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Liver and Bile Duct Cancer Tests, Diagnosis, Prognosis and Stages

The cancer experts at Banner MD Anderson Cancer Center have extensive experience diagnosing patients with liver and bile duct cancer and developing customized treatment plans for their specific needs. If you’re at high risk for liver or bile duct cancer, have signs or symptoms or have already been diagnosed, our caring team of specialists can help.

Are There Screening Tests for Liver and Bile Duct Cancers?

At this time, only people at high risk of developing liver cancer need regular screening tests.

A screening test can find cancer before you show symptoms. Being at increased risk for liver cancer doesn’t mean you will get the disease. However, you should talk to your doctor about having regular screenings if you have risk factors, such as chronic hepatitis B or C or cirrhosis. You also should be familiar with your body to notice changes like jaundice (a yellow tint to the skin) or weight loss.

Your greatest chance for successful treatment of liver cancer is to find it early.

Unfortunately, there currently are no bile duct cancer screening methods for people who don’t have symptoms. Since the bile ducts are located deep inside the body, small tumors are undetectable on physical exams, and no blood tests can reliably detect bile duct cancer early enough to be useful as a screening test.

Liver Cancer Screening Guidelines for Adults at Increased Risk

  • Liver ultrasound every six months
  • Alpha-fetoprotein (AFP) liver cancer blood test every six months

What Tests Are Used to Diagnose Liver Cancer

Tests and procedures used to diagnose liver cancer include:

  • Physical exam: Your doctor will feel your abdomen for lumps, swelling or changes in the liver, spleen and nearby organs. Your doctor also will look for signs of jaundice.
  • Blood tests: Your doctor will test your blood for a substance called alpha-fetoprotein (AFP) as well as hepatitis B and C. Elevated levels of alpha-fetoprotein are found in 50% to 70% of patients with liver cancer.

In addition, your doctor will need to see where the liver tumor is located and if the cancer has spread to other parts of the body. To do this, your doctor may use one or more of the following tests or procedures:

  • Imaging tests: Ultrasound, computerized tomography (CT), magnetic resonance imaging (MRI) and other imaging tests allow your doctor to make a three-dimensional (3D) picture of the inside of your body.
  • Laparoscopy: Under sedation, your doctor inserts a thin tube through a small incision in the abdomen to look at the liver.
  • Biopsy: Your doctor removes a small tissue sample by inserting a thin needle through your skin into your liver. The sample is sent to a lab to look for cancer cells.
  • Molecular testing: Lab testing can be done to identify specific genes, proteins and other characteristics of the tumor that are helpful if deciding on targeted therapy treatment options.

What Tests Are Used to Diagnose Bile Duct Cancer?

If your doctor thinks you may have bile duct cancer, one or more of the following tests may be used for diagnosis:

  • Tumor marker test: Carbohydrate antigen (CA) 19-9 is a protein that is overproduced by bile duct cancer cells. High levels of carbohydrate antigen 19-9 in your blood may indicate cancer but may also indicate other bile duct diseases like bile duct obstruction or inflammation.
  • Liver function tests: Blood tests measuring your liver function can help determine what may be causing your symptoms.
  • Imaging tests: Computerized tomography (CT), ultrasound and magnetic resonance imaging (MRI), along with magnetic resonance cholangiopancreatography (MRCP), can help your doctor see your internal organs to search for signs of bile duct cancer.
  • Endoscopic retrograde cholangiopancreatography (ERCP): Your doctor will pass a thin, flexible tube with a small camera on it through your throat and digestive tract to your small intestine to examine the area where the bile ducts connect to the small intestine.
  • Biopsy: Your doctor will remove a small tissue sample and send it to a lab to look for cancer cells. The biopsy may be taken during ERCP or by inserting a thin needle through your skin to the affected area.

What Is the Prognosis of a Liver or Bile Duct Cancer Diagnosis?

The outlook, or prognosis, for patients diagnosed with liver or bile duct cancer is often poor. Patients are generally diagnosed with liver and bile duct cancers at late stages, limiting available treatment options and their success. However, early diagnosis drastically improves the chances of survival for patients with liver and bile duct cancers.

Liver and Bile Duct Cancer Stages

If you’ve been diagnosed with liver or bile duct cancer, your doctor will need to determine the extent of the cancer. This process is called staging. It identifies the tumor’s size, location and if the cancer has spread (metastasized).

  • Stage 0 (bile duct cancer): The cancer is only in the mucosa (the innermost layer of cells in the bile duct) and has not started growing into the deeper layers or spread into distant sites or nearby lymph nodes
  • Stage I (1): Tumor is in the liver or bile duct but has not spread
  • Stage II (2): Multiple small tumors are present and/or one or more tumors have grown into surrounding tissue but have not spread to distant sites or lymph nodes
  • Stage III (3): Various large tumors or one tumor has reached a main, large blood vessel and may have spread to nearby lymph nodes, but not distant sites
  • Stage IV (4): Cancer has spread to other parts of the body

After your doctor has identified the stage of liver or bile duct cancer, treatment can begin.

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