Tests that allow us to ‘see’ the liver are not necessary in every person with cancer. They are usually only recommended when there are clues from symptoms, clinical examinations or blood tests that there is liver abnormality. A radionuclide liver scan shows us the size of the liver and whether there are any areas in it that are not functioning normally. Normal X-rays do not show up the liver. A CT scan does and it may also pick up cancer deposits as they let through less X-rays than the normal liver. In some cases, the combination of symptoms, clinical findings, blood tests and scans build up a picture so typical of liver secondaries that a biopsy for conclusive proof may not be recommended. However, when there is something unusual or unexpected about the situation, or when it is very important to be quite certain, a liver biopsy should be considered.
This can be done with a special type of needle through the skin, under local anaesthetic. Because the liver moves up and down as you breathe, it is important to try hard to hold your breath when the doctor asks you to. Before doing a liver biopsy, your doctor should make quite sure that your blood can clot normally. If not, injections can be given to correct this. Even so, it is possible to bleed internally after a liver biopsy. This is unusual, but has to be watched for carefully. After the biopsy you will be kept lying still for some hours while the tiny hole in the liver seals over. During this time your pulse rate and blood pressure should be checked regularly. The main danger of bleeding is right after the biopsy. Sometimes transfusion is necessary. Very rarely, an operation is needed to stop the bleeding.
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