What Tests Are Required for Liver Cancer Diagnosis

Liver cancer, specifically hepatocellular carcinoma, is a malignant tumor that originates in the liver. Early and accurate diagnosis is crucial for effective treatment planning. Here are the key diagnostic tests typically recommended for liver cancer detection and evaluation:

1. Blood Tests for Liver Function and Viral Markers
A comprehensive blood workup is essential in assessing liver health and potential cancer presence. This includes a complete blood count (CBC), biochemical profile, and coagulation tests. Particular attention is given to prothrombin time (PT), international normalized ratio (INR), albumin, and bilirubin levels, which help determine liver function classification. Patients with Child-Pugh Class A liver function are generally suitable candidates for surgical resection, while those with Class B or C may require alternative treatments. Additionally, hepatitis B screening is critical, as chronic infection is a major risk factor for liver cancer. In cases considering surgical removal, an indocyanine green (ICG) clearance test may be performed to evaluate liver reserve.

2. Imaging Studies to Assess Tumor Characteristics
Imaging plays a vital role in diagnosing and staging liver cancer. Common modalities include ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). These tests help determine tumor size, location, number, vascular invasion, and lymph node involvement. In some cases, positron emission tomography–computed tomography (PET-CT) may be used to detect distant metastases. Imaging also evaluates the degree of liver cirrhosis and residual liver volume post-surgery, aiding in the decision between surgical resection, ablation, liver transplantation, or interventional therapies. Detection of extrahepatic lesions, such as lung or bone metastases, indicates advanced disease, often requiring a combination of systemic therapies alongside local treatments.

3. Tumor Biomarkers for Diagnosis and Monitoring
Alpha-fetoprotein (AFP) is the most commonly used tumor marker for liver cancer, with elevated levels observed in approximately 70% of cases. AFP not only aids in diagnosis but also serves as a valuable tool for monitoring treatment response. A decline in AFP levels following therapy suggests effective tumor control, while a subsequent rise may indicate disease progression. In such cases, switching to alternative therapies may be necessary. Regular monitoring of AFP levels can provide critical insights into the effectiveness of ongoing treatment strategies and help guide clinical decisions.