No single blood test can diagnose liver cancer, but liver cancer blood tests can detect signs of liver dysfunction. Depending on a person’s signs and symptoms, a doctor may recommend further testing, such as a liver biopsy.

Although blood tests cannot diagnose liver cancer, they can screen for signs of cancer. Blood tests can also check for other causes of a person’s symptoms — these causes can include viral hepatitis.

Some liver diseases, including viral hepatitis, are risk factors for liver cancer. So, the presence of one diagnosis does not necessarily mean a person does not have cancer.

In this article, we examine the blood tests doctors use to detect liver cancer. We look at the types of blood tests, what they measure, and other tests healthcare professionals use for liver cancer.

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A doctor may order blood tests to screen for liver cancer if a person has a high risk of liver cancer. This includes people with a history of:

  • cirrhosis
  • hereditary hemochromatosis, where the body absorbs excess iron from the diet
  • chronic hepatitis B

A doctor may also order liver cancer blood tests if someone has symptoms of liver cancer, such as:

  • an enlarged liver
  • weight loss
  • chronic abdominal pain
  • swelling in the belly
  • jaundice

Additionally, a doctor may order liver cancer blood tests if routine bloodwork returns an atypical result.

Liver cancer blood tests can test for several symptoms of liver cancer, including:

  • Liver dysfunction: Liver function tests can show signs of liver damage. This may mean a person has liver disease, including cancer or nonalcoholic fatty liver disease.
  • Alpha-fetoprotein (AFP): AFP is present in high levels in people with cancer or liver disease or who are pregnant.
  • Blood clotting issues: The liver helps make proteins that support blood clotting. A blood clotting test that shows slow clotting could be a sign of liver damage from cancer or another disease.
  • Organ damage: Blood urea nitrogen (BUN) and creatinine levels can help assess how well the kidneys work. Kidney disease can be a risk factor for and sometimes a byproduct of liver disease.
  • Other diseases: Blood tests for other diseases, such as hepatitis, may help explain symptoms of liver damage.
  • Other signs of disease: Changes in blood chemistry or the balance of red and white blood cells may signal severe disease, including liver cancer.

The following various blood tests can screen for symptoms of liver cancer:

Complete blood count

A complete blood count can show signs of illness. For example, white blood cells may be higher than expected in a person with cancer or an infection. A doctor may recommend additional tests according to the results of a complete blood count.

Blood chemistry testing

Blood chemistry testing looks for changes in the balance of various chemicals in the blood. For instance, an increase in calcium and a drop in glucose could indicate liver cancer.

Liver function tests

When the liver is damaged, it releases enzymes into the bloodstream. These enzymes include alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP).

Certain liver diseases that decrease bile flow can also elevate bilirubin levels in the blood. High liver enzymes or bilirubin suggest that a person has liver disease, such as liver cancer, but a doctor will need to carry out more tests.

The proportion of liver enzyme elevations may help indicate cancer. For example, elevations in ALT and AST without significant elevations in bilirubin or ALP may suggest a problem in the cells of the liver, including potential cancer.

Hepatitis tests

Viral hepatitis is a contagious and relatively common condition that can damage the liver, which could explain symptoms of liver disease. A person can receive a diagnosis of hepatitis using a blood test, and the condition is treatable.

However, chronic hepatitis is a risk factor for liver cancer. So, a doctor may still recommend other tests to rule out liver cancer.

Test of blood clotting

The liver helps manufacture proteins that allow blood to clot and stop bleeding. Slower clotting times may signal damage to the liver. A prothrombin time test measures how long it takes the blood to clot.

AFP test

AFP is a protein that may rise to higher than usual levels in the blood of people with cancer, including liver cancer. It also tends to increase in those with liver disease and during pregnancy. So, while it may help point to a liver issue, it cannot diagnose liver cancer without additional tests.

A doctor will need to carry out additional testing to diagnose liver cancer. Some tests a doctor might recommend may include:

  • liver biopsy to check for signs of cancer in the liver
  • MRI scans to view a suspected tumor and assess how large it is
  • CT scans to look for signs of cancer
  • other cancer tests to look for cancer that has spread from the liver or to the liver from other locations

Typical blood tests should show:

  • no signs of hepatitis or other infections
  • no elevations in liver enzymes
  • no changes in blood chemistry
  • no signs of kidney failure, such as elevated BUN levels
  • typical blood clotting rate

Blood tests alone cannot conclusively diagnose cancer. But in combination with other tests, such as a liver ultrasound, they may strongly indicate the disease. If a doctor suspects liver cancer, they may order a biopsy or MRI scan of the liver.

If a person already has another type of cancer, atypical test results could mean either that cancer has spread to the liver or is damaging organs.

Atypical test results may also signal another type of liver disease, such as:

No single blood test can diagnose liver cancer, but blood tests can help indicate liver problems that doctors can confirm through further testing.

Many different medical conditions can cause elevated liver enzymes and other signs of liver damage. Some conditions, such as nonalcoholic fatty liver disease, are common and manageable, while others, such as viral hepatitis, require rapid treatment.

Early stage liver cancers with a liver transplant have 5-year survival rates of 60–70%. This means it is vital to get an early diagnosis to have the best possible outcome.

Doctors perform further investigations following atypical liver function tests to rule out cancer and other severe medical conditions. Blood tests and other testing methods can also help people access treatment before their condition worsens.