Did you know that liver cancer may sometimes be detected before symptoms appear? For people at increased risk, an ultrasound or AFP blood test may reveal the first warning sign, while CT or MRI can provide detailed information about a suspicious liver lesion.
 
Liver cancer diagnosis rarely depends on one test alone. Doctors usually consider medical history, risk factors, blood-test results and imaging findings together. In selected cases, a biopsy may also be needed.

 

How does liver cancer diagnosis begin?

Assessment usually starts with a review of symptoms, medical history and risk factors, including:

• Chronic hepatitis B or hepatitis C
• Cirrhosis
• Metabolic dysfunction-associated steatotic liver disease
• Long-term heavy alcohol consumption
• A previous cancer that could spread to the liver
• A liver nodule found during another examination

 
Blood tests may assess liver function, identify hepatitis infection and measure alpha-fetoprotein, or AFP. Imaging tests then help doctors locate and evaluate abnormal liver tissue.

What does a liver ultrasound show?

Ultrasound uses sound waves to create images of the liver. It is noninvasive, does not use radiation and is often the first imaging test used to look for nodules or masses.
 
For people at increased risk of hepatocellular carcinoma, or HCC, ultrasound may also be used as part of regular surveillance. It can help doctors:

• Detect a liver nodule or mass
• Estimate its size and location
• Examine the liver’s general appearance
• Decide whether more detailed imaging is needed

 
Ultrasound cannot always determine whether an abnormal area is cancerous. If a suspicious lesion is found, further evaluation with contrast-enhanced CT or MRI is usually required.

How does a CT scan help diagnose liver cancer?

A computed tomography (CT) scan uses X-rays and computer processing to create detailed cross-sectional images. A multiphase contrast-enhanced CT scan captures images at different times after contrast material is given, helping doctors assess how a liver lesion receives and releases blood.
 
Certain imaging patterns may strongly suggest HCC, particularly in people with cirrhosis or other recognized risk factors.
 
Bumrungrad also provides Photon-Counting CT with AI, an advanced imaging technology designed to produce ultra-high-resolution images and support lower-dose imaging protocols compared with conventional CT. Its detailed images may help doctors evaluate liver tumors and the surrounding tissues and blood vessels.
 
CT imaging may help determine:

• The number, size and location of tumors
• Whether nearby blood vessels are involved
• Whether cancer may have spread beyond the liver
• Whether surgery or another treatment may be possible
• How a tumor responds to treatment
• Whether there are signs of recurrence

How is MRI different from CT?

Magnetic resonance imaging (MRI) uses a magnetic field and radio waves rather than X-rays. Contrast-enhanced MRI can provide detailed images of liver tissue and may help characterize lesions that remain uncertain after ultrasound or CT.
 
MRI may be particularly useful for:

• Examining small liver lesions
• Distinguishing certain cancerous and noncancerous masses
• Assessing nearby blood vessels and other structures
• Clarifying findings from previous imaging tests

 
The choice between CT and MRI depends on the clinical question, previous findings, kidney function, suitability for contrast material and the specialist’s assessment.

 

What does an AFP blood test mean?

An alpha-fetoprotein (AFP) is a protein that may be elevated in some people with HCC, but it is not a stand-alone test for liver cancer.
 
A high AFP result does not automatically mean cancer, and a normal result does not completely rule it out. Doctors interpret AFP together with:

• Imaging findings
• Liver function test results
• Medical history and risk factors
• Changes in AFP levels over time

 
AFP may also increase with hepatitis, liver injury, fibrosis and certain other conditions. In selected patients, it may help doctors monitor the response to treatment.

 

Is a liver biopsy always necessary?

No. In some high-risk patients, characteristic findings on contrast-enhanced CT or MRI may allow doctors to diagnose HCC without a biopsy.
 
A biopsy may be recommended when:

• Imaging findings are inconclusive
• A lesion does not have the typical appearance of HCC
• Another tumor type is suspected
• Tissue analysis is needed to guide treatment

 
During a liver biopsy, a small tissue sample is collected and examined under a microscope.
 
 

What happens after liver cancer is diagnosed?

Further imaging and blood tests may help doctors:

• Determine the cancer stage
• Assess liver function
• Identify whether the disease has spread
• Evaluate whether surgery or another treatment is possible
• Develop an individualized treatment plan

 
Treatment may involve liver surgery, transplantation, ablation, embolization, radiation therapy, systemic therapy or a combination of approaches.

 

Why choose Bumrungrad for liver cancer diagnosis and care?

At Bumrungrad International Hospital, the Digestive Disease (GI) Center and Horizon Regional Cancer Center coordinate care with diagnostic and interventional radiologists, pathologists, hepatobiliary surgeons, radiation oncologists, transplant specialists and the Bumrungrad Robotic Surgery Center.
 
Advanced liver imaging is available through the Diagnostic Radiology and Nuclear Medicine Center, including ultrasound, CT, MRI and image-guided liver biopsy when clinically appropriate. This multidisciplinary approach supports individualized diagnosis and treatment planning.
 
In Newsweek and Statista’s Best Specialized Hospitals Asia Pacific 2026, Bumrungrad ranked 10th in Gastroenterology and 58th in Oncology, placing No. 1 in Thailand in both specialties. Bumrungrad was also ranked No. 96 worldwide in Newsweek’s World’s Best Hospitals 2026, remaining the only hospital from Thailand in the global Top 100.

 

Medical references

1. Singal AG, Llovet JM, Yarchoan M, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78(6):1922–1965. https://doi.org/10.1097/HEP.0000000000000466
2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. Journal of Hepatology. 2025;82(2):315–374. https://doi.org/10.1016/j.jhep.2024.08.028
3. Chernyak V, Fowler KJ, Kamaya A, et al. Liver Imaging Reporting and Data System, Version 2018: Imaging of hepatocellular carcinoma in at-risk patients. Radiology. 2018;289(3):816–830. https://doi.org/10.1148/radiol.2018181494
4. van der Bie J, van Straten M, Booij R, et al. Photon-counting CT: Review of initial clinical results. European Journal of Radiology. 2023;163:110829. https://doi.org/10.1016/j.ejrad.2023.110829
5. Racine D, Mergen V, Viry A, et al. Photon-Counting Detector CT with Quantum Iterative Reconstruction: Impact on liver lesion detection and radiation dose reduction. Investigative Radiology. 2023;58(4):245–252. https://doi.org/10.1097/RLI.0000000000000925
6. Graafen D, Stoehr F, Halfmann MC, et al. Quantum iterative reconstruction on a photon-counting detector CT improves the quality of hepatocellular carcinoma imaging. Cancer Imaging. 2023;23:69. https://doi.org/10.1186/s40644-023-00592-5

Medically reviewed by:
Asst. Prof. Supachaya Sriphoosanaphan, M.D., Ph.D.
Gastroenterology & Hepatology
Last medically reviewed: August 2026