Screening for Liver Cancer & Liver Metastases

At NYU Langone, primary care doctors usually conduct blood tests at least once a year during routine checkups. They check the blood for high levels of liver enzymes, which can signal liver disease.

Liver enzymes are substances that help the liver function, including processing and storing nutrients that your body needs and filtering harmful substances from the blood.

High levels of certain enzymes in the blood, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), may indicate a person has a liver condition such as cirrhosis, fatty liver disease, or hepatitis B or C. If you have high liver enzyme levels, a blood sample may be taken to test for hepatitis B or C.

Liver Cancer Screening for Those at High Risk

If you receive a diagnosis of cirrhosis, fatty liver disease, or hepatitis B or C, you are at increased risk of developing liver cancer. You may need to consider frequent liver cancer screening.

Several other factors, such as having a family history of liver cancer, can also increase your risk. Asian Americans, African Americans, and men are more likely to develop liver cancer, as are people older than age 40, especially if they already have a condition that causes liver damage.

If your primary care doctor or other physician determines that you are at high risk for liver cancer, you may want to discuss the tests you need with a Perlmutter Cancer Center specialist. These experts may include a hepatologist, who is a doctor who specializes in liver diseases, or a gastroenterologist.

Your specialist may recommend having the following blood and imaging tests every 6 to 12 months.

Alpha-Fetoprotein Testing

Our doctors may conduct a blood test to determine whether you have high levels of a protein called alpha-fetoprotein, or AFP. An elevated AFP level can be a sign of liver cancer, but not always. If liver cancer is present, high AFP levels can mean the condition has spread.

Blood Tests

If you have had a gastrointestinal cancer in the past, such as colorectal cancer, your doctor may test the blood for CEA, a substance that is made by cancer and therefore a tumor marker. Your doctor may also order CT or MRI scans to check for cancer in the liver.


An ultrasound uses sound waves to create images of structures in the body on a computer monitor. Your doctor may order this test to look for liver tumors.

If liver cancer is diagnosed, doctors may use ultrasound to detect any change in tumor size.

CT Scans

If an ultrasound reveals a suspicious growth, your doctor may order a CT scan, in which a series of X-ray images are sent to a computer to create cross-sectional pictures of the liver from different angles. CT scans are also used to detect tumors in people with cirrhosis or with a history of cancer such as colorectal cancer.

Usually, a contrast agent is injected into a vein before the scan. The agent makes abnormal areas of the liver easier to detect on the scan and helps highlight potential tumors.

MRI Scans

An MRI scan, which uses a magnetic field and radio waves to create multiple computerized images of structures in the body from different angles, detects liver cancer in people with cirrhosis. It can also be used to detect liver metastases in people with a history of cancer such as colorectal cancer. Our doctors usually inject a contrast agent into a vein in the arm.

Compared with CT scans, MRI scans are better at detecting the number and characteristics of liver tumors. Whereas CT scans use a low dose of radiation to produce images, MRI scans do not require radiation.

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