SCREENING TESTS – BASIC (Rs 3, 000)
Alpha-fetoprotein (AFP)| Full Blood Count (FBC)| Liver Function Test (LFT)| Consultation
SCREENING TESTS – ADVANCED (Rs 28, 000)
PET Scan| Alpha-fetoprotein (AFP)| Full Blood Count (FBC)| Liver Function Test (LFT)| Consultation
Liver Cancer Treatment :
Recommendation: People with cirrhosis and/ or advanced scarring of the liver should be screened every six (6) months
Tests and procedures used to diagnose liver cancer include:
⦁ Blood tests. Blood tests may reveal liver function abnormalities.
⦁ Imaging tests. Your doctor may recommend imaging tests, such as an ultrasound, CT and MRI.
Positron Emission Tomography (PET) Scan
PET scan is a type of test that create 3 dimensional (3D) pictures of the inside of your body.
The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal. It’s used to help diagnose some conditions including cancer. It can also help to find out where and whether cancer has spread.
It usually takes between 45 and 60 minutes. You will be in the department for at least an hour beforehand. This is because you have an injection of a radioactive liquid (radiotracer) before the scan.
PET scans are often combined with CT scans to produce more detailed images. These are called PET-CT scans.
A PET scan can help to:
⦁ show up a cancer
⦁ find out how big it is and whether it has spread (stage a cancer)
⦁ show whether a lump is cancer or not
⦁ decide the best treatment for your cancer
⦁ show how well a treatment is working
After you have had treatment for cancer, a CT scan may show that there are still some signs of the cancer left. But this may not be active disease. It could be scar tissue left over from cancer killed off by your treatment. A PET scan can show whether this tissue is active cancer or not.
PET scans are sometimes used to look for cancer in the lymph nodes in the centre of the chest.
Preparing for your PET scan
- For most PET scans, you need to stop eating for about 4 to 6 hours beforehand. You can usually drink unflavoured water during this time.
- You might have instructions not to do any strenuous exercise for between 12 and 24 hours before the scan.
- Call the number on your appointment letter if not eating is a problem for you, for example if you’re diabetic. You might need to adapt your diet and sugar control and your appointment time could change.
Some people feel claustrophobic when they are having a scan. Contact the department staff before your test if you’re likely to feel like this. They can take extra care to make sure you’re comfortable and that you understand what’s going on. Your doctor can arrange to give you medicine to help you relax, if needed.
At the hospital
Your radiographer might ask you to change into a hospital gown. You have to remove any jewellery and other metal objects such as hair clips, coins, belts and a wired bra. Metal interferes with the images created by the scanner.
You have an injection of radiotracer about an hour before the scan. You have the injection through a small plastic tube in your arm (cannula). It’s only a small amount of radiation.
You need to rest and avoid moving too much during this hour. This allows the radiotracer to spread through your body and into your tissues.
The radiotracer is a radioactive sugar. The one commonly used is called FDG (fluorodeoxyglucose). Cancer cells are very active when they are growing and reproducing in a specific area. They need energy to grow. So, active cancer cells take up the FDG which then shows up brighter on the scan.
In the scanning room
Your radiographer takes you into the scanning room. The PET machine is large and shaped like a doughnut.
You have most scans lying down on the machine couch on your back.
Once you’re in the right position, your radiographer leaves the room. They can see you on a TV screen or through a window from the control room. You can talk to each other through an intercom.
Having the PET scan
- The couch slowly slides backwards and forwards through the scanner. The machine takes pictures as you move through it.
- The scan is painless but can be uncomfortable because you have to stay still. Tell your radiographer if you’re getting stiff and need to move.
- It’s not particularly noisy but you’ll hear a constant background noise. In most places the radiographer will be able to play music for you.
- When it’s over, your radiographer will come back into the room and lower the couch so you can get up.
This 3-minute video shows you what happens when you have a PET scan or PET-CT scan.
After your PET scan
Your radiographer removes the cannula from your arm before you go home.
You can then eat and drink normally.
The radiation in the radioactive tracer is very small. Drinking plenty of fluids after your scan helps to flush the radiotracer out of your system.
The radioactive tracer gives off very small levels of radiation that go away very quickly. As a precaution, you should avoid close contact with pregnant women, babies and young children for 6 hours after the scan.
You need someone to take you home and stay overnight if you’ve had medicine to help you relax (sedative).
For the next 24hours you also shouldn’t:
⦁ drive
⦁ drink alcohol
⦁ operate heavy machinery
⦁ sign any legally binding documents
Most airports have sensitive radiation monitors, which may pick up the trace of radiation following your test. If traveling abroad within a week of your scan, it’s a good idea to take your appointment letter with you.
Possible risks
A PET scan is a safe test for most people. But like all medical tests it has some risks. Your doctor and radiographer make sure the benefits of having the test outweigh these risks.
Pregnancy
Pregnant women should only have the scan in an emergency. There’s a risk that the radiation could harm the developing baby. Contact the department beforehand if you’re or think you might be pregnant.
Breastfeeding
If you’re breastfeeding, let the department know a few days before your appointment. They will let you know if you need to stop breastfeeding for a length of time after having the radioactive drug. You might need to store enough expressed milk for at least one feed.
Radiation
Exposure to radiation from the radiotracer during a PET scan slightly increases your risk of developing cancer in the future. Talk to your doctor if this worries you.
Bruising and swelling
You might get a small bruise around the area where they put the needle in.
There’s is a risk that the radioactive tracer will leak outside the vein. This can cause swelling and pain in your arm but it’s rare.
Allergic reaction
Rarely, people have an allergic reaction to the radioactive tracer. This most often starts with weakness, sweating and difficulty breathing. Tell your radiographer immediately if you feel unwell.
Getting your results
Your scan will be looked at by a specialist doctor and you should get your results within 48 hours. You won’t get any results at the time of the scan.
Waiting for results can make you anxious. Ask your doctor or nurse how long it will take to get them. Contact them if you haven’t heard anything after 48 hours.
Alpha-fetoprotein (AFP) Test for Liver Cancer Treatment
Alpha-fetoprotein (AFP) is a protein normally made by the liver and yolk sac of a developing baby. AFP levels go down soon after birth. It is not normally found in healthy adults.
Why an AFP test is done
Your doctor may order an AFP test to help diagnose, monitor response to treatment and check for recurrence of the following cancers:
⦁ a type of testicular cancer called non-seminoma germ cell tumour
⦁ a type of ovarian cancer called germ cell tumour
In rare cases an AFP test may be used to help diagnose the following cancers:
⦁ bile duct
⦁ colon
⦁ stomach
⦁ lung
⦁ breast
⦁ lymphoma
⦁ pancreas
In the past, doctors used the AFP test to help them diagnose a type of liver cancer called hepatocellular carcinoma. But the AFP test can’t specifically identify hepatocellular carcinoma, so doctors no longer use it to diagnose liver cancer. Doctors may still order an AFP test to help diagnose some liver problems such as cirrhosis and hepatitis.
How an AFP test is done
It is measured with a blood test. No special preparation is needed. The blood sample is analyzed by special machines.
What the results mean
AFP may be found in the blood if you have one of the following non-cancerous conditions:
⦁ cirrhosis
⦁ hepatitis
⦁ a rare inherited disorder called ataxia-telangiectasia
It may also suggest that a person may have a testicular or ovarian germ cell tumour.
If someone with cancer had a high AFP level before treatment, lower AFP levels may mean that the cancer has responded well to treatment. Higher AFP levels may mean that the cancer is not responding well to treatment, is still growing or has come back (recurred). A slight increase may not be significant. The doctor looks at trends in the increase over time.
What happens if a change or abnormality is found?
The doctor will decide if more tests, procedures, follow-up care or additional treatment is needed.
Special considerations for children
Liver function tests (LFTs)
Liver function tests (LFTs) check how well your liver is working. LFTs look for levels of enzymes and proteins made by the liver or which are cleared by the liver.
They include:
⦁ alanine aminotransferase (ALT)
⦁ aspartate aminotransferase (AST)
⦁ alkaline phosphatase (ALP)
⦁ gamma-glutamyl transferase (Gamma GT)
They might be raised if you have a blockage in your liver or bile duct, or if you drink a lot of alcohol.
LFTs also look at the amount of bilirubin in the blood. This is a chemical in bile.
Bilirubin can be raised if you have a problem with your liver or gallbladder. Bilirubin can cause yellowing of your skin and eyes (jaundice).
LFTs also measure albumin. This is a protein in the blood that can be low in some types of cancer. You can also have low albumin if you’ve been eating small amounts and are malnourished.
Full Blood Count (FBC)
A full blood count (FBC) is a common blood test that your doctor may recommend to:
⦁ Help diagnose some blood cancers, such as leukemia and lymphoma
⦁ Find out if cancer has spread to the bone marrow
⦁ See how a person’s body is handling cancer treatment
⦁ Diagnose other, noncancerous conditions
A FBC measures the amount of 3 types of cells in your blood:
⦁ White blood cell count. A white blood cell count, also called a leukocyte count, measures the total number of white blood cells in a sample of blood. These cells protect the body from infection by attacking invading bacteria, viruses, and other foreign materials in the body. Some white blood cells can also attack cancer cells.
⦁ White blood cell differential. A white blood cell differential measures the number of each type of white blood cell. There are 5 major types of white blood cells, and each type plays a different role in protecting the body. Your doctor can learn valuable information about your health by measuring the levels of these cells:
⦁ Neutrophils
⦁ Lymphocytes
⦁ Monocytes
⦁ Eosinophils
⦁ Basophils
⦁ Red blood cell count. Red blood cells carry oxygen throughout your body. A red blood cell count, also called an erythrocyte count, measures the number of red blood cells in a sample of blood. There are several ways to measure red blood cells.
Two of the most common are:
⦁ Hematocrit (Hct), the percentage of your blood that is made up of red blood cells
⦁ Hemoglobin (Hgb), the amount of the protein in red blood cells that carries oxygen
⦁ Platelet count. A platelet count measures the number of platelets in a sample of blood. Platelets help to stop bleeding by forming blood clots.
The amounts of each of these types of cells have a normal range. Your health care team will note this range on your FBC lab results. A range is used instead of a specific number because a normal amount is different for each person.
By the time liver cancer signs and symptoms develop, the cancer is usually too advanced for curative treatment. Studies show liver cancer screening reduces the risk of dying of liver cancer.