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Diagnosis

Generally, complains of a liver tumour arise late in the course of the disease when these tumours are grown large. In case you have had previous bowel cancer, you will be examined for liver metastasis frequently. Generally, symptoms of liver metastasis arise late in the course of the disease, when the tumour is large and compresses the bile ducts.

Symptoms that can occur are: jaundice, fatigue, itchiness and dark urine. Examination of liver tumours exists of physical examination, blood tests, ultrasound, CT or MRI. See below for information about the different methods that can be used to diagnose liver metastasis.

Click on the subject for detailed information.

Ultrasound

Echobeeld van de lever

Ultrasound imaging of the Liver

Ultrasound is an imaging technique that uses sound waves. A so-called transducer emits high frequency sound waves that can penetrate into the body. For improved conduction of the sound waves, a layer of gel is applied between the transducer and the skin. Consequently, the sound waves are reflected (=ultrasound) by the body and the organs and collected by the transducer. The degree of reflection differs for every organ type. A computer programme measures the reflected signals and produces the ultrasound images.

Echo apparaat

Ultrasound device

Ultrasound imaging is considered a painless and harmless investigation. The investigation does not take longer than 15-30 minutes. Ultrasound imaging is also used for biopsies where a needle is placed in a tissue. Thereafter a fragment is taken out for microscopic examination. The ultrasound imaging is used to guide the needle and determine the location of the biopsy accurately. Ultrasound imaging is a frequently used diagnostic tool for diagnosing liver abnormalities. It is used as a first screening method or to additionally define areas seen on a previous scan.



CT-scan

CT-scan van de lever

CT scan of the Liver

A CT scanner uses X-rays that pass through the body and then get absorbed in different degrees by different organs. A CT scanner is a tubular device where the patient is placed in. In the scanner, a beamprojector and a beam detector are placed that circle around the patient. Thereafter, different images of the body are developed. The images are cross sections of the body. This investigation is painless and takes about 20 minutes.

Usually, prior to the scan, a series of blank images are developed (without contrast fluid). The blank images are followed by images with a contrast fluid. Specific tissues absorb the contrast in a different degree and this results in blockage of the X-rays. Consequently, more contrast is created between the different tissues and the organs are better visible on the images.

For examination of the liver, the doctor can decide to develop images after several series of contrast fluid are administered, the so-called 3-phase CT scan. The contrast fluid is administered through an intravenous line. This can cause a warm or cold feeling and is sometimes followed by mild nausea. In order to minimize the chance of these side effects, patients are recommended to stay sober in the hours before the examination. In some cases, a CT scan is not sufficient to differentiate between the various pathologies. In these cases, a MRI scan can be performed.

MRI-scan

MRI scan of the liver

MRI scan of the liver

A MRI scan uses magnetic energy and radio waves in order to develop images of the body. The MRI scanner is a tube with cylindrical magnet. During the examination, signals are delivered. The energy delivered by these signals is partly absorbed by the hydrogen atoms in the body en partly reflected. The reflected signals (radio waves) are measured by a computer system and translated into images.

MRI-scanner

MRI-scanner

An advantage of the MRI scanner is that the images are developed in all directions. MRI imaging can be useful for differentiation between pathologies that are not detectable by using only CT imaging. During this investigation, the patient is placed in a tube.

The investigation takes about 40 minutes and is painless.


PET-scan

PET-scan

PET-scan

The PET scan provides information about your metabolism. It is a nuclear investigation where radioactive nutrients (for example sugars and proteins) are delivered in the patient. In areas with high metabolic activity, such as in malignant tumour lesions, more nutrients are absorbed. This can be visualized on PET images.

Prior to the scan, a fluid with the radioactive substance is delivered in the patient. PET imaging is not part of the standard investigations for liver pathologies. In patients with cancer in the bowel and metastasis in the liver, a PET scan may be developed if the CT or MRI is not sufficient.

Blood investigation

Blood from patients is taken for laboratory investigation. Liver damage or damage to the bile duct cells can be detected by means of blood investigation, which is expressed by a raised value of specific tests (for example, liver enzymes). Furthermore, it is also possible to measure the bilirubin level, which is raised in cases where there is a decreased liver function or bile duct obstruction. The ammoniac level of the blood expresses the degree of protein degradation and is decreased in case of increased liver function. The liver function can also be expressed by the clotting function as well as the sugar level in the blood.

It is also possible to measure the so-called ‘tumour markers’, which are substances produced by the tumour. The value of these markers is used to detect and follow the tumour lesions. Currently, several tumour markers are used in the daily practise. In case of liver metastasis from bowel cancer, the Carcino-Embryonal Antigen (CEA) is measured and alfa-Foeto Proteïne in case of primary liver cancer (hepatocellular carcinoma).

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