Diagnosing Liver & Bile Duct Cancers

At NYU Langone’s Perlmutter Cancer Center, specialists at the Liver Tumor Program are experts at diagnosing liver and bile duct cancer. Our team includes hepatologists, who specialize in liver diseases, as well as medical oncologists, oncologic surgeons, interventional radiologists, radiation oncologists, nurses, social workers, and rehabilitative and palliative medicine specialists.

The liver, located in the right upper abdomen, processes and stores nutrients that your body needs and filters harmful substances from the blood. The liver and gallbladder—the small organ adjacent to the liver—secrete bile, a fluid that aids in the digestion of lipids, or fats, in the small intestine.

Most cancers that start in the liver are hepatocellular, meaning they form in the hepatocytes, or liver cells. This cancer is called hepatocellular carcinoma. The second most common type of liver cancer is intrahepatic cholangiocarcinoma, or bile duct cancer, which starts in the cells that line the small tubes that carry bile from the liver to the small intestine. Other cancers can spread to the liver or bile ducts, typically from the colon and other gastrointestinal organs, but also from other organs, such as the kidneys.

Treatment for liver cancer and bile duct cancer is most effective when the condition is diagnosed early. Many people with both types of cancer are diagnosed when the disease is advanced, because early symptoms may be absent or vague and therefore go unnoticed. For this reason, Perlmutter Cancer Center doctors recommend that people at high risk be screened regularly for liver cancer. Currently, there are no screening tests for bile duct cancer.

Liver Tumor Program

Our experts specialize in a wide range of advanced diagnostic and treatment techniques for liver tumors.

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Ongoing communication between you and your doctors, in addition to your personal preferences, guide all treatment decisions.

Symptoms of liver cancer include a loss of appetite, unexplained weight loss, fever, fatigue, weakness, nausea, dark urine, and jaundice, which is yellowing of the skin or eyes. These symptoms are similar to those associated with other liver conditions, such as cirrhosis, fatty liver disease, or hepatitis B or C. Bile duct cancer can cause itching, dark urine, jaundice, light-colored or greasy stools, abdominal pain, unexplained weight loss, and nausea.

If liver cancer is advanced, signs and symptoms may also include abdominal pain and internal bleeding.

To diagnose liver or bile duct cancer, your doctor asks about your medical history and conducts a physical exam. He or she may also perform several blood and imaging tests.

Blood Tests

Your doctor may draw blood to determine if you have high levels of alpha-fetoprotein, which can be a sign of liver cancer. High levels of this protein can indicate if other forms of liver disease are present. For this reason, your doctor may also perform imaging tests, such an ultrasound or CT or MRI scan, to see if you have a tumor.

Your doctor may test your blood for tumor markers, substances made by cancer, that are found in the blood. People with bile duct cancer may have high levels of CEA and CA 19-9 tumor markers. If you have a history of other cancers, particularly colon cancer, your doctor may test the blood for CEA and perform CT or MRI scans to check the liver and bile ducts for cancer.

Doctors may also use blood tests to measure liver function. These tests can reveal elevated levels of enzymes, such as alanine aminotransferase and aspartate aminotransferase, as well as high levels of bilirubin—a substance found in bile that is produced after blood cells are broken down in the liver. Results of these tests can help doctors diagnose fatty liver disease, hepatitis B or C, or cirrhosis and determine how severe they are.

These conditions may need to be managed in addition to cancer.

Ultrasound

An ultrasound uses sound waves to create images of structures in the body on a computer monitor. This test may give your doctor a first look at a liver or bile duct tumor and help determine if further scans are necessary.

CT Scans

If an ultrasound reveals a suspicious tumor in the liver or bile duct, your doctor may order a CT scan. A contrast agent, an iodine-based dye, is injected into a vein to enhance the CT images, and a specialist takes X-rays of the liver as the contrast agent moves through the blood vessels, highlighting any tumors. These X-ray images are sent to a computer to create cross-sectional images of the liver from different angles. A CT scan may indicate whether cancer has spread to other organs in the abdomen or chest.

MRI Scans

Your doctor may also order an MRI scan, which uses a magnetic field and radio waves to create images of structures in the body from different angles. A contrast agent called gadolinium is injected into a vein before the scan to enhance images of the blood vessels and other body structures.

An MRI scan may reveal whether you have a liver or bile duct tumor. It can also help doctors determine if the tumor is affecting other structures in the liver or if the cancer has spread to organs in the abdomen or chest or to the bones.

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