In its early stages, liver cancer has few, if any, signs or symptoms. That’s why people at higher than average risk of developing liver cancer should undergo regular liver cancer screening tests.

Liver cancer  is on the rise in the United States, says Eugene R. Schiff, MD, director of the Center for Liver Disease at the University of Miami Medical Center. Two conditions, says Dr. Schiff, are largely behind the increase: hepatitis B and hepatitis C. Both infections can lead to chronic liver disease, or cirrhosis, he explains, and about 3 percent of patients with chronic liver disease will develop liver cancer.

Liver Cancer: Screening Those at Risk

Early diagnosis and treatment of liver cancer can mean the difference between life and death. That’s why the Hepatitis B Foundation, among other organizations, recommends that people who are at high risk of liver cancer be screened for the disease at least every six months. People at higher than average risk of liver cancer include:

• Men 40 and older who have  hepatitis B and cirrhosis.
• Women 50 and older who have hepatitis B and cirrhosis.
• Anyone who has hepatitis B and a family history of liver cancer.
• Anyone who has hepatitis C.

Additionally, Schiff says that all people with cirrhosis, due to any cause, should consider regular screening for liver cancer.

Liver Cancer Screening: Ultrasound and Blood Tests

An ultrasound exam every six months is “the mainstay of screening” for liver cancer, says Schiff. During an ultrasound exam, a technician moves an instrument called a transducer over your abdomen, where your liver is located. The transducer sends sound waves through your body, which bounce off the organs and create echoes. A computer uses the echoes to create images visible on a monitor. These ultrasound images can reveal tumors growing in the liver.

Ultrasound exams are often performed in conjunction with a blood test for alpha – fetoprotien (AFP). AFP is a protein that is present in fetal blood, but usually goes away after birth. Its presence in adult blood can be a warning sign for certain cancers, including liver cancer.

Some experts point out that AFP testing is not always accurate, but “everybody agrees it’s helpful,” Schiff says. Finding both AFP in the blood and a liver mass on ultrasound is strong evidence of a liver tumor and should prompt further tests, he says. Whenever someone has an elevated AFP level, however, Schiff recommends further testing, even if the ultrasound results are normal.

Liver Cancer Screening: Additional Imaging Studies

If doctors find signs of liver cancer in screening exams, they may suggest more detailed diagnostic tests, including:

• Computed tomography (CT). This test creates highly detailed images of the internal organs. A special X-ray machine rotates around your body, working with a computer to produce cross-sectional pictures of your organs, including the liver. Before the test, you may be injected with a special dye that helps create especially clear images of the liver.
• Magnetic resonance imaging (MRI). Another test that produces very detailed images, MRI uses powerful magnets and radio waves instead of X-rays to examine the inside of the body. Like a CT, this test may require injection with a special dye. MRI requires that you lie within a large, cylindrical tube for as long as an hour, which can be uncomfortable for some. Newer machines have a more open design.
• Angiography. Angiography allows doctors to see blood vessels within and around your liver. Doctors insert a thin tube, called a catheter, into an artery leading to the liver. They inject a special dye through the catheter, which makes the blood vessels visible on X-ray. An experienced radiologist can detect blood vessels going to a tumor, and may also be able to determine whether or not the tumor can be surgically removed. Angiography is sometimes combined with MRI or CT, instead of X-rays, to obtain even more detailed images.

Liver Cancer Screening: Liver Biopsy

Sometimes the combination of finding a visible mass on an imaging study and a very high level of AFP is enough for doctors to make a diagnosis of liver cancer. Even so, most people undergo a tissue biopsy to confirm the diagnosis. During a liver biopsy, a surgeon removes all or part of the mass in your liver. The surgeon then sends a sample of the tissue to a pathologist, who studies the sample under a microscope to determine if cancer cells are present.

Depending on your particular situation, doctors may recommend different types of biopsies, including:

• Needle biopsy. Doctors insert a hollow needle through the skin in the abdomen and into the liver and use a syringe to pull cells from any tumors or growths into the needle. The cells are sent to a pathologist for analysis.
• Laparoscopic biopsy. During laparoscopy, doctors insert a thin tube attached to a tiny camera through a small incision in the abdomen. The camera transmits images to a monitor, allowing the doctor to see your liver and any abnormal masses. The doctor may remove a sample to test for cancer cells.
• Surgical biopsy. Most often, doctors prefer to have the biopsy results before they perform traditional surgery to remove a tumor. In some cases, though, they may perform an intraoperative biopsy, meaning a biopsy is performed during a larger surgery to take out a mass and part of the liver, if necessary.

Liver Cancer Screening: Additional Tests

Your doctor may also order blood and urine tests, such as liver function tests, kidney function tests, a complete blood count, and blood clotting tests, in order to evaluate how well your liver and other organs are working. The tests can help your doctor determine your ability to withstand surgery or other cancer treatments, such as chemotherapy and radiation.

If you have hepatitis B, hepatitis C, cirrhosis, or a family history of liver cancer, talk to your doctor about how often you should undergo cancer screening.