Understanding Liver Cancer Diagnosis and Staging

Doctors may use a combination of blood tests and imaging to investigate suspected liver cancer. A biopsy may also be recommended in certain situations. The investigations required can depend on how the abnormality was detected and whether imaging provides enough information to characterise the liver lesion.

Blood tests can help doctors assess how well the liver is functioning. This provides important context when evaluating a suspected abnormality and planning treatment if cancer is confirmed. However, liver function tests cannot determine on their own whether a liver lesion is cancerous.

A doctor may also measure alpha-fetoprotein (AFP), a tumour marker that can be elevated in some people with liver cancer. However, AFP levels alone cannot confirm or rule out liver cancer, as elevated levels may occur for other reasons and some liver cancers do not cause an increase.

Imaging allows doctors to examine suspicious liver lesions, including their size and where they are located. Tests may include ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI).

CT and MRI scans performed with contrast can provide more detailed information about a liver lesion and its blood supply. In some cases, characteristic findings on these scans may provide enough information to diagnose liver cancer without a biopsy. Imaging may also help determine whether the cancer has spread beyond the liver or involved nearby blood vessels.

A liver biopsy involves removing a small sample of tissue so it can be examined under a microscope. It may be considered when imaging and other findings do not provide enough information to make a diagnosis, but it is not required for every patient with suspected liver cancer.

The tumour, node, metastasis (TNM) system stages liver cancer according to the extent of the primary tumour, lymph node involvement and whether the cancer has spread to distant parts of the body. The stages below provide a simplified overview of how these findings are grouped.

Stage I liver cancer generally refers to a single tumour that has not grown into nearby blood vessels. The cancer has not spread to nearby lymph nodes or distant parts of the body.

Stage II liver cancer may involve a single tumour that has grown into nearby blood vessels or multiple tumours, with none larger than 5 cm. The cancer has not spread to nearby lymph nodes or distant parts of the body.

Stage III liver cancer is more extensive within or around the liver. It may involve multiple tumours, including at least one larger than 5 cm, or cancer that has grown into major blood vessels or certain nearby structures. It has not spread to distant parts of the body.

Stage IV liver cancer involves spread to nearby lymph nodes or to distant parts of the body.

After liver cancer is confirmed, further investigations may be needed to establish its extent and assess liver function before treatment is planned.

Your doctor will then discuss which treatment approaches may be appropriate based on the findings and your overall condition. Depending on your circumstances, treatment planning may also involve input from different specialists involved in liver cancer care.

After a liver cancer diagnosis, a surgical opinion can help determine whether the tumour may be suitable for removal. This depends on the cancer findings as well as whether enough healthy liver can be preserved after surgery.

At Tay Khoon Hean Surgery, Dr Tay Khoon Hean specialises in hepatopancreatobiliary (HPB) and advanced laparoscopic surgery, including the surgical management of liver conditions. If you have been referred for a surgical opinion, book an appointment with us to discuss whether liver surgery may be appropriate based on your diagnosis and clinical findings.