What is liver disease? What is pancreatic cancer? What are liver tumors

How do I get treatment?

For further information and appointments please see the below contact numbers:

For Mr Rob Hutchins: 

020 7234 2940

For the following Consultants: 

020 7234 2730

Professor Nigel Heaton
Professor Mohamed Rela
Mr Parthi Srinivasan
Mr Andreas A. Prachalias
Dr Phil M. Harrison
Dr Kosh Agarwal and 
Dr Michael Heneghan

Hepatocellular Carcinoma (HCC) Diagnosis London

How is HCC diagnosed?

A diagnosis of HCC is generally made through a number of tests which may include a combination of: blood tests, scans, and/or more rarely a biopsy.

Usually you will have first seen your GP, who will examine you and arrange for any tests that may be necessary.  Your GP will refer you to a hospital specialist for these tests and for expert advice and treatment.  If necessary your local hospital may refer you on to a specialist team, such as the HCC team at London Bridge Hospital, for a review of your investigations and an exploration of the treatment options available to you.

At the hospital you will have a physical examination and blood tests to check your general health.  You will have blood tests known as liver function tests (LFTs) to check how your liver is working.  You should also have a blood test to check the level of AFP (alpha-foetoprotein).  Raised levels of AFP in the blood, can be a marker for HCC as some patients’ HCC tumours secrete AFP.

Your doctor may also arrange for you to have one or more of the following tests for HCC:

Liver ultrasound scan: This test uses sound waves to make up a picture of the liver.  It is done in the hospital scanning department.  You will be asked not to eat, and to drink clear fluids only (nothing fizzy or milky) for 4–6 hours before the scan.  Once you are lying comfortably on your back, a gel is spread onto your abdomen.  A small device like a microphone is then rubbed over the area.  The sound waves are converted into a picture using a computer.  The test is completely painless and takes about 15–20 minutes. 

CT (computerised tomography) scan: This is a series of x-rays that builds up a three-dimensional picture of the inside of the body.  The scan is painless and takes about 30 minutes.  It may be used to find where a tumour started and can also show whether a tumour has spread. 
You may have had this type of scan at your local hospital. More often than not, this scan will be repeated at London Bridge Hospital in order that our specialist liver radiologists, in conjunction with your Consultant Surgeon/Physican can assess exactly where your problem lies and how best to treat this.   Our CT scans are biphasic scans (which look at both venous (from the veins) blood flow through the liver and arterial (from the arteries) blood flow through the liver.

MRI (magnetic resonance imaging) scan: This type of scan uses magnetism (not x-rays) to form a series of cross-sectional pictures of the inside of the body.  During the scan you will be asked to lie very still on the couch inside a metal cylinder.  The test can take up to an hour and is completely painless, although the machine is quite noisy.  If you don’t like enclosed spaces you may find the machine claustrophobic. 
You may be required to have another type of MRI scan, called a MR Tesla, if you are referred to for treatment.  This type of MRI scan uses a particular contrast dye, which shows liver tumours particularly clearly.  It is most often used when a patient has a tumour but the team are not sure which type this is, or when the patient’s liver texture means that a CT scan cannot differentiate between tumour and the background liver.

Liver biopsy: We very rarely perform a liver biopsy to confirm diagnosis of HCC, as we can make definitive diagnoses on the basis of the scans outlined above, in combination with a clinical assessment and/or blood test results.  This is because there is a small risk that the cancer can spread along the pathway of the biopsy needle. 
However, occasionally we will need to take samples of the liver tissue, called a liver biopsy, to examine under a microscope when there is serious doubt as to the nature of the tumour(s) seen on the scans

We may also want to perform a liver biopsy of the ‘normal liver’, that is the part of the liver which is not affected by tumour, to assess the condition of the liver, to assess how well the patient may withstand treatments for their tumour.  This type of biopsy does not carry the same risk of spreading the cancer.

A biopsy can be taken percutaneously, using a fine needle this is passed into the tumour through the skin after the area has been numbed using a local anaesthetic injection.  CT or ultrasound will be used at the same time, to make sure that the biopsy is taken from the right place.
A biopsy can also be taken at the time of surgery, which may be open surgery or laparoscopic (key hole).
After a liver biopsy you will need to stay in hospital for a couple of hours and possibly overnight. This is because there is a risk of bleeding afterwards.  We do liver biopsies either as an in-patient procedure or as a day case, depending on the clinical needs of the patient.

London HCC Care

Our experienced, specialist multi-disciplinary team work with patients to provide appropriate treatments with the aim of curing or extending patients’ quality of life for as long as possible.