Tests will be performed to investigate symptoms of liver cancer and confirm a diagnosis. Some of the more common tests include:

• a physical examination
• examination of a blood sample – this may be sent for tests that include liver function tests, blood clotting tests, hepatitis tests, and tests for tumour markers (specifically alpha-fetoprotein, or AFP)
• imaging of the liver and nearby organs, which may include ultrasound, computed tomography (CT) scans or magnetic imaging resonance (MRI); these show the size and location of abnormal tissue, and whether the cancer has spread
• nuclear medicine imaging such as a positron emission tomography (PET) scan to see where the cancer is active and if it has spread.
• examination of the inside of the abdomen using a laparoscope (a thin tube with a light on the end)
• taking a sample of tissue (biopsy) from the liver for examination under a microscope; this may be a fine needle aspiration biopsy, core needle biopsy or laparoscopy (‘keyhole’ surgery).

Staging^[1]

If you are diagnosed with liver cancer, you might have more tests to determine the stage of the disease and whether the cancer has spread to other parts of the body. Knowing the stage of the disease helps your medical team plan the best treatment for you.

The Child-Pugh score is a cirrhosis staging system. It is used to record how well the liver is working based on the damage caused by cirrhosis. Liver function can be scored as:

• A – the liver is working well and cirrhosis is not advanced
• B – the liver is working moderately well
• C – the liver is not working well and cirrhosis is advanced.

The Child-Pugh score, and the size and spread of the cancer, are used to stage the disease. Liver cancer is usually staged using the Barcelona Clinic Liver Cancer system.

Stages of liver cancer are:

• 0 (very early): there is a single tumour that is smaller than 2 cm. The Child-Pugh score is A.
• A (early): there is a single tumour that is larger than 2 cm, or there are 3 tumours that are less than 3 cm. The Child-Pugh score is A or B.
• B (intermediate): there are many tumours in the liver. The Child-Pugh score is A or B.
• C (advanced): the tumour has spread to one of the main blood vessels of the liver, to the lymph nodes, or to other body organs. The Child-Pugh score is A or B.
• D (end-stage): the tumour is any size. The Child-Pugh score is C.