Doctors can often diagnose liver cancer with a CT scan and blood tests. A biopsy may be needed if imaging results are inconclusive.

Liver cancer is often diagnosed after someone develops symptoms such as jaundice or abdominal swelling. Occasionally, live cancer is found during routine screening in high risk people without symptoms.

According to the CDC, around 25,000 men and 11,000 women are diagnosed with liver cancer each year in the United States.

Doctors use a variety of tests to diagnose liver cancer or to help stage it. Tests include:

  • a physical exam and review of your medical history
  • blood tests
  • imaging tests
  • biopsies

A CT scan is often the primary test used to make a liver cancer diagnosis. A biopsy can provide healthcare professionals with more information if imaging is inconclusive.

Keep reading to learn about the tests doctors use to diagnose liver cancer and when each test might be recommended.

If your doctor suspects a problem with your liver, they’ll often start with a physical exam. They’ll also review your personal and family medical history with you.

During a physical exam, your doctor will assess your abdomen for lumps or swelling. They’ll also look for signs of jaundice (a yellowish tint to your skin), which is one of the characteristic signs of problems with the liver.

AFP is an enzyme produced by your liver. Elevated levels of AFP in your blood can suggest liver cancer. However, abnormal levels of AFP can be seen with other medical conditions too.

This protein is normally found in the bloodstream of developing babies but decreases rapidly after birth.

Healthy adults usually have AFP levels of around 5–10 nanograms per milliliter (ng/mL).

Research suggests that levels over 400 ng/mL are suggestive of the most common type of liver cancer called hepatocellular carcinoma.

High levels of AFP can also be a sign of:

Liver function tests are blood tests that measure levels of substances produced by your liver. Abnormal levels of these substances may suggest liver cancer.

Liver function tests include:

  • Alanine transaminase (ALT): ALT is an enzyme in your liver and kidneys. High levels can suggest liver damage.
  • Aspartate transaminase (AST): High levels of AST can suggest liver or heart damage.
  • Alkaline phosphatase (ALP): High levels of ALP can suggest liver damage.
  • Prothrombin time (PT): Prothrombin time is a measure of how long it takes for your blood to clot. Slower clotting time can suggest liver damage.
  • Bilirubin: Bilirubin is produced by the breakdown of red blood cells. High levels suggest a problem with your liver.
  • Albumin: Low albumin levels can suggest liver damage.

Along with helping detect cancer, liver function tests can help:

  • screen for liver infections
  • monitor medication side effects
  • measure cirrhosis severity
  • determine how well a treatment is working
  • monitor the progression of cancer or liver disease

An ultrasound uses sound waves to create a picture of your insides. It’s often the first test doctors request to examine your liver since it’s cheap and readily available. It may also be used as a screening tool for people with a higher risk of developing liver cancer.

An ultrasound can show tumors in your liver. However, finding signs of a tumor on an ultrasound is not enough to diagnose liver cancer. In an ultrasound image, you cannot tell the difference between cancerous and noncancerous (benign) tumors.

If your doctor sees something suspicious, they will likely order more advanced imaging such as computed tomography (CT) scans or magnetic resonance imaging (MRI).

Doctors can use a variety of other imaging techniques to visualize your liver, such as:

  • CT scans: CT scans can help doctors see the size and shape of liver cancer, if present. These scans are used to diagnose liver cancer in most cases.
  • MRI: MRIs use strong magnets to produce an image of your liver. MRIs can potentially show healthcare professionals if a tumor is cancerous or has spread to other locations.
  • Positron emission tomography (PET) scan: PET scans are sometimes combined with CT scans to stage your cancer or detect reoccurrence. CT scans or MRIs alone can detect most tumors.
  • Angiogram: An angiogram is a type of X-ray that examines your blood vessels. It can help doctors understand if your cancer can be removed surgically.
  • Bone scans: Bone scans can help doctors see if the cancer has spread to your bones.

A biopsy involves taking a small sample of cells to exam under a microscope. You may need a biopsy if imaging is inconclusive.

Methods for collecting a liver biopsy include:

  • Fine-needle aspiration biopsy: A doctor uses a long, thin needle to take a sample of your liver.
  • Core needle biopsy: A wider needle is used to collect the tissue sample.
  • Laparoscopy: A small incision is made in your abdomen, and a doctor inserts a thin tube with a light and special tools to collect the tissue sample.

Symptoms of liver cancer include:

Risk factors for liver cancer include:

Liver cancer can often be diagnosed with imaging tests such as a CT scan. Blood tests can provide supportive evidence for your diagnosis.

If imaging is inconclusive, you may need a liver biopsy. A biopsy involves taking a tissue sample that is then examined under a microscope.

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