What to Expect After a Liver Cancer Diagnosis
A liver cancer diagnosis may develop over several days or weeks. It may start with a preliminary diagnosis based on your symptoms, blood tests, and abdominal imaging; but you’ll undergo more tests and procedures to confirm the diagnosis, rule out other causes, and devise a treatment plan. Read about the different tests for liver cancer, including blood tests and imaging, as well as treatment options and prognosis.
The first part of your journey is to undergo testing to confirm your doctor’s suspicion that you have liver cancer. This would involve undergoing several types of tests that not only validate the liver cancer diagnosis, but also if and where it may have spread. You may have certain tests more than once, to ensure the results are consistent. This information will help guide your cancer care team to the right treatment for you.
Liver cancer testing may include:
- Blood tests: The first step is blood draws for tests. Among other things, these blood tests check for abnormal liver function. Abnormal liver function tests could mean other liver diseases though, such as viral hepatitis or cirrhosis. Different types of blood tests will narrow down the possible reasons for your symptoms.
- Imaging: In order to check for tumors or liver abnormalities, your doctor may order imaging tests, such as X-rays, ultrasounds, CT scan (computed tomography), or MRI (magnetic resonance imaging). These are often repeated throughout cancer treatment to check if the tumors are responding to treatment, such as shrinking in size, staying the same, or growing.
- Angiography of the liver: This is another form of imaging that uses a dye or contrast medium to make the liver images clearer. A catheter (narrow tube) is inserted into the artery that brings blood to the liver. The radiologist injects the dye directly to the liver. X-rays then show if there are any abnormalities in the liver. Or, you may have an IV where the contrast dye is injected into your bloodstream and then you have a CT scan or MRI to follow the blood’s path through your liver.
- Biopsy: This is a test where your doctor takes a tissue sample to be checked in a laboratory for cancerous cells. A biopsy is not done very often with liver cancer. Most diagnoses can be made without this invasive test, which some doctors feel may disturb the cancer cells and cause them to spread. If you are a candidate for liver cancer surgery, the surgeon will send a sample of the tumor to the pathology lab during or after your surgery.
Symptoms of liver cancer that has progressed include:
- Upper abdominal pain and swelling
- White, chalky stools
- Yellowish tint to the whites of your eyes and your skin
One of your first thoughts after a liver cancer diagnosis may be to start fighting the cancer. However, your doctor can also prescribe medicine to help with your liver cancer symptoms. Symptoms are more likely to occur with later stages of liver cancer. Early stage liver cancer does not typically cause symptoms.
Treating the symptoms will help you feel better, which will make it easier to concentrate on your treatment decisions. Talk openly and frankly with your doctor about what you are feeling, both physically and mentally. You will probably need help and support to cope with the diagnosis, not only from your doctor, but from loved ones as well. Tell your doctor if you do not have a good support system. Hospitals and cancer treatment centers have cancer support networks you can connect with.
Once you have been diagnosed with liver cancer, your oncologist must determine what stage of cancer you have. Is it stage 1 (the earliest) or stage 4 (the most advanced)? The stage will guide your treatment options. During the staging part of your diagnosis, you may also want to discuss your liver cancer prognosis based on the stage and your treatment choice, which could include combinations of treatments.
The main types of liver cancer treatment are surgery, embolization, radiation, chemotherapy and immunotherapy.
The four stages of liver cancer and potential treatment options are:
- Stage 1A or B: The tumor is small and has not affected the nearby blood vessels nor have cancer cells spread to the lymph nodes. People with this stage may undergo surgery to remove the tumor or have a liver transplant, if they are healthy enough overall. A liver transplant is the best way to treat liver cancer with the best outcomes. If surgery is not an option, your oncologist may propose ablation or embolization.
- Stage 2: More than one tumor, with one at least 5 cm across in size. The cancer cells have not spread to the lymph nodes or beyond the liver. Stage 2 liver cancer may also be treated with surgical removal. Surgery and transplants are the treatments that offer the best life expectancy.
- Stage 3A or B: At least one tumor is larger than 5 cm in size, but the cancer cells have not yet spread beyond the liver nor invaded the portal or hepatic veins. Treatment options may include ablation, embolization, radiotherapy or chemotherapy.
- Stage 4: This is the most advanced stage of liver cancer. Liver cancer cells have spread beyond the primary location to one or more distant sites throughout the body. This is called metastatic liver cancer. Immunotherapy drugs will not cure the cancer, but can increase your life expectancy and improve your quality of life. Targeted therapy is another option.
People with liver cancer who have another liver disease, such as cirrhosis, may be limited as to the type of treatments they can have for cancer. The prognosis for people with liver cancer and cirrhosis is often poorer than liver cancer alone, but every case is different.
If you or a loved one has liver cancer, find an oncologist who specializes in liver cancer if possible. You may see a hepatologist, a doctor who specializes in liver diseases. A liver oncologist is more likely than a general oncologist to know the most up-to-date information on liver cancer treatment and outcomes.