Screening and Diagnosis

Liver Cancer Risk Factors

The cause of liver cancer is unknown, but certain factors may increase your risk of developing liver cancer. Risk factors include:

• Hepatitis B or C
• Heavy alcohol use
• Diabetes (when combined with other risk factors)
• Obesity
• Certain chemical exposures
• Other diseases, including:
• Hereditary hemochromatosis
• Tyrosinemia
• Alpha-1 antitrypsin
• Porphyria cutanea tarda
• Wilson disease
• Glycogen storage diseases

Diagnosing Liver Cancer

Your care team will use a variety of leading-edge methods to diagnose liver cancer.

Diagnostic tests and imaging to detect liver cancer may include:

• Blood panel: Samples of your blood will be tested in a lab to assess how your liver is working.
• Ultrasound: This uses high-frequency sound waves to create an image of the internal organs, including the liver, pancreas, spleen and kidneys, and to assess blood flow through various vessels. The ultrasound may be done with an external or internal device.
• Computed tomography scan (CT scan): This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce images of the body. CT scans are more detailed than general X-rays.
• Magnetic resonance imaging (MRI): Using large magnets, radiofrequencies and a computer, an MRI produces detailed images of organs and structures in the body.
• Liver biopsy: A sample of liver tissue is surgically removed to be examined under a microscope for cancerous cells.

Stages of Liver Cancer

“Staging” is the term oncologists use to define where liver cancer is located and how much it has spread. After the stage of liver cancer is determined, your physician can recommend a particular course of treatment.

Most cancer teams use the system developed by the American Joint Committee on Cancer, known as the TNM staging system.

T = Tumor
Where is the primary tumor and how large is it?

N = Nodes
Has the tumor spread to nearby lymph nodes (part of your immune system)?

M = Metastasis
Has cancer spread to other parts of the body?

For each letter, there are five numbered stages, from zero to four, depending on how much the cancer has spread. The lower the number, the more the cancer cells look like normal cells and the easier they are to treat and cure. A higher number means it has spread more.

The place where cancer forms is called the primary site. Cancer can spread from the primary site to other parts of the body. Even if liver cancer is found in other parts of your body, it’s still considered liver cancer. For example, if liver cancer has spread to the colon, it’s called metastatic liver cancer, not colon cancer.

For treatment, physicians often use a simpler system of categorizing liver cancer:

• Resectable cancer: These cancers can be surgically removed (resected).
• Borderline resectable cancer: These cancers can be surgically removed but are very close to major blood vessels, or other important parts of your body.
• Locally advanced cancer: These cancers are still only in the area around the liver, but they cannot be removed completely with surgery, often because they are growing into nearby blood vessels. This category is also called unresectable because the cancer cannot be removed with surgery.
• Metastatic cancer: These cancers have spread to other parts of the body, so they cannot be removed completely with surgery (meaning they are also unresectable). Surgery may still be done, but it's used to relieve symptoms that the tumors in other areas of the body are causing.

Be sure to talk to your physician about your stage of cancer and how that will impact your treatment.

For more information about the stages of liver cancer, please visit our Health Library.