, the cancer may be described to be in stage 2.

• Stage 3:

  In this stage, 3 things can happen. Stage 3A refers to more than a single tumor and at least one of them is larger than 5 cm. But the cancerous cells have not grown in the lymph nodes or any other part of the body. Stage 3B refers to the cancer that has grown either into the portal vein or hepatic vein. Again, there is no growth of cancerous cells in any part of the body or lymph nodes. Stage 3C describes the stage where the cancer has spread into organs of the body that are close to the liver, like pancreas but not to lymph nodes or any distant organs.

• Stage 4:

  Stage 4A refers to the phase where there can be more than one tumor of any size in the liver. Also the cancerous cells may have spread to other organs around the liver and also blood vessels. The cancer has spread to lymph nodes but not to other body parts. Stage 4B is the phase when cancer has spread to another part of the body. The tumor is any size and may be more than one. It may have spread to the blood vessels and other organs around the liver. There may or may not be any presence of cancerous cells into the lymph nodes.

Doctors may follow any of the two staging criteria mentioned above or even go for some other staging processes.