The number of annual liver cancer diagnoses has tripled since the 1980s, making it one of the most common forms of cancer. While there is good news, and the number has trended downward in the last year, the Center for Disease Control and Prevention (CDC) reports that 33,000 Americans are diagnosed with hepatocellular carcinoma (HCC) each year. Of those cases, about 85% are fatal. Fortunately, point-of-care ultrasound (POCUS) can play an important role in increasing the chances of early detection of the disease and therefore improving patient prognosis.
The early stages of liver cancer often present no detectable symptoms. As the disease progresses, patients may experience pain, loss of appetite, unintended weight loss, and jaundice. By the time these symptoms appear, or the tumor is large enough to be felt through the rib cage, the cancer has likely progressed beyond the chance of remission. Early diagnosis significantly increases treatment options. In these cases, curative therapies or surgeries—such as a partial hepatectomy or transplant—may be viable, however, in cases where the cancer has spread, the only options are those that will help the body fight as long as possible.
Because of its affordability and non-invasive nature, ultrasound is many clinicians’ method of choice for liver screenings. By performing routine abdominal imaging scans, especially on patients at high risk of liver cancer, doctors are more likely to detect tumors early in development.
Individuals with existing cirrhosis or liver disease are at the highest risk of HCC and should be screened every six months. Even patients at risk of contracting diseases such as fatty liver disease or hepatitis C should undergo regular screenings to monitor liver health. In fact, more than half of those infected with hepatitis C experience cirrhosis and liver cancer, so getting tested for hepatitis C is vital. As is the case with HCC, this disease is treatable and often curable if diagnosed early. A liver ultrasound can assist in detecting both the hepatitis virus and liver cancer by scanning for inflammation, scar tissue, and abnormal cell growth.
In a previous blog post, we explained that the liver normally has a homogenous echogenicity. In conducting a POCUS exam, monitor for variations, such as increased or decreased echogenicity, masses, or lesions. Take notice of any coarseness or nodularity, as the liver should have a smooth capsular contour. After visualizing the liver, freeze the image to measure the liver span from the diaphragmatic surface to the inferior border. Any appearance outside of the norm should proceed with a thorough history and physical exam.
Studies show that ultrasound screenings for liver cancer are more accurate when accompanied by screenings for tumor markers. Alpha-fetoprotein (AFP) is a highly specific glycoprotein secreted by tumors in the liver. High levels of AFP should only appear in healthy adult bloodstreams in low levels between 10 and 20 ng/mL. Higher levels may be an indication of liver cancer.
Performing a blood biomarker screening in addition to ultrasound can increase the likelihood of early diagnosis by as much as 40%, according to a study conducted by UT Southwestern’s Simmons Cancer Center. If a mass is detected in the imaging process, an AFP test can help to confirm malignancy, and if a small mass goes undetected by ultrasound, elevated levels of AFP in the bloodstream may be the key to identifying the disease as early as possible.
Though POCUS can serve to help clinicians diagnose liver cancer in its early stages, helping to improve prognosis, the best outcome is always prevention. The best way to decrease the chances of HCC is by increasing liver health. Moderate smoking, alcohol consumption, and drug use. Eat a healthy diet, exercise regularly, and get vaccinated against hepatitis B. If at risk, get tested for hepatitis C.
Care providers trained and certified to use POCUS will increase diagnostic confidence and make informed decisions regarding treatment for cancer or other liver diseases. Clinicians who understand POCUS’s strengths and limitations can utilize it wisely to improve patient care.
The Point-of-Care Ultrasound (POCUS) Certification Academy™ offers easily accessible certifications for care providers interested in taking advantage of POCUS to improve the patient experience.