Blood tests liver cancer

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

The following tests may be used to diagnose HCC. This section describes options for diagnosing liver cancer. Not all tests listed below will be used for every person.

  • Physical examination. If a person has symptoms of HCC, the doctor will feel the abdomen to check for lumps, swelling, or other changes in the liver, spleen, and other nearby organs. The doctor will also look for an abnormal buildup of fluid in the abdomen and for signs of jaundice, including yellowing of the skin and whites of the eyes.

  • Blood tests. At the same time as the physical examination, the doctor will most likely do a blood test to look for a substance called AFP. In the United States, AFP is found in elevated levels in the blood of about 50% to 70% of people who have HCC. The doctor will also test the patient’s blood to see if there is hepatitis B or C. Other blood tests can show how well the liver is working.

In addition, other tests are commonly needed to diagnose HCC, to find where the tumor is located in the liver, and to see if it has spread to other parts of the body. After the physical examination and blood tests, the doctor may recommend 1 or more of the following tests:

  • Ultrasound. An ultrasound uses sound waves to create a picture of the structures inside the body, using a small amount of radiation. The sound waves bounce off the liver, other organs, and tumors. Each creates a different picture on a computer monitor.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow. Often, HCC can be diagnosed based on features specific to the cancer that are seen on a CT scan. This helps patients avoid a liver biopsy (see below). A CT scan can be used to measure the tumor’s size.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Angiogram. An angiogram is an x-ray picture of the blood vessels. A dye is injected into the bloodstream so the blood vessels of the liver show up on an x-ray.

  • Laparoscopy. Laparoscopy is a test that allows the doctor to see inside the body with a thin, lighted, flexible tube called a laparoscope. The person is sedated as the tube is inserted through a small incision in the abdomen. Sedation uses medication to make the person relaxed and sleepy. Local anesthetic is also used to numb the area.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    The type of biopsy performed will depend on the location of the cancer. The biopsy can be done during a laparoscopy, a fine-needle aspiration, or a core biopsy. During a fine-needle aspiration, cells are removed using a thin needle inserted into the tumor. A core biopsy uses a thicker needle. Either procedure is done by a radiologist who uses an ultrasound to direct the needle to the particular part of the liver with the tumor. The actual biopsy procedure usually lasts for less than 1 minute. It is typically not painful, and few people have complications from the procedure.

    Before the biopsy, your doctor will test your blood to make sure it clots normally. This decreases the risk of bleeding after the procedure. Sometimes your doctor might perform a laparoscopy and biopsy to look at the non-cancerous part of the liver to find out if you have cirrhosis, which will help determine the best treatment options.

    • When the AFP blood test, CT scan, or MRI strongly indicates HCC, and other test results are typical of HCC, a biopsy may not be needed. Also, most surgeons will recommend that a biopsy be done as part of surgery if all or part of the liver is being removed, rather than as a separate procedure beforehand. See the Types of Treatment section for more information about surgery for liver cancer.

      It is also important to note that with newer imaging methods, very small masses are easier to find. However, it is not always possible to identify what a very small mass is and if it is cancer. In these instances, especially when the mass is 1 centimeter or smaller in size, the doctor may recommend a “watch and wait” approach, also called active surveillance or watchful waiting. This means that the scans are repeated in 3 to 6 months. If the later scan shows that the size hasn’t changed, the surveillance approach is continued. If it grows, the doctor will then do a biopsy.

  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see Types of Treatment).

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is HCC, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

How is liver cancer diagnosed?

Medical oncologist Prescribes and coordinates the course of chemotherapy Cancer nurse coordinators and nurses Administer drugs – including chemotherapy – provide care, information and support throughout your treatment Social worker, physiotherapist, occupational therapist Link you to support services and help you to resume your activities Dietitian Recommends an eating plan for you to follow while you are in treatment and recovery Palliative care team Aims to improve people’s quality of life by symptom management without trying to cure the disease

This website page was last reviewed and updated July 2017.

Information reviewed by: Dr Benjamin Thomson, Hepato-pancreato-biliary Surgeon, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, VIC; Joyce Bonello, Cancer Care Coordinator – GIT, Prince of Wales Hospital, NSW; Carol Cameron, Cancer Nurse Coordinator Upper GI, WA Cancer & Palliative Care Network; Karen Hall, Clinical Nurse Cancer Services Division, Flinders Medical Centre, and Cancer Council Helpline Nurse, SA; Robyn Hartley, Consumer; Mamta Porwal, Project Coordinator, B Positive Project, Cancer Council NSW; Chris Rivett, Clinical Nurse Oncology, Western Hospital, and Cancer Council Helpline Nurse, SA; and Dr Kellee Slater, Hepatobiliary, General and Liver Transplant Surgeon, Princess Alexandra Hospital, QLD.

Liver Cancer

The liver is your body’s largest organ. It’s responsible for digestion, blood clotting and helping get rid of toxins. But unlike other organs, it has two blood sources. This makes the liver vulnerable to cancer cells moving through the bloodstream. The cancers that most commonly spread to the liver through the bloodstream are colorectal, breast and lung cancers.

When cancer starts in the liver, it’s called hepatocellular carcinoma. This type of liver cancer can start as a single tumor or as multiple spots on the liver caused by heavy drinking, obesity or a long-term hepatitis infection. These conditions cause scarring and permanent damage, known as cirrhosis of the liver.

To learn more about liver cancer symptoms, diagnosis and treatment, we spoke with Emma Holliday, M.D. Here’s what she had to say.

What are common symptoms of liver cancer?

Many patients don’t experience any symptoms in the early stages of liver cancer. When symptoms do develop, they may include abdominal pain or bloating, fatigue, nausea, vomiting, and yellowing of the skin or eyes, known as jaundice. Keep in mind that these symptoms vary from person to person.

Are some people more likely to develop liver cancer?

Hepatocellular carcinoma is more common in men than women, and the average age of diagnosis is 63.

Patients with cirrhosis of the liver are more likely to develop hepatocellular carcinoma, so it’s important to understand what can lead to cirrhosis:

  • Alcohol consumption: Alcohol should be avoided. Talk with your doctor about what that means for you.
  • Chronic hepatitis infection: Hepatitis B and C increase your risk, so it’s important to seek treatment if you have either of these infections. New antiviral medications can treat both types.
  • Non-alcoholic fatty liver disease: This is caused by a buildup of fat in the liver. You can lower your risk by maintaining a healthy weight, eating a plant-based diet and staying active.
  • Genetic conditions: Hemachromatosis, Wilson disease, Alpha 1-antitrypsin deficiency, porphyria and other rare conditions can lead to cirrhosis. If you have a family history of liver cancer, talk with your doctor about whether you should meet with a genetic counselor.

What are screening options are available for liver cancer?

National guidelines recommend routine screening liver cancer screening for patients with cirrhosis. This includes a blood test for a cancer marker called alphafetoprotein as well as an ultrasound looking for any suspicious liver masses. This screening regimen is typically done every six months. Your doctor can advise if this is right for you.

How is liver cancer diagnosed?

Talk to your doctor if you have any liver cancer symptoms. Your doctor may order a CT scan or an MRI along with an alphafenoprotein blood test to look for cancer. In some cases, CT scans or MRI results, along with blood test results, may be enough to make a diagnosis. But if the images aren’t clear, your doctor may remove a tissue sample for closer examination by doing a biopsy.

How is liver cancer treated?

The type of liver cancer treatment your doctor recommends will depend on the tumor’s size and location, whether you have cirrhosis, and your overall health.

If the cancer is early stage and your liver is healthy, surgery may be an option. If the tumors are small and haven’t spread to nearby blood vessels, your doctor may suggest a liver transplant.

Sometimes surgery isn’t an option, especially if the tumor is too large to be removed safely or is in a difficult location. In these cases, your doctors may recommend radiation therapy, which uses an external beam of X-rays or protons to destroy tumors. They may also suggest radiofrequency ablation, which uses a needle-thin probe to deliver electric currents directly to the tumor, heating it until it’s destroyed.

Another approach is to prevent blood flow from reaching tumors through a process called chemoembolization. A needle is inserted into an artery in the groin, and a tiny tube is threaded into the artery that leads to the liver to deliver drugs to the tumor. Afterward, the artery is blocked to prevent blood flow to the liver. In some cases, patients may instead undergo radioembolization, where the doctor injects liquid containing tiny radioactive spheres that treat the tumor.

Chemotherapy and immunotherapy may also be options for some patients.

What’s next for liver cancer treatment? Tell us about promising research developments and clinical trials here at MD Anderson.

Unfortunately, liver cancer is one of the most rapidly increasing types of cancer in the U.S. But we’re hopeful for the future based on new research. At MD Anderson, we have several clinical trials exploring new liver cancer treatments.

One clinical trial is comparing chemotherapy with a type of radiation called stereotactic body radiotherapy, which delivers a high dose of radiation precisely to the tumor while limiting exposure to healthy cells.

Another clinical trial is comparing proton therapy with intensity-modulated radiotherapy, and others are looking at T-cell therapy for patients with advanced liver cancer. MD Anderson is also investigating using microscopic glass beads called TheraSpheres to target tumors with internal radiation in a treatment called radioembolization.

What advice do you have for liver cancer patients?

There are many liver cancer treatment options, but not all options are right for all patients. And weighing through these treatment options can be overwhelming, so make sure you find a team of doctors you trust who can answer your questions and help you choose the right treatment for you.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Tests for liver cancer

Blood tests

Hepatocellular carcinoma (HCC or liver cancer) cannot be diagnosed by routine blood tests. There is only one specific blood test which can be used towards a diagnosis of HCC. This test specifically measures for the levels of the protein alfa-fetoprotein in serum (AFP).

Unfortunately only about half of all tumours will give a raised reading of AFP. So a normal AFP test does not exclude the presence of HCC. This is further complicated by the fact that AFP is also produced by proliferating liver cells so somebody with cirrhosis and liver regeneration is likely to have raised AFP levels already. As a consequence doctors will probably want to monitor whether the AFP levels are stable or not. Rising levels of AFP are more likely to indicate HCC.

Even where there is no detectable sign of HCC people with cirrhosis and an abnormal AFP still have a high risk of developing it. Anybody with cirrhosis and an elevated AFP, particularly with steadily rising AFP levels, will most likely either develop HCC or already have an undiscovered HCC.

Imaging studies
There is no single imaging technique that will correctly identify all HCC’s. Current techniques each have their strengths and weaknesses.

Ultrasound

Ultrasound is usually the first screening test carried out if HCC is suspected. The accuracy of an ultrasound depends very much on the technician or radiologist who performs the scan. Some experienced operators may be able to detect lesions (areas of abnormal tissue) as small as 0.5cm. Others may only be able to identify much larger lesions. An ultrasound has the advantages of not involving ionizing radiation and intravenous contrast material (injecting a chemical into the body to improve the contrast of the imaging). The cost of ultrasound is also lower than other types of scans.

Computerised Tomography (CT) scans

When performed with an enhancing contrast agent CT scans can be just as sensitive as ultrasound. This is because the agent improves the imaging of the arterial and venous systems. CT scans are much less operator-dependent than ultrasound. They also have the advantage of being able to provide images of more areas of the body. CT scans are considerably more expensive than ultrasound and expose people to ionising radiation.

Hepatic Angiography

In this procedure a catheter is inserted into the hepatic artery and intravenous contrast material is injected into the liver. It may be useful for evaluating difficult lesions but it also involves ionizing radiation risks, arterial puncture and the administration of contrast agent. Hepatic angiography is usually carried out on people who are considered to be at high risk but who have failed to show any signs of HCC with other imaging studies. At the time of angiography, if a tumour is detected, it may be decided to block the artery feeding the tumour and before injecting anticancer drugs into it (chemoembolisation).

Magnetic Resonance Imaging (MRI)

MRI is becoming increasingly popular for the diagnosis of hepatic tumours. Like a CT scan it can examine large areas of the chest and abdomen in a single session. But because no ionizing radiation is involved the imaging can be repeated many times with little risk. The technology has evolved to the point that the newer MRIs can reconstruct images of the bile ducts, the gallbladder and of the arteries and veins of the liver. The use of intravenous contrast agents significantly increases the sensitivity of the procedure, but also increases the costs. MRI is currently expensive and availability of MRI machines is limited.

Liver biopsy

The only clear way to tell the difference between a malignant or benign growth is to examine it by removing a sample of tissue and reviewing it under a microscope. This process is called biopsy. A biopsy may be undertaken at the same time as an ultrasound or CT scan.

Laparoscopy

In this procedure a surgeon places an instrument called a laparoscope (a thin, flexible tube with a camera and light at the tip) into the body via a small cut in the abdomen. The laparoscope allows the surgeon to look directly at the liver to assess for signs of HCC.

Liver tumors can be diagnosed using a combination of blood tests and other diagnostic tests. Blood tests look at liver function and levels of tumor markers (certain substances which are linked to specific types of cancer). Liver tumors will often show on an ultrasound scan but full assessment requires a CT (computerized tomography) scan or MRI (magnetic resonance imaging) scan. If the results from blood tests and CT or MRI scans are not obvious, a needle biopsy using ultrasound (or other imaging) guidance will usually confirm the diagnosis. The following sections provide more detailed information on the following tests and procedures which may be used to detect (find) and diagnose liver cancer.

Physical exam and history

Your doctor will examine your body to check your general health, including any signs of disease (such as lumps or weight loss) or anything else that seems unusual. The doctor will also take a history of your health including past illnesses and treatments and will ask about your symptoms (the things you experience about your illness, eg, tiredness, loss of appetite).

Ultrasound scan

This test uses high frequency sound waves which bounce off your internal organs and tissue to create a picture of a part of the body. The scan will show any abnormal growths in your liver. You may be asked not to eat or drink for at least four hours before the scan. The scan takes only a few minutes and is painless. You usually sit or lie near the ultrasound machine. A clear gel is spread on your skin over the area that will be scanned. The gel helps to transmit the sound waves. You can usually go home as soon as the scan is over.

Computed tomography (CT) scan

A CT scan makes a series of x-rays of areas inside the body. This series of cross sections or “slices” through the part of the body being scanned are used to build a very detailed three-dimensional picture of the inside of the body. This type of scan may be used to look for signs of cancer in your liver (using a CT scan of your abdomen) and for cancer in other parts of your body. A CT scan can give a very accurate picture of the location and size of a tumor. It can also show how close major body organs are to the area that needs to be treated or operated on. A contrast medium (dye) may be injected partway through the scan to help show more details of your liver and the tumors. A CT scanning machine is large and “doughnut” shaped. You lie on a bed that can slide backwards and forwards through the hole of the machine. The pictures are taken as you move through the machine. An abdominal CT scan takes from 10 to 30 minutes and is painless. You can usually go home as soon as the scan is over.

CT is also called computed axial tomography (CAT).

Magnetic resonance imaging (MRI) scan

An MRI scan is similar to a CT scan but uses magnetic fields instead of x-rays to build up a series of cross sections through the part of the body being scanned. An MRI scan will be clearer than a CT scan for some types of tissues. Your doctor will know the best scan for you.

The MRI scanner is a large cylinder with a bed that can move backwards and forwards through the cylinder. The images are taken inside the cylinder. You will need to remove all metal belongings before going into the room because the cylinder is a very powerful magnet. You may have an injection of a contrast medium (dye) just before the scan. This dye helps to show body tissues and organs more clearly on the scan. MRI is painless but the machine is very noisy. You may be given earplugs or headphones to wear. The test may take between 1 and 1.5 hours. You are usually able to go home as soon as the scan is over.

MRI is also called nuclear magnetic resonance imaging (NMRI).

PET (positron emission tomography) scan

A PET scan uses low-dose radioactive sugar to measure the activity of cells in different parts of the body. Cancers rely on sugar for their energy and usually use it more rapidly than normal tissues. This means that radioactivity accumulates in the cancer(s), and shows up as a “hot spot” on the scan. The PET scan can be used to detect tumors as small as 1cm. The radioactivity decays within a very short time and only stays in the body for a few hours. A PET-CT scan is a test that is completed with the aid of a CT scan performed on the patient during the same session, in the same machine.

Serum tumor marker test

A sample of your blood is taken and tested to measure amounts of certain substances released into your blood by organs, tissues, or tumor cells in your body. Certain substances, called tumor markers, are linked to specific types of cancer when they are found in higher levels than usual in the blood.

CEA (carcinoembryonic antigen) is very high in patients with secondary colorectal cancer in the liver (it may also be elevated in people with other cancers of the digestive system, lung, and breast and in some non-cancerous diseases and in otherwise healthy smokers).

Not every person with liver tumors will have higher levels of a tumor marker. Thus, doctors will consider tumor marker levels along with other information, for example from imaging tests.

Liver function tests (LFT)

These blood tests show if the liver is working properly. It is important to realize that the normal liver function can be affected by many conditions other than cancer. LFTs are also useful as an indicator of how well the liver works before, during and after treatment.

Biopsy

The only way to clearly diagnose cancer is to take a sample of tissue. This is called a biopsy. The tissue is viewed under a microscope. It can also show the origin and type of tumor that may be present in the liver. You may have a biopsy at the same time as an ultrasound or CT scan, usually with a thin needle. This is called a fine-needle aspiration (FNA) biopsy. The skin is numbed with a local anesthetic and a fine needle is inserted into the liver through the skin.

A biopsy is usually only done if other tests including blood tests and CT or MRI scans are not conclusive, ie, do not have obvious results. A biopsy always carries the risk that the tumor will spread along the needle track.

Following a liver biopsy, you may have to stay in hospital for a few hours or overnight. This is because the liver has a very rich blood supply and there is a risk of bleeding afterwards.

Blood Tests for Liver Cancer and Liver Disease

Blood tests help doctors at the UPMC Liver Cancer Center determine:

  • Your general health
  • How well your liver works
  • Whether you have been exposed, in the past, to hepatitis B or hepatitis C, and whether the hepatitis is active

Platelet Count

A platelet count can detect liver cancer in its early stages.

A white cell count below the normal range can be a sign of an enlarged spleen (splenomegaly) and/or an increase in the blood pressure within the liver’s blood vessels (portal hypertension).

Blood Chemistries

Blood tests — known as blood chemistries — evaluate liver function, specifically:

  • Albumin levels
  • Blood creatinine levels
  • Prothrombin time
  • Transaminase levels (ALT, AST, GGTP)

Tumor Markers

Blood tests for specific tumor “markers” detect the presence of:

  • Alpha-fetoprotein (AFP)
  • Des-gamma-carboxy prothrombin (DCP or PIVKA-2)
  • Neurotensin

DCP and neurotensin are markers (in the presence of a normal AFP) for the fibrolamellar variant of liver cancer, which often occurs in children.

CT scan of a liver with cholangiocarcinoma

Researchers at the University of Texas Southwestern have recently discovered that combining ultrasound images with blood tests that test for high alpha fetoprotein (AFP) levels can improve detection of early-stage liver cancer by 40%.

There are about 42,220 new liver cancer diagnoses and about 30,200 will die from it per year. It affects more men than women and its prevalence has more than tripled since 1980. The American Cancer Society reports that it is harder to detect liver cancer in its early stages because the liver is surrounded by the rib cage. By the time the tumor is able to be felt, it might be too big.

“If the cancer is found early, then we can perform curative therapies, allowing patients to live many years,” hepatologist Dr. G. Amit Singal, associate professor of internal medicine and clinical science at UT Southwestern Harold C. Simmons Comprehensive Cancer Center, said in a press release. “Unfortunately, most liver cancer in the United States is discovered at later stages, when curative treatment is not possible and survival is much worse.”

Risk factors for liver cancer include hepatitis C, chronic heavy alcohol consumption and non-alcoholic fatty liver disease caused by diabetes and obesity. Patients who have cirrhosis undergo liver cancer screenings with varying guidelines that recommend both imaging and AFP measurements.

The study is a meta-analysis of 32 previous studies and focuses on using normal ultrasound imaging that is used to check the liver for cancer in addition to using blood tests that scan for AFP to detect liver cancer in its early stages.

“Liver cancer screening in patients with chronic liver disease has traditionally been performed using an abdominal ultrasound. While ultrasound is readily available and noninvasive, it misses many cancers when they are small,” Amit Singal, a professor in clinical cancer research, said. “Our study found that adding the blood biomarker alpha fetoprotein increased detection of early-stage hepatocellular carcinoma from 45 percent with ultrasound alone to 63 percent using the two tests in combination.”

AFP is a plasma protein that liver cells abundantly produce in the fetus. However, those levels are typically low in adults, so a rise in AFP levels could indicate liver cancer.

“Our results highlight the important of continued development and validation of blood-based biomarkers for liver cancer early detection. Most importantly, our results support a change in clinical practice and the routine use of ultrasound and biomarkers together for liver cancer screening,” Singal said.

The research is published in the journal Gastroenterology and was supported by the National Cancer Institute and the Cancer Prevention Research Institute of Texas.

A complete blood count (CBC) is a common blood test that your doctor may recommend to:

  • Help diagnose some blood cancers, such as leukemia and lymphoma

  • Find out if cancer has spread to the bone marrow

  • See how a person’s body is handling cancer treatment

  • Diagnose other, noncancerous conditions

If you are receiving chemotherapy, your doctor will likely watch your blood cell counts often using a CBC.

What does a complete blood count measure?

A CBC measures the amount of 3 types of cells in your blood:

  • White blood cell count. A white blood cell count, also called a leukocyte count, measures the total number of white blood cells in a sample of blood. These cells protect the body from infection by attacking invading bacteria, viruses, and other foreign materials in the body. Some white blood cells can also attack cancer cells.

  • White blood cell differential. A white blood cell differential measures the number of each type of white blood cell. There are 5 major types of white blood cells, and each type plays a different role in protecting the body. Your doctor can learn valuable information about your health by measuring the levels of these cells:

    • Neutrophils

    • Lymphocytes

    • Monocytes

    • Eosinophils

    • Basophils

  • Red blood cell count. Red blood cells carry oxygen throughout your body. A red blood cell count, also called an erythrocyte count, measures the number of red blood cells in a sample of blood. There are several ways to measure red blood cells. Two of the most common are:

    • Hematocrit (Hct), the percentage of your blood that is made up of red blood cells

    • Hemoglobin (Hgb), the amount of the protein in red blood cells that carries oxygen

  • Platelet count. A platelet count measures the number of platelets in a sample of blood. Platelets help to stop bleeding by forming blood clots.

The amounts of each of these types of cells have a normal range. Your health care team will note this range on your CBC lab results. A range is used instead of a specific number because a normal amount is different for each person.

What do the results mean?

Your health care team must carefully read CBC test results. Keep in mind that many factors, including noncancerous conditions, can lead to results that fall out of the normal range. Ask your doctor to help you understand what your results mean.

  • Low white blood cell count. Some cancer treatments, mainly chemotherapy, may lower your body’s white blood cells. Cancers that affect the blood and bone marrow can also lower the count. These types of cancers include leukemia, lymphoma, and multiple myeloma.

  • Amounts of different white blood cells. Higher-than-normal numbers of lymphocytes or monocytes can indicate the possibility of certain types of cancers.

    Some cancers and their treatments may cause neutropenia. Neutropenia is when a person has low numbers of neutrophils. This increases the chance of getting a bacterial infection. At times, your doctor may lower your chemotherapy dose to lower your chance of developing neutropenia. Your doctor may also recommend medication, such as white blood cell growth factors, to increase your body’s production of neutrophils, especially if you develop a fever.

  • Low red blood cell count. Some cancer treatments, mainly chemotherapy and radiation therapy, may lower your red blood cells count. This condition is known as anemia. Blood loss, either from surgery or specific cancers, and cancers that directly involve the bone marrow can also cause or worsen anemia. People whose red blood cell count falls too low may need a blood transfusion or medication to help bring it up.

  • Low platelet count. Some cancer treatments, such as chemotherapy or radiation therapy, may cause a decrease in platelets. Cancers that directly involve the bone marrow can also lower the platelet count. An unusually low number of platelets is called thrombocytopenia. People with low platelet levels have a greater risk of serious bleeding or bruising. If your platelet count falls to very low levels, your doctor may recommend platelet transfusions.

Questions to ask your health care team

Consider asking the following questions about your CBC test:

  • Why am I having this test?

  • How and where is this test done?

  • Do I need to avoid eating and drinking before the test? If so, for how long?

  • How will I get the results of my test?

  • What are normal test results?

  • What do my test results mean? Will someone explain them to me?

  • If my results are within a normal range, what are the next steps?

  • If my results are outside of a normal range, what are the next steps?

  • How do these test results compare with my previous results?

  • Will I need additional tests? If so, when?

Related Resources

When the Doctor Says Cancer

More Information

College of American Pathologists: Healing Begins in the Laboratory (video)

Lab Tests Online: Follow that Blood Sample – A Short Lab Tour

Lab Tests Online: White Blood Cell Count, White Blood Cell Differential, Red Blood Cell Count, and Platelet Count

MedlinePlus: Laboratory Tests

Blood Tests

When your doctor orders a blood test, he or she chooses from a list of chemical studies to be performed in a laboratory on your blood sample. These lab tests can provide important clues about what’s going on inside your body.

If your doctor suspects you may have cancer, he or she may test your blood to:

  • Measure the number of red cells, white cells and platelets
  • Detect biomarkers that may indicate cancer activity
  • Examine various chemicals that can indicate how other parts of your body are functioning, including your liver, kidney, heart and lungs

Read about the following blood tests, below:

  • How Are Blood Tests Done?
  • Complete Blood Count
  • Blood Chemistry
  • Blood Smear
  • Cytogenetic Analysis
  • Flow Cytometry
  • Fluorescence in Situ Hybridization (FISH
  • Gene Expression Profiling
  • Immunophenotyping
  • Karyotype Test
  • Polymerase Chain Reaction (PCR)
  • White Cell Differential

How Are Blood Tests Done?

Ask your doctor if you need to follow any special instructions. For example, your doctor may ask you to fast (not eat or drink) before having your blood taken. Blood tests are usually done in one of two ways:

  • A needle is inserted into a vein (usually in the fold of your arm) and blood is withdrawn. You may feel a slight pinprick. Your sample is placed in a test tube and sent to a laboratory for analysis.
  • If only a small amount of blood is needed, your doctor can obtain blood by simply pricking your finger. Your blood sample is placed on a glass laboratory slide to be examined under a microscope or in a test tube for analysis.

Blood Chemistry

Your blood chemistry is examined using a group of tests called “chemistry panels,” which provide information about your general health. Depending on the type of panel, these tests can measure:

  • Electrolyte balance (such as sodium or potassium)
  • Protein (such as albumin, beta2 -microglobulin, immunoglobulins and lactate dehydrogenase )
  • Blood glucose (sugar)
  • Cholesterol
  • Chemical substances that indicate liver and kidney function
  • Antibodies, including those developed from vaccinations (such as poliovirus antibodies)
  • Hormones (such as thyroid hormone)
  • Minerals (such as iron, calcium or potassium)
  • Vitamins (such as B12 or folate)

How Is It Done? You may be asked to fast before getting the blood test. Once your blood is drawn, it’s placed in a tube(s) and usually left to clot. The fluid portion of the blood that remains after clotting, called the serum, is used for various chemical studies.

What Do the Results Mean? The results give your doctor information about your overall health and identify potential problems that may need treatment. Higher levels of certain blood proteins can be signs of disease severity (for example, tumor size and growth rate). High levels of uric acid can sometimes indicate disease as well.

Blood Smear

Your doctor may order a blood smear (also called a peripheral blood smear or manual differential) if your CBC results are abnormal or unclear or if he or she thinks a disorder or disease may be disrupting normal blood cell production. This test helps determine whether red cells, white cells and platelets are normal in appearance and number. It’s also used to determine the proportion of each type of white cell relative to the total white cell count. The results also help your doctor monitor cell production and cell maturity before and during blood cancer therapy.

How is it done? A single drop of blood is spread on a glass slide, dried and then stained with a special dye. The sample is then examined under the microscope to calculate the number of each type of blood cell. The doctor also compares the size, shape and general appearance of the sampled cells to “normal” cells.

What do the results mean? This test can show the presence of abnormal or immature cells, which may indicate an underlying condition, provide information about its severity and suggest the need for further testing.

Complete Blood Count

A complete blood count (CBC) is a common test that gives a general picture of your health. A CBC measures the number of red cells, white cells (neutrophils, eosinophils, basophils, monocytes and lymphocytes) and platelets and levels of hemoglobin and hematocrit in your blood. Many health conditions cause increases or decreases in blood counts. Your doctor may order a CBC regularly to monitor your condition or track your response to treatment.

How Is It Done? The blood is placed in a test tube containing an anticoagulant (to prevent clotting) and sent to a laboratory to be examined by a pathologist. Dyes are added to the blood sample so that different types of blood cells are noticeable. The slide with the sample of blood cells is examined under a microscope to count the number of cells and see whether they’re normal or, if abnormal, the nature of the changes.

What Do the Results Mean? Normal ranges vary slightly among different labs, so ask your doctor to review the results with you. Results above or below normal ranges may signal health problems.

Cytogenetic Analysis

Samples of fluid, tissue and cells are examined under a microscope to look for chromosome changes. Cytogenetic analysis detects chromosome alterations and, in some cases, may identify the actual genes that have been affected. The individual who prepares and examines the chromosomes and interprets the results is called a “cytogeneticist.”

How Is It Done? Cell samples are collected through blood or bone marrow tests.

What Do the Results Mean? The findings help healthcare professionals diagnose specific types of blood cancers, determine treatment approaches and monitor the response to treatment.

Flow Cytometry

Flow cytometry analyzes your blood or bone marrow cells to determine whether a high white cell count is the result of blood cancer. The test identifies cells as they flow through an instrument called a flow cytometer. Flow cytometry measures the number and percentage of cells in a blood sample and cell characteristics such as size, shape and the presence of biomarkers on the cell surface. This method helps to subclassify cell types so your doctor can decide on the best treatment plan. Flow cytometry can also detect residual levels of disease after treatment. This helps your doctor identify disease relapse and restart treatment as needed.

Fluorescence in Situ Hybridization (FISH)

Fluorescence in situ hybridization (FISH) is a test performed on your blood or bone marrow cells to detect chromosome changes (cytogenetic analysis) in blood cancer cells. FISH helps identify genetic abnormalities that may not be evident with an examination of cells under a microscope. This helps ensure that you receive the proper treatment. Once treatment begins, doctors use FISH — usually every three to six months — to determine whether a therapy is working.

Gene Expression Profiling

A test that can help identify cancer subtypes and risk factors. Gene expression profiling is not generally used in clinical practice and these tests are still mostly used as research tools. This test uses a method called “microarray analysis” to identify combinations of genes that are turned off or on in response to specific conditions.

How Is It Done? Genes are collected from blood or tissue sample.

What Do the Results Mean? The test findings may allow for more accuracy classifying tumors and help doctors to predict how patients will respond to treatment, as well as which patients may be at increased risk for disease relapse.

Immunophenotyping

Immunophenotyping identifies a specific type of cell in a sample of blood, bone marrow or lymph node cells. This procedure can be important in determining the best treatment. For example, immunophenotyping can distinguish myeloid leukemic cells from lymphocytic leukemic cells, normal lymphocytes from leukemic lymphocytes, and B-cell lymphocytes from T-cell lymphocytes. Immunophenotyping also reveals whether your cells are monoclonal (derived from a single malignant cell).

Karyotype Test

A karyotype test uses a map of the 46 human chromosomes of a cell to identify and evaluate changes to the expected chromosome arrangement, size, shape and number in a sample of blood or bone marrow cells. In some cases, a dye called Giemsa may be used as a stain to make the banding pattern of chromosome pairs easier to see. This is also referred to as “G-banding.” The findings can help your doctor develop a more specific treatment plan.

Polymerase Chain Reaction (PCR)

Polymerase chain reaction (PCR) is an extra-sensitive test that measures the presence of certain biomarkers in blood or bone marrow cells. It measures any remaining blood cancer cells not found by cytogenetic methods such as FISH. PCR is used to diagnose and check a patient’s molecular response to treatment. PCR can detect a specific DNA abnormality or marker found in patients with certain blood cancers such as acute promyelocytic leukemia and chronic myeloid leukemia. PCR allows more sensitive follow-up of patients in remission and can help determine whether additional treatment is needed.

White Cell Differential

A white cell differential (also called a CBC plus differential or a differential) measures the amount of the different kinds of white cells (leukocytes) in the blood. A white cell differential is often included as part of the CBC. This helps determine your body’s ability to react to and fight infection. It can also identify various types and stages of blood cancers, detect the existence and severity of infections and measure your response to chemotherapy. The absolute neutrophil count (ANC) is the number of neutrophils (a type of white cell) in the blood that will fight infection.

How Is It Done? After your blood is drawn, it’s placed on a stained blood slide and examined. The pathologist determines the percentage of different types of white cells present.

What Do the Results Mean? Abnormal patterns of white cells may point to infections, leukemia, immune disorders, inflammation and other problems.

Related Links

  • Download or order The Leukemia & Lymphoma Society’s free booklet, Understanding Lab and Imaging Tests.

Diagnosis Methods

Bone Marrow Biopsy

A bone marrow biopsy takes tissue from the center of the bone for analysis. Typically a hollow needle is placed into the back of the large bone in the pelvic area called the posterior iliac crest, under either local anesthetic or conscious sedation. The needle is inserted through a small incision. Though preliminary results can be available in a day or two, an extensive analysis can take two to three weeks.

Complete Blood Count

At Torrance Memorial Physician Network – Cancer Care we’re able to perform complete blood count (commonly called a “CBC”) with just a finger-stick and to obtain a result within minutes. The test measures the levels of various blood elements including number and subtypes of white blood cells, quantity of red blood cells, and numbers of platelets. White blood cells fight infection and when low in number place a patient at risk of infection. Red blood cells carry oxygen and when low in number results in fatigue. Platelets prevent or help stop bleeding. CBC results can help diagnose cancer, or help with monitoring treatment side effects.

Metabolic Panel

Chemistry (metabolic) panels measure a variety of organ functions. At Torrance Memorial Physician Network – Cancer Care, our chem panel includes measurements of electrolytes, kidney function, nutritional level, and potential damage to the liver and skeletal system. The electrolytes include levels of sodium, potassium, chloride, and carbon dioxide. Kidney function is measured by BUN and creatinine and high levels are undesirable. Albumin, a protein made by the liver, will be low if nutrition is poor or there is dysfunction of the liver. Liver function tests also include bilirubin, transaminases (AST and ALT), and alkaline phosphatase. Mild elevation of liver tests is common and doesn’t usually indicate disease. Persistently significant elevations are undesirable and require evaluation. Alkaline phosphatase can also be elevated due to skeletal system damage.

Tumor markers are substances that can be found in the body when cancer is present. The classic tumor marker is a protein found in higher amounts in the blood when a certain type of cancer is present. Other tumor markers are found in urine or other body fluid, and some are found in tumors and other tissue. The tumor marker may be made by the cancer cells themselves, or by the body in response to cancer or other conditions. Most tumor markers are proteins, but some newer markers are genes or other substances.

There are many different tumor markers. Some are linked only to one type of cancer, while others can be found in many types of cancer.

To test for a tumor marker, the doctor most often sends a sample of the patient’s blood or urine to a lab. Sometimes a piece of the tumor itself is tested for tumor markers.

Tumor markers alone are rarely enough to show that cancer is present. Most tumor markers can be made by normal cells as well as by cancer cells. Sometimes non-cancerous diseases can also cause levels of certain tumor markers to be higher than normal. And not every person with cancer has higher levels of a tumor marker.

This is why the clinical judgment of a medical oncologist is essential for determining whether or not the use of a tumor marker will result in better treatment for a patient. When a doctor looks at the level of a tumor marker, he or she will consider it along with the patient’s history, physical exam, and other lab tests or imaging studies.

Imaging and Radiology

Doctors use imaging tests to make pictures (images) of the inside of the body. Imaging tests can be used in many ways, including to look for cancer, to find out how far it has spread, and to help determine if cancer treatment is working.

Some of the common types of imaging tests include:

  • Ultrasound: An ultrasound uses high-frequency sound waves to visualize the inside of the body. No radiation is involved. A probe (transducer) is placed over an area of the body such as the breast or liver; radio waves are transmitted through the body part, bouncing back and recorded. An ultrasound can detect an abnormality of a body part and suggest whether or not it is cancer, but is not proof that a cancer is present. A biopsy of the abnormal area is the only way to establish without doubt that the abnormality is cancer.
  • Computed Tomography (CT): Computer Axial Tomography uses low dose X-rays to image the body. Patients lie on a moving platform which slides into an X-ray machine shaped like a large donut. Within that structure an X-ray unit rotates around the patient’s body, creating computer generated images that produce a 3D view of the inside of the body.
  • Magnetic Resonance Imaging (MRI): Another test that doesn’t use X-ray, MRI stands for magnetic resonance imaging. A patient lies on a moving platform that slides into a relatively narrow tunnel that contains a very powerful magnet. A computer generates a 3D view of the inside of the body by reading changes in the electromagnetic fields of different internal structures. MRI is particularly useful for evaluating the brain and spinal cord. It is also used to evaluate the breast.
  • Positron Emission Tomography (PET): PET scan is a nuclear medicine test. A small amount of radioactive glucose is injected into the vein and the scan measures differences in rate of glucose uptake by different structures within the body. Following the injection, the patient lies on a moving platform which passes through a open circular structure and a computer generates a 3D picture. Although a photo is made of the scan for the purpose of placement in a patient’s chart, the scan is actually read on a computer monitor, so that the image can be rotated 360 degrees, permitting more accurate interpretation.
  • Bone Scan: This is a nuclear medicine test and should not be confused with a bone density X-ray which is used to diagnose osteoporosis. A bone scan requires the injection of a small amount radioactive substance into the vein, which then travels to areas of high bone activity. After several hours, pictures are taken with a special camera.
  • Mammogram (Breast Scan): Mammogram use a very low dose of X-ray energy to image the breast to find abnormal tissue (formed by the breast in reaction to cancer) and/or collections of calcium in a pattern seen on the mammogram that is determined to be suspicious by the radiologist.

Tests That Diagnose Liver Cancer

In its early stages, liver cancer has few, if any, signs or symptoms. That’s why people at higher than average risk of developing liver cancer should undergo regular liver cancer screening tests.

Liver cancer is on the rise in the United States, says Eugene R. Schiff, MD, director of the Center for Liver Disease at the University of Miami Medical Center. Two conditions, says Dr. Schiff, are largely behind the increase: hepatitis B and hepatitis C. Both infections can lead to chronic liver disease, or cirrhosis, he explains, and about 3 percent of patients with chronic liver disease will develop liver cancer.

Liver Cancer: Screening Those at Risk

Early diagnosis and treatment of liver cancer can mean the difference between life and death. That’s why the Hepatitis B Foundation, among other organizations, recommends that people who are at high risk of liver cancer be screened for the disease at least every six months. People at higher than average risk of liver cancer include:

  • Men 40 and older who have hepatitis B and cirrhosis.
  • Women 50 and older who have hepatitis B and cirrhosis.
  • Anyone who has hepatitis B and a family history of liver cancer.
  • Anyone who has hepatitis C.

Additionally, Schiff says that all people with cirrhosis, due to any cause, should consider regular screening for liver cancer.

Liver Cancer Screening: Ultrasound and Blood Tests

An ultrasound exam every six months is “the mainstay of screening” for liver cancer, says Schiff. During an ultrasound exam, a technician moves an instrument called a transducer over your abdomen, where your liver is located. The transducer sends sound waves through your body, which bounce off the organs and create echoes. A computer uses the echoes to create images visible on a monitor. These ultrasound images can reveal tumors growing in the liver.

Ultrasound exams are often performed in conjunction with a blood test for alpha-fetoprotein (AFP). AFP is a protein that is present in fetal blood, but usually goes away after birth. Its presence in adult blood can be a warning sign for certain cancers, including liver cancer.

Some experts point out that AFP testing is not always accurate, but “everybody agrees it’s helpful,” Schiff says. Finding both AFP in the blood and a liver mass on ultrasound is strong evidence of a liver tumor and should prompt further tests, he says. Whenever someone has an elevated AFP level, however, Schiff recommends further testing, even if the ultrasound results are normal.

Liver Cancer Screening: Additional Imaging Studies

If doctors find signs of liver cancer in screening exams, they may suggest more detailed diagnostic tests, including:

  • Computed tomography (CT). This test creates highly detailed images of the internal organs. A special X-ray machine rotates around your body, working with a computer to produce cross-sectional pictures of your organs, including the liver. Before the test, you may be injected with a special dye that helps create especially clear images of the liver.
  • Magnetic resonance imaging (MRI). Another test that produces very detailed images, MRI uses powerful magnets and radio waves instead of X-rays to examine the inside of the body. Like a CT, this test may require injection with a special dye. MRI requires that you lie within a large, cylindrical tube for as long as an hour, which can be uncomfortable for some. Newer machines have a more open design.
  • Angiography. Angiography allows doctors to see blood vessels within and around your liver. Doctors insert a thin tube, called a catheter, into an artery leading to the liver. They inject a special dye through the catheter, which makes the blood vessels visible on X-ray. An experienced radiologist can detect blood vessels going to a tumor, and may also be able to determine whether or not the tumor can be surgically removed. Angiography is sometimes combined with MRI or CT, instead of X-rays, to obtain even more detailed images.

Liver Cancer Screening: Liver Biopsy

Sometimes the combination of finding a visible mass on an imaging study and a very high level of AFP is enough for doctors to make a diagnosis of liver cancer. Even so, most people undergo a tissue biopsy to confirm the diagnosis. During a liver biopsy, a surgeon removes all or part of the mass in your liver. The surgeon then sends a sample of the tissue to a pathologist, who studies the sample under a microscope to determine if cancer cells are present.

Depending on your particular situation, doctors may recommend different types of biopsies, including:

  • Needle biopsy. Doctors insert a hollow needle through the skin in the abdomen and into the liver and use a syringe to pull cells from any tumors or growths into the needle. The cells are sent to a pathologist for analysis.
  • Laparoscopic biopsy. During laparoscopy, doctors insert a thin tube attached to a tiny camera through a small incision in the abdomen. The camera transmits images to a monitor, allowing the doctor to see your liver and any abnormal masses. The doctor may remove a sample to test for cancer cells.
  • Surgical biopsy. Most often, doctors prefer to have the biopsy results before they perform traditional surgery to remove a tumor. In some cases, though, they may perform an intraoperative biopsy, meaning a biopsy is performed during a larger surgery to take out a mass and part of the liver, if necessary.

Liver Cancer Screening: Additional Tests

Your doctor may also order blood and urine tests, such as liver function tests, kidney function tests, a complete blood count, and blood clotting tests, in order to evaluate how well your liver and other organs are working. The tests can help your doctor determine your ability to withstand surgery or other cancer treatments, such as chemotherapy and radiation.

If you have hepatitis B, hepatitis C, cirrhosis, or a family history of liver cancer, talk to your doctor about how often you should undergo cancer screening.

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Liver cancer

Diagnosing liver cancer

A thorough and accurate cancer diagnosis is the first step in developing a liver cancer treatment plan. Your team of liver cancer experts will use a variety of tests and tools designed for diagnosing liver cancer, evaluating the disease and developing your individualized treatment plan. Throughout your treatment, we’ll use imaging and laboratory tests to track the size of the tumors, monitor your response to treatment, and modify your plan when needed.

Examples of procedures for diagnosing liver cancer include:

Biopsy: Once liver cancer has been diagnosed, your doctor will obtain a tissue sample to determine the type and stage of the disease, choosing from several biopsy methods, including fine needle aspiration (FNA) biopsy, core needle biopsy or laparoscopic biopsy. Laparoscopy is a minimally invasive method of obtaining a tissue sample without the risks of surgery.

Bone scan: If you are experiencing bone pain or blood tests reveal elevated calcium levels, your radiation oncologist may perform a bone scan to detect whether liver cancer has spread to the bone.

CT scan: A CT scan can provide precise information about the size, shape and position of tumors in the liver or elsewhere in the abdomen, as well as nearby blood vessels. CT scans may also be used to guide a biopsy needle precisely into a suspected tumor (CT-guided needle biopsy).

Lab tests: To diagnose liver cancer, your doctor will perform a variety of liver function tests to assess the function of the liver by measuring the level of certain proteins or waste products in the blood. These tests may also be used to develop a treatment plan and evaluate your response to it.

MRI: These scans may help distinguish between benign and malignant tumors. They may also be used to examine blood vessels in and around the liver.

PET/CT: This test may help doctors determine whether the liver cancer has spread to areas such as the bones or lungs.

Ultrasound: This test may be recommended every six to 12 months to assess the progress of treatment.

Next topic: How is liver cancer treated?

Pairing ultrasound with a blood test to detect high alpha fetoprotein (AFP) levels demonstrated up to a 40 percent improvement in detecting early-stage liver cancer, according to new research published in the journal Gastroenterology.

Liver cancer is on the rise and currently the fastest increasing solid-tumor cancer in the U.S., according to a National Cancer Institute (NCI) statistic.

“If the cancer is found early, then we can perform curative therapies, allowing patients to live many years,” said corresponding author G. Amit Singal, MD, and associate professor of internal medicine and clinical sciences with UT Southwestern Harold C. Simmons Comprehensive Cancer Center in a university release. “Unfortunately, most liver cancer in the United States is discovered at later stages, when curative treatment is not possible, and survival is much worse.”

A lack of standard screening guidelines for patients with cirrhosis adds to this problem, with some calling for imaging alone and others requiring imaging along with alpha fetoprotein (AFP) measurement.

In the meta-analysis, published online Feb. 6, UT researchers looked through 32 studies, totaling 13,367 patients, to compare the performance of surveillance imaging, with or without AFP, for early detection of early-stage hepatocellular carcinoma (HCC) in patients with cirrhosis.

Below are some key findings:

  • Results showed ultrasound detected any stage HCC with 84 percent sensitivity, but early-stage HCC with only 47 percent sensitivity.
  • Ultrasound alone detected HCC with a higher level of specificity than ultrasound plus AFP measurement.
  • However, ultrasound with AFP detected early-stage HCC with 63 percent sensitivity, and without AFP with 45 percent sensitivity.

“Our results highlight the importance of continued development and validation of blood-based biomarkers for liver cancer early detection. Most important, our results support a change in clinical practice and the routine use of ultrasound and biomarkers together for liver cancer screening,” said Singal.

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