Symptoms, Risk and Diagnosis of Liver Cancer

The liver has several functions: to filter harmful substances from the blood so they can be passed from the body in stools and urine; to make bile to help digest fat that comes from food; and to store glycogen (sugar), which the body uses for energy. The most common primary liver cancer is hepatocellular cancer. Much more often, liver tumors are metastasized from cancer of another organ. Your oncologist will make the determination on what kind you have.

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Symptoms of Liver Cancer

  • A hard lump on the right side just below the rib cage
  • Discomfort in the upper abdomen on the right side
  • A swollen abdomen
  • Pain near the right shoulder blade or in the back
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Easy bruising or bleeding
  • Unusual tiredness or weakness
  • Nausea and vomiting
  • Loss of appetite or feelings of fullness after eating a small meal
  • Weight loss for no known reason
  • Pale, chalky bowel movements and dark urine
  • Fever

Risk Factors for Primary Liver Cancer

  • Having hepatitis B or hepatitis C: Having both hepatitis B and C types increases the risk even more
  • Having cirrhosis, which can be caused by: hepatitis (especially C); or drinking large amounts of alcohol for many years or being an alcoholic
  • Having metabolic syndrome: a group of conditions that that include: extra fat around the abdomen, high blood sugar, high blood pressure, high levels of triglycerides and low levels of high-density lipoproteins in the blood
  • Having liver injury that is long-lasting, especially if it leads to cirrhosis
  • Having hemochromatosis, a condition in which the body takes up and stores more iron than it needs and stores it in the liver, heart and pancreas
  • Eating foods tainted with aflatoxin, a poison from a fungus that can grow on grains and nuts that have not been stored properly

Making a diagnosis of liver cancer may involve different approaches. The following tests and procedures may be used:

  1. Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities.
  2. Serum tumor marker test: A sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. An increased level of alpha-fetoprotein (AFP) in the blood may be a sign of liver cancer, but can also be elevated in noncancerous conditions, including cirrhosis and hepatitis. Sometimes the AFP level is normal even when there is liver cancer.
  3. Liver function tests: A blood sample is checked to measure the amounts of certain substances released into the blood by the liver. Higher than normal amounts can be a sign of liver cancer.
  4. CT scan (CAT scan) of the abdomen: This procedure that makes a series of detailed pictures of areas inside the abdomen, taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver. This is called triple-phase, spiral or helical CT because the x-ray machine scans the body in a spiral path.
  5. PET scan (positron emission tomography scan): This procedure finds malignant tumor cells in the body, by using a small amount of radioactive glucose (sugar) injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  6. MRI (magnetic resonance imaging): An MRI uses a magnet, radio waves, and a computer to make a series of detailed pictures of the liver. To create detailed pictures of blood vessels in and near the liver, dye is injected into a vein. Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver.
  7. Ultrasound exam: This procedure uses high-energy sound waves (ultrasound) bounced off internal tissues or organs to form a picture of body tissues.
  8. Biopsy: Taking a sample of cells so they can be viewed under a microscope by a pathologist to check for signs of cancer, can be accomplished by:
  • Fine-needle aspiration biopsy: removing cells, tissue or fluid using a thin needle.
  • Core needle biopsy: removing a thicker specimen of cells or tissue using a slightly wider needle.
  1. Laparoscopy: This surgical procedure looks at the organs inside the abdomen to check for signs of disease through small incisions (cuts) made in the wall of the abdomen. A laparoscope (a thin, lighted tube) is inserted into one of the incisions. Another instrument is inserted through the same or another incision to remove the tissue samples.

Staging of Liver Cancer

The Barcelona Clinic Liver Cancer (BCLC) Staging System is widely used to predict the patient’s chance of recovery and to plan treatment, based on the following:

  • Whether the cancer has spread within the liver or to other parts of the body
  • How well the liver is working
  • The general health and wellness of the patient
  • The symptoms caused by the cancer

The BCLC staging system has five stages:

  • Stage 0: Very early
  • Stage A: Early
  • Stage B: Intermediate Stage
  • Stage C: Advanced Stage
  • Stage D: End-stage

For BCLC stages 0, A, and B, treatment is given to cure the cancer. For stages C and D, treatments are not likely to cure it but symptoms can be relieved.


The prognosis (chance of recovery) depends on the following:

  • The stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body).
  • How well the liver is working.
  • The patient’s general health, including whether there is cirrhosis of the liver.
  • Whether the patient is a candidate for liver transplant.

Liver cancer is best controlled before it has spread and can be removed by surgery. Clinical trials are a good option for getting the latest treatment.