Liver cancer diagnosis and staging

Diagnosing liver cancer

For high-risk patients, some liver cancers can be screened for before the development of symptoms. Exams, tests, and procedures to diagnose liver cancer include:


In some cases, to help make a definitive diagnosis, a small amount of liver tissue will be removed and tested in a laboratory for liver cancer. This procedure is called a biopsy and is conducted by inserting a needle into the liver to obtain the tissue sample. Note: not all patients with liver cancer require a biopsy. The three types of biopsies include:

  • Laparoscopic biopsy is a procedure where a scope is used during a laparoscopy to remove tissue samples. The scope allows the doctor to see the surface of the liver to take specimens from abnormal-appearing areas.
  • Needle biopsy is a procedure where a long hollow needle is inserted into the liver to remove a small amount of tissue.
  • Surgical biopsy is done during surgery where either a portion of a tumor (incisional biopsy) or the entire tumor and some surrounding tissue (excisional biopsy) is removed.

Blood tests

To check liver kidney and liver function, number of blood cells, and help diagnose cancer or other conditions, a blood test may be ordered. There are a number of different blood tests that can help identify liver cancer. These tests include:

  • The alpha-fetoprotein blood test (AFP) looks for elevated levels of this protein. Elevated levels of AFP can sometimes indicate cancer is present.
  • A blood chemistry test checks the levels of calcium, glucose, and cholesterol which can all be affected by the presence of liver cancer.
  • Blood clotting tests measures the levels of blood clotting factors to determine if the liver has been damaged. A low blood clotting factor count can lead to an increased risk of bleeding.
  • A complete blood count (CBC) is a test that measures the levels of red blood cells, white blood cells, and platelets in the blood. Lower levels of red blood cells mean the bone marrow is not functioning properly, elevated levels of white blood cells mean there is an infection the body is trying to fight off, and a low platelet count means the blood has low clotting factors.
  • Kidney function tests look at the blood urea nitrogen (BUN) and creatinine levels to determine how well the kidneys are functioning.
  • A liver function test (LFT) helps reveal liver function abnormalities which may lead to a liver cancer diagnosis.

Imaging tests

To look inside the body and help find suspicious looking areas of the liver, imaging tests like an ultrasound, CT scan, MRI scan, or angiogram may be ordered.

  • Ultrasound is usually the first test to look at the liver and its condition. An ultrasound can show tumors forming in the liver.
  • An angiogram is an x-ray test that uses a dye injected into an artery to look at the blood vessels in the liver.
  • A CT scan uses x-rays to take detailed images of the body and can help identify several types of liver tumors. A CT scan can provide detailed information about the size, shape, and location of tumors in the liver.
  • MRI scans use radio waves and magnets to take images of the body. MRIs can be used to look at the blood vessels in the liver to see blockages.

UCHealth follows the American Joint Committee on Cancer (AJCC) TNM system, which is based on three key pieces of information:

  • The extent (size) of the tumor (T): How large has the cancer grown? Is there more than one tumor in the liver? Has the cancer reached nearby structures like the veins in the liver?
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant lymph nodes or distant organs such as the bones or lungs?

Cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand.