TESTS AND SCREENING

TESTS AND SCREENING4

Liver Cancer Test and screening

Depending on your symptoms, your GP or Hospital doctor may take a number of tests which will provide more detailed information about your condition. If your condition requires further testing you will be referred to a local hospital, liver specialist centre or clinic. Here, more specific blood samples may be taken for tests involving liver function, virology (viruses) and immunology (antibodies). Generally blood test results cannot be seen in isolation. Other factors will be considered such as your symptoms, overall health, your age, how long you’ve had symptoms for, medications you are taking as well as your lifestyle. Liver cancer cannot be confirmed by blood tests alone, you will also need specialised scans such as a CT or MRI. The most common type of tests done on the liver are called ‘liver function tests’. These can be taken with a fine needle used to remove a small amount of blood from a vein in your arm and can be carried out by your GP or by a nurse at your local hospital.

TESTS

The most common tests are listed below1,4,5

Serum Bilirubin Serum bilirubin

Bilirubin is a yellow-brown pigment that is a breakdown product of red blood cells, and it is present in the bile. In many liver diseases, the bilirubin level in the blood goes up, and this gives a yellow colour to the skin and the whites of the eyes, which is referred to as jaundice.

Clotting Tests

In chronic liver disease, the clotting of blood may be affected, and this shows up by an increase in what is called the prothrombin time (clotting ability). Clotting is the thickening of blood, known as coagulation. When a person suffers from liver damage, their blood may become too ‘thin’ and takes longer to clot.

Liver Enzymes Liver enzymes

The serum levels of certain liver enzymes such as ALT and AST (also called transaminases) are raised when there is damage to liver cells. ALT and AST can indicate the level of inflammation, they leak into the blood stream when the liver cells are damaged. These values are usually higher in patients who present with hepatitis – sometimes up to 50 times higher than normal. Raised levels of ALP (alkaline phosphatase), an enzyme found mainly in the bile ducts of the liver and GGT (Gamma GT), can indicate obstructive or cholestatic liver disease, showing that the flow of bile is totally or partially suppressed.

Serum albumin

Albumin is a very important protein that helps keep fluid pressures in the body stable and carries many substances in the body. In chronic disease, the liver’s ability to make proteins can be diminished, and this shows up by a fall in the serum albumin level. Abnormal liver function tests do not always indicate that you have a liver disease or indeed liver cancer. Further investigation may be considered if any of your results are found to be outside of the normal range in a liver function test.

IMAGING TESTS

Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. The consultant who will arrange and supervise your test is a radiologist.

Types of common imaging tests include:

Ultrasound

This is often the first test used to look at the liver. This involves running sound waves through the abdomen and picking up abnormal echoes which creates an image on the computer screen. A probe, (called a transducer) will be moved across the surface of the skin – gel will be applied to your skin which may feel cold. The gel helps to make this movement easier and ensures that the sound waves can be directed through your skin as the probe passes over your liver area. It is painless, quick, relatively inexpensive, and does not involve radiation. It may take 10-15 minutes to complete.

CT (computed tomography)

This is an x-ray test that produces detailed cross-sectional images of your body. It can obtain pictures, called tomograms, from different angles around your body which are then seen as serial horizontal or vertical slices through the body. It is often described as a large donut that has a narrow table running through the centre of it. It can help to identify the type of liver tumour as well as the size, shape and position of any tumours in the liver or elsewhere in the abdomen. It is possible for the scan to take only several minutes unless many pictures are required and in this case it may take up to 30 mins.

MRI (magnetic resonance imaging)

Somewhat similar to CT, but uses a different principle, and no radiation. It provides a more detailed view of your organs than a CT scan. The scanner is more like a small tunnel that one has to lie in, and you will be required to lie very still. It can take up to one hour but the majority of scans will take between 20 and 30 minutes.

Angiography Angiography

A special X-ray that studies the veins and arteries that supply blood to the liver is known as hepatic angiography. A catheter is placed into a blood vessel through a small incision in your groin and then a dye is usually injected into the artery to outline blood vessels while x-ray images are taken. Angiography can be used to show the arteries that supply blood to a liver cancer, which can help doctors decide if a cancer can be removed and to help plan the operation. Some patients find the procedure uncomfortable and you will need to stay very still while the catheter is put in place – a local anaesthetic is often used to numb the area before inserting the catheter.

If your doctor thinks you might have liver cancer and the imaging tests are inconclusive, further tests may be carried out, such as:

Laparoscopy

It is possible for doctors to pass a camera that is contained within a flexible tube, into your tummy, through a small cut in your skin (keyhole) to take pictures of your liver – this is called a laparoscopy. This procedure is done in the operating room. Usually you are under general anaesthesia, although in some cases you may be sedated and only the area of the incision will be numbed. Laparoscopy can help plan surgery or other treatments, and can help doctors confirm the stage of the cancer.

Liver Biopsy Liver Biopsy

This involves passing a needle through the skin into the liver and removing a tiny piece of liver tissue for testing. It is done under local anaesthesia, usually in the x-ray department. Sometimes, the only way to be certain that liver cancer is present is to take a biopsy and look at it under a microscope. You may experience pain or discomfort during or after the liver biopsy. Your results can take anything up to 2 weeks, depending on your local services. Usually, your doctor will schedule an appointment with you to discuss your results.5