Liver cancer screening
Liver cancer can sometimes start in your liver (primary) or spread from another organ.
Here at The London General Practice we screen for primary liver cancer as it can often go undiagnosed.
One of the goals of our screening programmes is to identify liver cancer early.
There are essentially two types of liver cancer, primary and secondary.
Primary liver cancer usually hepatocellular carcinoma and this is most common form in adults.
There are also cholangiocarcinoma, angiosarcoma, haemangiosarcoma and hepatoblastoma.
Secondary liver cancer, that is metastatic liver cancer, is when the cancer has spread from elsewhere in the body such as the pancreas, colon, stomach, breast or lung.
Because this has spread this is known as secondary cancer and these tumours are mainly treated based on their primary site.
Secondary liver tumours are much more common than primary liver cancer although this is not true for many areas of Asia and Africa.
By definition secondary liver cancer will have resulted by spread from cancer within other organs and clearly this will be at an advanced stage of the malignant process.
Here at the London General Practice we are screening for primary liver cancers by screening before they are causing symptoms.
It is often hard to find liver cancer early because signs and symptoms often do not appear until it is in its later stage.
Small liver tumours are hard to detect on physical examination because most of the liver is covered by the right ribcage. By the time a tumour can be felt, it might be already too large.
Currently there is no widely recommended screening test for liver cancer, particularly for those who are at average risk.
Testing, however, might be recommended for some people at a higher risk.
Here at The London General Practice we apply an algorithm to determine your risk and also perform the alpha-fetoprotein, a protein that can be measured in the blood of patients with liver cancer. However, this is not a perfect test for liver cancer.
Many patients with early liver cancer have normal alpha-fetoprotein levels and also alpha-fetoprotein levels can be increased from other kinds of cancer, as well as some non-cancerous conditions.
For people at higher risk of liver cancer because they have cirrhosis from any cause, significant fibrosis, hereditary haemochromatosis or chronic hepatitis B infection then the alpha-fetoprotein blood test and ultrasound can help to improve survival.
The London General Practice screen involves the alpha-fetoprotein and an algorithm to determine whether there should be any onward referral for either abdominal ultrasound scan or hepatology referral.