Liver Cancer Diagnosis

Blood analysis

Very important for the diagnosis are the clinical manifestations that this tumor can give, associated with a history of hepatitis or alcoholism.

Indices of liver function

The next step consists in the so-called "liver function tests", that is "going to search in the blood for the quantity of substances normally produced by the liver (cholesterol, vitamin k, coagulation proteins such as fibrinogen and others) - which will be reduced in the case of tumor - and of the liver enzymes, the transaminases, which are released in the blood whenever there is a breakdown of the hepatocytes and which therefore increase in the case of cancer, although not as strikingly as during an acute hepatitis.

Bilirubin (a yellow-green substance, which derives from the degradation of hemoglobin contained in dying red blood cells and which is eliminated with bile), and some indices that reveal a disease in an always active phase (called protein C) also often increase. reactive or PCR and erythrocyte sedimentation rate or ESR).

Alphafetoprotein

The diagnosis may be supported by the dosage of another protein, called α-fetal protein (AFP). This is synthesized by the liver of the developing fetus in the mother's uterus, but no longer by the adult liver. It reappears in the blood of patients with hepatocarcinoma, because the hepatocyte is transformed by the tumor and tends to "differentiate", regaining the typical capabilities of fetal cells. In reality, traces of this substance exist even in normal adults (up to 10-15 nanograms per milliliter), but values over 200 should be considered highly suspicious for the presence of a liver tumor. This increase occurs in a large number of hepatic neoplasms, especially if extensive, and tends to regress completely after removal of the mass. However, AFP can also increase in the blood during other non-cancerous liver diseases and, in particular, during liver cirrhosis. Finally, it has been found that 25% of hepatocarcinomas do not produce AFP, so this marker has anyway limits.

Instrumental examinations

Among the instrumental tests, the most important is undoubtedly the "ultrasound of the abdomen with the radioactive contrast medium, which makes it possible to identify nodules with a diameter of less than 2 centimeters.

It can also be used as a guide to aspirate the contents of the tumor mass with a very fine needle, which will then be analyzed under a microscope (cytological examination).

Less sensitive, but still useful, is computed tomography (CT). Nuclear magnetic resonance imaging (MRI) is instead used only after the CT scan if the latter has not been satisfactory from a diagnostic point of view. Useful - especially before surgery - is another exam called angiography, that is an X-ray of the liver vessels, in which a radioactive contrast medium is previously injected to be able to see them well on X-rays. This technique allows to highlight the vascularization of the neoplasm.

In any case, the diagnosis of certainty can only be made with a small surgical procedure, during which a small piece of tumor is taken (liver biopsy) to be able to analyze it under a microscope (histological examination).

Early diagnosis

Hepatocarcinoma screening programs have not been proven to improve survival.

In clinical practice, screening of high-risk patients (chronic HBV or HCV infection, alcoholic liver disease) with ultrasound and / or alpha-fetoprotein dosage is widespread.

Currently, the reduction in mortality is related to viral infection control measures, through the use of the HBV vaccine and preventive measures for HCV, which include screening of blood and blood products, organs and tissues donated, and control measures during all medical, surgical and dental procedures.