Liver Cancer Screening

Once a tumor has become large enough for your physician to detect by palpating the abdomen, it has likely progressed beyond Stage II, when a tumor measures between two and five centimeters across. That’s why understanding the risk factors for liver cancer and screening for the disease early can greatly improve your outcome.

Consider this: Even though primary liver cancer (HCC) is the fifth most common cause of cancer deaths worldwide, patients with early-stage liver cancer who have had a liver transplant benefit from a five-year survival rate of 80%. But early screening isn’t the only key to detecting liver cancer. It’s also the frequency of screenings and the modality used to screen. That’s where Winship comes in. As a National Cancer Institute-designated Comprehensive Cancer Center, our team combines top-rated liver cancer specialists with real-world clinical programs to screen more people, more regularly, and with the most innovative imaging techniques available.

Screening for early detection of primary liver cancer is not a routine test, although a blood test done during an annual physical can alert your primary care provider to abnormalities in liver function. Regular screenings are recommended for adults who are at risk for liver cancer. How do you know if you’re at risk? Risk factors include obesity, alcohol-induced cirrhosis, chronic hepatitis B, chronic hepatitis C, fatty liver disease and hemochromatosis. National liver cancer screening guidelines define “regular” as occurring every six months. Talk to your physician if you think you might be at risk and in need of a liver-cancer screening.

Because it is widely available and inexpensive, ultrasound is the most common way hepatologists screen for liver cancer. But while ultrasound is capable of detecting tumors as small as one centimeter – and is a great first option – other methods may be prescribed as a follow-up to pinpoint and more accurately diagnose liver cancer.

Additional screening options include:

• Blood tests. When cancerous cells develop in certain parts of the body, they release a protein known as carcinoembryonic antigen (CEA). A simple blood test is used to detect CEA. Some studies showed that elevated CEA counts corresponded to cancer more than 90% of the time. Alpha-fetoprotein (AFP), a substance normally present in fetuses but that decreases after birth, may also be detectable in the bloodstream if malignancies are present. An elevated AFP may indicate liver cancer — AFP is high in nearly 75% of cancers. Both CEA and AFP proteins, however, can’t tell doctors what type of cancer is present. If your CEA or AFP levels are abnormally high, your physician may schedule follow up imaging. Elevated levels of iron can also be a marker for liver cancer.
• High-resolution CT scan. Using the Liver Imaging Reporting and Data System (LI-RADS), clinicians can diagnose and surveil liver cancers under CT, MRI and ultrasound. CT and MRI produce similar cross-sectional images of the body and layers can be combined to create highly detailed three-dimensional images of the liver. Even though CT provides a lower-resolution image than MRI and fewer modal variations, it may be the best option for patients who are unable to tolerate the strict physical conditions required to undergo an MRI exam. The latest CT scans take only seconds to perform, whereas the average MRI can take 15 or more minutes, depending on the range of images needed. CT is also a great alternative for those who experience claustrophobia in an MRI setting. Like the other imaging techniques, CT can be enhanced with contrast. By injecting extracellular contrast agents (ECA) into the bloodstream, our interventionalists can use CT scans to detect abnormalities in the liver that would indicate the presence of cancerous tissue.
• Magnetic resonance imaging (MRI) scan. Magnetic resonance is another common diagnostic tool physicians use to identify potentially cancerous lesions in the liver. An MRI uses a magnetic field and computer-generated radio waves to create detailed photos of the liver, which can show tumors or irregular tissues. Using a variety of imaging sequences, our radiologists can detect minute characteristics of a liver mass, including diffusion restriction, arterial phase hyperenhancement (APHE), mosaic vasculature, rim enhancement and nodule-in-nodule appearance. Although some lesions can be characterized under CT scan, a dynamic contrast-enhanced MRI provides radiologists with the highest specificity. In many cases, primary liver tumors can be diagnosed, staged and surveilled under MRI, altogether avoiding the need for biopsy.

Because the quality of an ultrasound can be operator-dependent — and because ultrasounds don’t always offer the most precise look at an obese body —Winship physicians screen for liver cancer by alternating a patient’s ultrasound with an MRI every six months.

By alternating ultrasounds with MRIs, you’re able to get screened on the recommended six-month cadence, but with the addition of at least one annual MRI. This gives our specialists a better, more accurate snapshot of your liver’s health. Your screenings are performed and analyzed by a team of experts who specialize in liver cancer and who meet weekly to review patient cases.

Talk to your primary care physician about your risk of liver cancer or call Emory Healthcare's Digestive Diseases Program at 404-778-3184 to schedule a screening.