Current gold standard for diagnosing primary liver cancer is through multi-phasic imaging with CT scans or MRI scans.

In high-risk patients, regular screening is carried out using abdominal ultrasound and a blood test for serum alpha-feto protein (AFP), which is a cancer marker. If either the ultrasound or serum AFP is abnormal, then a CT scan or MRI scan would be done to confirm the diagnosis.

Tests and procedures used to diagnose liver cancer:

• Imaging
• The simplest imaging study of the liver is an ultrasound. There is no radiation risk and it can be done on a regular basis, especially in individuals who are at risk of liver cancer, for e.g., hepatitis B carriers. However, it is not the most accurate or specific imaging study.
• A CT scan is a better way of detecting liver cancer and is crucial for treatment planning. This is the basic imaging done by the liver surgeon to detect and plan a treatment strategy. In certain cases, if a CT scan is not enough or is inconclusive, additional investigations like MRI or a PET scan may be performed.
• Blood tests
• A blood test can be done to measure the level of a protein produced by the liver called alpha fetoprotein (AFP). AFP is associated with primary liver cancer. However, this blood test should not be used in isolation or as a routine screening test.
• Liver biopsy / Removing a sample of liver tissue for testing
• A liver biopsy involves the removal of a small amount of liver tissue via a needle procedure for laboratory testing.
• For primary liver cancer, a biopsy is not usually necessary or advised as it carries a potential risk of bleeding and spreading the tumour. A biopsy is only advised by the doctor if there is uncertainty in diagnosis, based on other methods.