Liver ultrasound and CT scanning are both useful to identify the lesion within the liver and its extent; ultrasound is particularly useful at assessing the patency of the biliary tree. Both scans will be extended to look for an extra-hepatic source of the cancer or, conversely, as to whether the primary liver cancer has spread outside the liver itself (and forthis reason the doctor may well scan the lungs – which is a common site for metastases from hepatocellular carcinoma).
The serum test: alpha-foetoprotein (AFP) is a useful serum marker that is raised in approximately two thirds of patients with hepatocellular carcinoma and in much higher levels than in benign liver disease.
The CA19-9 level (see colorectal carcinoma section) is raised in cholangiocarcinoma but the level rises in obstructive jaundice (i.e. when the biliary tree is obstructed) and as this occurs early in cholangiocarcinoma the test is usually of little use.
The definitive proof of the diagnosis is by biopsy (taking a piece of the tumour through a skin needle puncture access) and microscopic examination. Often, the abnormal liver function impacts on the blood’s clotting system and if the coagulation tests in the blood are sufficiently deranged, then the biopsy may be deemed risky and the diagnosis is then based on other criteria.
