For many people, the first stage of diagnosing liver cancer is a consultation with a GP, although people at risk are usually tested regularly for the condition.

If you visit your GP, they will ask about your symptoms, when they started, and when they are noticeable. They will also examine you.

If they feel you need further tests, they will refer you to a hospital specialist. Some of the tests you may have are described below.

Surveillance for liver cancer

If you are in a high-risk group for developing liver cancer, regular screening – known as surveillance – is often recommended. This is because the earlier the cancer is diagnosed, the greater the chance there is of curing it.

Surveillance is usually carried out every six months and often involves:

• ultrasound scans – high-frequency sound waves are used to create an image of your liver, which can highlight any abnormalities
• blood tests – your blood is tested for a protein called alphafetoprotein (AFP), which is found in some people with liver cancer

Surveillance is usually recommended if you have cirrhosis (scarring of the liver), although there are other factors that can also affect your risk of liver cancer.

The potential benefits of surveillance should be discussed with you before you enter any screening programme.

Further testing

The tests above can also be used to look for liver cancer in people who are not being routinely screened.

If these initial tests suggest there is a chance you could have liver cancer, one or more further tests will usually be recommended to confirm the diagnosis.

The further tests include:

• computerised tomography (CT) scans – a series of X-rays of your liver are taken to give a more detailed three-dimensional image
• magnetic resonance imaging (MRI) scans – uses a strong magnetic field and radio waves to build up a picture of the inside of your liver
• biopsy – a needle is inserted into your abdomen (tummy) to remove a small sample of liver tissue, which is then tested in a laboratory for cancerous cells
• laparoscopy – a small incision is made in your abdomen under general anaesthetic (where you are asleep) and a flexible camera called an endoscope is used to examine your liver

After these tests have been carried out, it will usually be possible to confirm a diagnosis of liver cancer and determine the condition's "stage".

Staging liver cancer

Staging is a term used to describe how far a particular cancer has spread. There are a number of different systems used to stage liver cancer.

Many liver cancer specialists use combination staging systems that include features of both the cancer and the underlying liver function to stage a person's condition.

This is because the length of time a person lives and how well they tolerate potential treatments will be determined not only by how advanced their cancer is, but also by their level of health and how good their underlying liver function is.

One combination system for staging liver cancer is known as the Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC staging system consists of five stages. These are:

• stage 0 – the tumour is less than 2cm (20mm) in diameter and the person is very well and has normal liver function
• stage A – a single tumour has grown but is less than 5cm (50mm) in diameter, or there are three or fewer smaller tumours less than 3cm (30mm) in diameter and the person is very well with normal liver function
• stage B – there are multiple tumours in the liver, but the person is well and their liver function is unaffected
• stage C – any of the above circumstances, but the person is not so well and their liver function is not so good, or where the cancer has started to spread into the main blood vessel of the liver, nearby lymph nodes or other parts of the body
• stage D – where the liver has lost most of its functioning abilities and the person begins to have symptoms of end-stage liver disease, such as a build-up of fluid inside their abdomen