For many people, the first stage of diagnosing liver cancer is a consultation with a GP, although people at risk are usually tested regularly for the condition.

If you visit your GP, they'll ask about your symptoms, when they started, and when they're noticeable. They'll also examine you.

If they feel you need further tests, you'll be referred to a hospital specialist. Some of the tests you may have are described below.

Surveillance for liver cancer

If you're in a high-risk group for developing liver cancer, such as having a history of liver disease, regular screening – known as surveillance – is often recommended. This is because the earlier the cancer is diagnosed, the greater the chance there is of curing it.

Surveillance is usually carried out every 6 months and often involves:

• ultrasound scans – high-frequency sound waves are used to create an image of your liver, which can highlight any abnormalities
• blood tests – your blood is tested for a protein called alphafetoprotein (AFP), which is found in some people with liver cancer

Surveillance is usually recommended if you have cirrhosis (scarring of the liver), although there are other factors that can also affect your risk of liver cancer.

The potential benefits of surveillance should be discussed with you before you enter any screening programme.

Further testing

The tests above can also be used to look for liver cancer in people who are not being routinely screened.

If these initial tests suggest there's a chance you could have liver cancer, one or more further tests will usually be recommended to confirm the diagnosis.

The further tests include:

• CT scans – a series of X-rays of your liver are taken to give a more detailed 3-dimensional image
• MRI scans – use a strong magnetic field and radio waves to build up a picture of the inside of your liver
• biopsy – a needle is inserted into your abdomen (tummy) to remove a small sample of liver tissue, which is then tested in a laboratory for cancerous cells
• laparoscopy – a small incision is made in your abdomen under general anaesthetic (where you are asleep) and a flexible camera called an endoscope is used to examine your liver

After these tests have been carried out, it's usually possible to confirm a diagnosis of liver cancer and determine the condition's "stage".

Staging liver cancer

Staging is a term used to describe how far a particular cancer has spread. There are a number of different systems used to stage liver cancer.

Many liver cancer specialists use combination staging systems that include features of both the cancer and the underlying liver function to stage a person's condition.

This is because the length of time a person lives and how well they tolerate potential treatments will be determined not only by how advanced their cancer is, but also by their level of health and how good their underlying liver function is.

In the UK, liver cancer specialists normally use a staging system called the Barcelona Clinic Liver Cancer (BCLC) staging system.

The BCLC staging system is based on how well your liver is working, how far the cancer has spread and your overall health.

There are 5 stages:

• stage 0 – the tumour is less than 2cm in diameter and the person is very well and has normal liver function
• stage A – a single tumour of any size has developed, or there are 3 or fewer smaller tumours less than 3cm in diameter and the person is very well and their liver is working well
• stage B – there are multiple tumours in the liver, but the person is well and their liver function is working well
• stage C – the cancer has spread into blood vessels, lymph nodes or other body organs, or the person is not feeling very well and is less active but their liver is still working well
• stage D – the person has severe liver damage or they are not well and need assistance from a carer(s)

Read more about staging primary liver cancer on the Cancer Research UK website.

The treatment for liver cancer depends on the stage of the condition. Treatment can include surgery and medicine.

Most hospitals use multidisciplinary teams (MDTs) to treat liver cancer.

These are teams of specialists that work together to make decisions about the best way to proceed with your treatment.

Deciding which treatment is best for you can often be confusing.

Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Your treatment plan

Your recommended treatment plan will depend on the stage your liver cancer is at.

Find out more about staging in diagnosing liver cancer

If your cancer is at stage A when diagnosed, a complete cure may be possible.

The 3 main ways this can be achieved are:

• removing the affected section of liver (a resection)
• having a liver transplant, where you have an operation to remove the liver and replace it with a healthy one
• using heat to kill cancerous cells (microwave or radiofrequency ablation, or RFA)

If your cancer is at stage B or C, a cure is not usually possible. But chemotherapy can slow the progression of the cancer, relieve symptoms, and prolong life for months or, in some cases, years.

There are also medicines, such as sorafenib, lenvatinib and regorafenib, which are a possible treatment for some people.

If your cancer is at stage D when diagnosed, it's usually too late to slow down the spread of the cancer.

Instead, treatment focuses on relieving any symptoms of pain and discomfort you may have.

Surgical resection

If damage to your liver is minimal and the cancer is contained in a small part of your liver, it may be possible to remove the cancerous cells during surgery.

This procedure is known as surgical resection.

As the liver can regenerate itself, it may be possible to remove a large section of it without seriously affecting your health.

But in the majority of people with liver cancer, their liver's regenerative ability may be significantly impaired and resection may be unsafe.

Whether or not a resection can be performed is often determined by assessing the severity of scarring of the liver (cirrhosis).

If a liver resection is recommended, it will be carried out under a general anaesthetic, which means you'll be asleep during the procedure and will not feel any pain as it's carried out.

Most people are well enough to leave hospital within 1-2 weeks after having surgery.

But depending on how much of your liver was removed, it may take several months for you to fully recover.

Risks

Liver resection is a complicated surgery and can have a considerable impact on your body.

There's a significant risk of complications occurring during and after surgery.

Possible complications of liver resection include:

• infection at the site of the surgery
• bleeding after the surgery
• blood clots that develop in your legs (deep vein thrombosis, or DVT)
• bile leaking from the liver – further surgery may be required to stop the leak
• yellowing of the skin and whites of the eyes (jaundice)
• your liver no longer being able to function properly (liver failure)

Liver resection can also sometimes cause fatal complications, such as a heart attack.

It's estimated around 1 in every 30 people who have liver resection surgery will die during or shortly after the operation.

Liver transplant

A liver transplant involves removing a cancerous liver and replacing it with a healthy one from a donor.

This is a major operation, and there's a risk of potentially life-threatening complications.

It's estimated around 1 in 10 people will die at some point in the year after surgery.

A liver transplant may be suitable for you if:

• you only have a single tumour less than 5cm in diameter
• you have a single tumour 5 to 7cm across that has not grown for at least 6 months
• you have 3 or fewer small tumours, each less than 3cm

If you're suitable for a liver transplant, you'll normally need to be placed on a waiting list until a donor liver becomes available.

The average waiting time for a liver transplant is 135 days for adults.

In some cases, a small part of the liver of a living relative can be used. This is known as a living donor liver transplant.

The advantage of using a living donor liver transplant is that the person receiving the transplant can plan the procedure with their medical team and relative, and will not usually have to wait very long.

Find out more about liver transplants

Microwave or radiofrequency ablation

Microwave or radiofrequency ablation (RFA) may be recommended as an alternative to surgery to treat liver cancer at an early stage, ideally when the tumour or tumours are smaller than 5cm in diameter.

They can also be used to treat tumours larger than this, but the treatment may need to be repeated in such cases.

These treatments involve heating the tumours with microwaves or radio waves produced by small, needle-like electrodes.

This heat kills the cancer cells and causes the tumours to shrink.

Similar procedures using lasers or freezing can also achieve the same result.

There are 3 main ways microwave ablation or RFA can be carried out:

• where the needles are passed through the skin (percutaneously)
• where the needles are inserted through small cuts in your abdomen (keyhole surgery, also known as a laparoscopy)
• where the needles are inserted through a single large cut made in your abdomen (open surgery)

Ultrasound or CT scans are used to make sure the needles are guided into the correct position.

Microwave ablation or RFA can be carried out under general anaesthetic or local anaesthetic, where you're awake but the area being treated is numbed, depending on the technique used and the size of the area being treated.

How long it takes to carry out the treatment depends on the size and number of tumours being treated, but it usually takes between 1 and 3 hours in total.

Most people need to stay overnight in hospital.

You may experience some minor discomfort and flu-like symptoms, such as chills and muscle pains, for a few days after the procedure.

The risk of complications occurring with microwave ablation or RFA is low, but possible problems can include bleeding, infection, minor burns and damage to nearby organs.

Chemotherapy

Chemotherapy uses powerful cancer-killing medicines to slow the spread of liver cancer.

A type of chemotherapy called transcatheter arterial chemoembolisation (TACE) is usually recommended to treat cases of stage B and C liver cancer.

In these cases, the treatment can prolong life, but cannot cure the cancer.

TACE may also be used to help prevent cancer spreading out of the liver in people waiting for a liver transplant.

TACE procedure

During TACE, a fine tube called a catheter is inserted into the main blood vessel in your groin (femoral artery) and passed along the artery to the main blood vessel that carries blood to the liver (hepatic artery).

Chemotherapy medication is injected directly into the liver through the catheter.

Either a gel or small plastic beads are injected into the blood vessels supplying the tumours to help slow down their growth.

TACE usually takes 1 to 2 hours to complete. After the procedure, you'll stay in hospital overnight before returning home.

This procedure can be completed several times if necessary.

Side effects

Injecting chemotherapy medicines directly into the liver, rather than into the blood, has the advantage of avoiding the wide range of side effects associated with conventional chemotherapy, such as hair loss and tiredness.

But the procedure is not free from side effects and complications.

The most common side effect is post-chemoembolisation syndrome, which can cause tummy (abdominal) pain and a high temperature, as well as making you be and feel sick.

These symptoms may last for a few weeks after a TACE session.

Find out more about chemotherapy

Alcohol injections

If you only have a few small tumours, alcohol (ethanol) injections may be used as a treatment. 

A needle passes through the skin to inject alcohol into the cancerous cells. This dehydrates the cells and stops their blood supply.

In most cases, this is carried out under a local anaesthetic, meaning you'll be awake, but the affected area is numbed so you will not feel any pain.

Sorafenib

Sorafenib is a medication given in tablet form that can disrupt the blood supply to liver tumours and slow down their growth.

It's a possible treatment for advanced liver cancer, but is only available on the NHS to adults whose liver is working normally.

Lenvatinib

Lenvatinib is a medication given in capsule form that can also slow the growth of liver cancer.

Like sorafenib, it's a possible treatment option for advanced liver cancer, but is only available on the NHS to adults if:

• surgery is not a treatment option
• whose liver is working normally
• they're well enough to carry out daily activities like light housework or office work

Regorafenib

Regorafenib is a new medicine for adults with advanced liver cancer who have been previously treated with sorafenib.

It's only available on the NHS to people whose liver is working normally.

Regorafenib is taken as daily tablets.

Pain relief for advanced liver cancer

Treatment for advanced liver cancer focuses on relieving symptoms like pain and discomfort, rather than attempting to slow down the progression of the cancer.

Some people with advanced liver cancer require strong painkillers, such as codeine or possibly morphine.

Feeling sick and constipation are common side effects of these types of painkillers, so you may also be given an anti-sickness tablet and a laxative.

Find out more about end of life care

Clinical trials

As the current methods of curing liver cancer are limited, you may want, or be asked, to take part in a clinical trial as part of your treatment.

Clinical trials are studies that use new and experimental techniques to see how well they work in treating or curing cancer.

But if you agree to take part in a clinical trial, be aware there's no guarantee the technique being studied will be any more effective than standard treatments for liver cancer.