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Several tests are used to diagnose HCC. The most important ones are lab tests, physical examination, and imaging tests. In some cases, liver biopsies are also done.

Lab Tests 

Your healthcare provider will order lab tests and bloodwork to check how well your liver is functioning. One of your lab tests will be an AFP test. AFP stands for alfa-fetoprotein. A high level of AFP can be a sign of HCC. If you’re considered to be at increased risk of developing lHCC, you may get an AFP test along with an ultrasound every 6 months.

Physical Exam

Your doctor might also give you a physical exam. They’ll check your skin for signs of jaundice. They might feel your abdomen for lumps or a change in the size of your liver. They’ll also check for ascites, which is a buildup of fluid in the abdomen (belly).

Imaging Tests

Imaging tests are key to diagnosing HCC. HCC can usually be diagnosed solely by imaging tests such as ultrasound, MRI, and CT scan.


An ultrasound of the abdomen is often the first imaging test that’s ordered. It can identify abnormal masses in the liver such as a tumor. It’s also used to screen for HCC in people who have a higher risk of developing the disease. High-risk patients usually get an ultrasound every 6 months to screen for HCC.

CEUS (Contrast Enhanced Ultrasound)

This is a type of ultrasound that uses microbubble contrast dye to look for tumprs in the liver. There’s no problem doing CEUS with poor renal function. CEUS is only available in a few highly specialized centres.


An MRI can provide more detail about blood vessels, organs, and lymph nodes. It’s useful for showing subtle differences in cells, and it can make it easier to see the liver and any tumors when there is fat in the liver.

When you get an MRI, you’re injected with a special dye called a contrast. If you have kidney problems or an allergy to iodine, the contrast dye most commonly used for MRIs might be safer for you than the one used for CT scans.

CT Scan

A CT scan combines a series of X-ray views taken from many angles to create a 3D image. It’s associated with a higher exposure to radiation.

CT scan images can provide much more information than plain X-rays. For HCC, a CT scan can show tumors and the blood vessels that the tumors might be growing into or around. A CT scan can also look at surrounding organs and check if the cancer is spreading into lymph nodes and other areas.

When you get a CT scan, you’re injected with a special dye called a contrast. The contrast dye makes the liver more visible.

Liver Biopsy

A liver biopsy removes cells or tissues from your liver so they can be viewed under a microscope for signs of cancer.

A biopsy isn’t usually required to diagnose liver cancer. However, if the tumor doesn’t look like a typical HCC on a CT scan or MRI, a biopsy can be helpful to ensure the diagnosis is accurate prior to treatment.


This material was adapted (with permission) from:

US Department of Veterans Affairs, Veterans Health Administration 

Canadian Liver Foundation

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