Diagnosis

When you go to see your doctor, explain your symptoms in full. It may help to write everything down before you go to ensure you tell them everything, including which symptoms you have noticed, when they started, when, and how often.

Tell your doctor about any existing illnesses you have (particularly liver disease, although that should be on your medical records) and any family history of liver disease or cancer.

Take a friend or relative along for support if needed. Sometimes, it’s hard to remember all the questions you want to ask or to absorb everything the doctor is telling you, and having someone there can really help.

Also, remember, there is no need to be embarrassed. Doctors are very used to discussing intimate problems; everything you tell them is entirely confidential.

Your doctor might do a general examination, particularly any areas that may be swollen or painful, such as the abdomen. They may refer you for tests or to a specialist.

Blood tests

Firstly, it is likely you will have a blood test. Blood tests can provide information on your overall health, and specifically how well your liver is working.

Liver blood tests look at how well the liver is functioning and can show whether there is any damage or inflammation inside the liver.

Scans

If the specialist wants to take a close look at your liver or biliary tract, or if they want to check for disease elsewhere in your body, they will probably suggest one of the following scans:

• Ultrasound: uses high frequency sound waves, which can reveal changes in the liver and bile ducts.
• Computed Tomography (CT) scan: uses X-rays to take detailed pictures of your body, revealing any abnormal areas in your liver and bile ducts.
• Magnetic Resonance Imaging (MRI) scan: creates pictures using magnetism and radio waves, revealing any abnormal areas in your liver and bile ducts. Magnetic resonance cholangiopancreatography (MRCP) is a specialist MRI scan used for CCA.

Biopsies

To make a definitive diagnosis of liver cancer it’s sometimes necessary to remove a piece of liver or bile duct tissue for laboratory testing. This is known as a biopsy.

A doctor will inject a local anaesthetic to numb the area. The doctor will then pass a thin needle through the skin into the tumour, using a CT scan or ultrasound to guide them to the exact area.
This will then be examined in the laboratory under a microscope.

Both HCC and CCA are diagnosed by testing samples (biopsies), and using medical imaging to view the affected area.

Specific Diagnosis of HCC

Ultrasound, CT, and MRI scans are used to view and measure the tumour growth. For patients with liver cirrhosis, there are ways to categorise the severity, which can indicate the level of cancer development (or pre-cancer).

In the laboratory, biopsy samples can be tested to confirm it is a cancerous tumour, and for details such as genetic information that may help guide treatment decisions.

Specific Diagnosis of CCA

It is important to determine which subtype of CCA you have, as this will guide the type of treatment.

Endoscopic retrograde cholangiography (ERC) involves having an endoscopy combined with x-rays. You will have medication to sedate you, and a small tube with a camera will be passed through your mouth down to your stomach. ERC helps to determine if you have pCCA or dCCA.

Endoscopic ultrasonography (EUS) is used if ERC doesn’t give enough information. A doctor will inject a local anaesthetic to numb the area then ultrasound will be used to guide a needle to take a biopsy.

If your CCA is caused by liver fluke infection, then this will need to be treated with medicine.