Blood Tests or Serology
Liver tests are conducted to rule out the many diseases of the liver in addition to primary liver cancer. When the liver malfunctions, it affects other functions and organs and that may result in abnormal blood tests, such as:
- Hypercalcemia or high levels of calcium in the blood.
- Hypoglycemia or low levels of sugar in the blood.
- Erythrocytosis or high counts of red blood cells. It may look like the person is flushed and red-faced.
- High cholesterol levels.
- Increased levels of alpha-fetoprotein (AFP) (a protein that is normally very low unless there is liver disease).
Other liver tests look for specific antibodies and/or proteins that are indicative of the Hepatitis B or C virus because they are precursors of cancer.
The techniques used to diagnose liver cancer through imaging have evolved significantly.
- X-rays with radioisotope scans were widely used to detect liver masses; however, they lacked sensitivity and specificity.
- Angiography is being used to detect liver cancer because it is highly vascular (a lot of blood vessels).
- Ultrasound can detect very small lesions (less than 2cm.), and it is very sensitive to metastatic spread of the tumour.
- CT scans and MRI scans are the most common imaging techniques used for diagnosis. They are combined with contrast techniques that are specific to the blood flow inside the tumour.
Biopsy of the liver is an important diagnostic technique. This procedure is performed with a fine needle or core biopsy that takes a small section of the liver for pathological diagnosis. However, there is a risk of spread of the tumour along the needle path. In most cases of non-cirrhotic livers, it is preferable to remove the liver lobule where the tumour is located. Not only is this technique diagnostic, it is also curative in 97% of the cases where cancer is detected early and there is no cirrhosis.
In diseases of the liver, staging refers to the size of the tumour as well as the involvement of surrounding structures and lymph nodes. The current staging classification in use is the Barcelona Clinic Liver Cancer (BCLC) classification which takes into consideration cancer-related symptoms and general well-being. The advantage of this classification is that it differentiates early stages of the disease with the more advanced stages while also identifying potential treatment options depending on what stage HCC a patient may be experiencing.
Below is a diagram of the BCLC staging and treatment strategy, from this article published January 4, 2018. Click the image to enlarge.
 Befeler, Alex S. et al. Hepatocellular carcinoma: Diagnosis and treatment Gastroenterology , Volume 122 , Issue 6 , 1609 – 1619
 El-Serag, Hashem B. et al. Diagnosis and Treatment of Hepatocellular Carcinoma Gastroenterology , Volume 134 , Issue 6 , 1752 – 1763
Uchunguzi wa damu au Serology: Uchunguzi wa ini unafanywa ili kuondoa magonjwa mengi ya ini pamoja na kansa ya ini ya msingi. Wakati ini inafanya kazi vibaya, huathiri kazi nyingine na viungo na inaweza kusababisha vipimo vya damu visivyo vya kawaida, kama vile: - Hypercalcemia au viwango vya juu vya kalsiamu katika damu. - Hypoglycemia au viwango vya chini vya sukari katika damu. - Erythrocytosis au idadi kubwa ya chembe nyekundu za damu. Huenda mtu huyo akaonekana kuwa amechanganyikiwa na ana uso mwekundu. - Kiwango cha juu cha kolesteroli. - Kuongezeka kwa kiwango cha alpha-fetoprotein (AFP) (protein ambayo kwa kawaida ni ya chini sana isipokuwa kuna ugonjwa wa ini). Uchunguzi mwingine wa ini hutafuta protini maalum na protini ambazo zinaonyesha virusi vya Hepatitis B au C kwa sababu ni viashiria vya saratani. Mbinu zinazotumiwa kugundua kansa ya ini kupitia upimaji wa picha zimebadilika sana. - X-ray na scans radioisotope walikuwa sana kutumika kugundua uzito wa ini; hata hivyo, walikosa unyeti na maalum. - Angiography inatumiwa kugundua kansa ya ini kwa sababu ni ya mishipa mingi ya damu (mishipa mingi ya damu). Ultrasound inaweza kugundua majeraha madogo sana (chini ya cm 2). Ni muhimu kwa ajili ya upanuzi wa metastatic ya uvimbe. CT scan na MRI scan ni mbinu za kawaida za upimaji wa picha zinazotumiwa kwa utambuzi. Hizi huunganishwa na mbinu za kutofautisha ambazo ni maalum kwa mtiririko wa damu ndani ya uvimbe. Uchunguzi wa ini ni mbinu muhimu ya kugundua ugonjwa. Utaratibu huu hufanywa kwa kutumia sindano ndogo au biopsy ya msingi ambayo huchukua sehemu ndogo ya ini kwa ajili ya utambuzi wa ugonjwa. Hata hivyo, kuna hatari ya kuenea kwa uvimbe kwenye njia ya sindano. Katika visa vingi vya ini zisizo na ugonjwa wa cirrhosis, ni afadhali kuondoa lobule ya ini ambapo uvimbe uko. Utafiti huu haujatumiwa tu kwa ajili ya utambuzi, lakini pia ni tiba katika 97% ya kesi ambapo kansa hupatikana mapema na hakuna cirrhosis. Katika magonjwa ya ini, hatua inahusu ukubwa wa uvimbe na pia kuhusika kwa miundo ya karibu na kibofu cha lymph. Utaratibu wa sasa wa hatua ni Barcelona Clinic Liver Cancer (BCLC) ambayo inachukua dalili zinazohusiana na kansa na ustawi wa jumla. Faida ya uainishaji huu ni kwamba inatofautisha hatua za mapema za ugonjwa na hatua za juu zaidi wakati pia kugundua chaguzi za matibabu zinazowezekana kulingana na hatua ya HCC ambayo mgonjwa anaweza kuwa nayo. Chini ni mchoro wa BCLC staging na mkakati wa matibabu, kutoka makala hii iliyochapishwa Januari 4, 2018. Bonyeza picha ili kupanua. Befeler, Alex S. na wengine. Hepatocellular Carcinoma: Utambuzi na matibabu Gastroenterology, Volume 122 (Toleo la 6) 1609 <unk> 1619 El-Saraj, Hashem B. et al. Ugonjwa wa Hepatocellular Carcinoma (HCC) na Ugonjwa wa Gastroenterology (GEC) - Volume 134 (Toleo la 6) 1752-1763