Diagnosis and Staging


Blood Tests or Serology

Liver tests are conducted to rule out the many diseases of the liver in addition to primary liver cancer. When the liver malfunctions, it affects other functions and organs and that may result in abnormal blood tests, such as:

  • Hypercalcemia or high levels of calcium in the blood.
  • Hypoglycemia or low levels of sugar in the blood.
  • Erythrocytosis or high counts of red blood cells. It may look like the person is flushed and red-faced.
  • High cholesterol levels.
  • Increased levels of alpha-fetoprotein (AFP) (a protein that is normally very low unless there is liver disease).

Other liver tests look for specific antibodies and/or proteins that are indicative of the Hepatitis B or C virus because they are precursors of cancer.


The techniques used to diagnose liver cancer through imaging have evolved significantly.

  • X-rays with radioisotope scans were widely used to detect liver masses; however, they lacked sensitivity and specificity.
  • Angiography is being used to detect liver cancer because it is highly vascular (a lot of blood vessels).
  • Ultrasound can detect very small lesions (less than 2cm.), and it is very sensitive to metastatic spread of the tumour.
  • CT scans and MRI scans are the most common imaging techniques used for diagnosis. They are combined with contrast techniques that are specific to the blood flow inside the tumour.[1]


Biopsy of the liver is an important diagnostic technique. This procedure is performed with a fine needle or core biopsy that takes a small section of the liver for pathological diagnosis. However, there is a risk of spread of the tumour along the needle path.[2] In most cases of non-cirrhotic livers, it is preferable to remove the liver lobule where the tumour is located. Not only is this technique diagnostic, it is also curative in 97% of the cases where cancer is detected early and there is no cirrhosis.[3]


In diseases of the liver, staging refers to the size of the tumour as well as the involvement of surrounding structures and lymph nodes. The current staging classification in use is the Barcelona Clinic Liver Cancer (BCLC) classification which takes into consideration cancer-related symptoms and general well-being. The advantage of this classification is that it differentiates early stages of the disease with the more advanced stages while also identifying potential treatment options depending on what stage HCC a patient may be experiencing.

Below is a diagram of the BCLC staging and treatment strategy, from this article published January 4, 2018. Click the image to enlarge.

BCLC Staging Diagram for Primary Liver Cancer

[1] Befeler, Alex S. et al. Hepatocellular carcinoma: Diagnosis and treatment Gastroenterology , Volume 122 , Issue 6 , 1609 – 1619

[2] Ibid

[3] El-Serag, Hashem B. et al. Diagnosis and Treatment of Hepatocellular Carcinoma Gastroenterology , Volume 134 , Issue 6 , 1752 – 1763