context: Screening for early detection of primary liver cancer is not performed routinely, but it may be considered for people at high risk for the disease. However, studies haven't determined if screening is beneficial for people who are not at increased risk. To diagnose liver cancer, a doctor must rule out other causes of liver dysfunction. Patients at high risk include patients with a condition called hemochromatosis, chronic hepatitis, and alcoholics. Additional tests include: Blood tests that measure tumor markers -- the levels of these substances rise in the blood if someone has a particular cancer -- can aid diagnosis. Liver cancers secrete a substance called alpha fetoprotein ( AFP) that is normally present in fetuses but goes away at birth. An elevated AFP in adults may indicate liver cancer as it is produced in 70% of liver cancers. Elevated levels of iron may also be a tumor marker. Imaging with ultrasound is the initial diagnostic test as it can detect tumors as small as one centimeter. High resolution CT scans and contrast MRI scans are used to diagnose and stage these tumors. A liver biopsy will distinguish a benign tumor from a malignant one. However, depending on the results of other tests, a biopsy might not be required to diagnose cancer. Laparoscopy, using tools and cameras through small incisions, is useful for detecting small tumors, determining the extent of cirrhosis, or obtaining a biopsy, and confirm previous tests, among other things. Any liver cancer is difficult to cure. Primary liver cancer is rarely detectable early, when it is most treatable. Secondary or metastatic liver cancer is hard to treat because it has already spread. The liver's complex network of blood vessels and bile ducts makes surgery difficult. Most treatment concentrates on making patients feel better and perhaps live longer. Patients with early-stage tumors that can be removed surgically have the best chance of long-term survival. Unfortunately, most liver cancers are inoperable at the time it's diagnosed, either because the cancer is too advanced or the liver is too diseased to permit surgery. In some patients, chemotherapy is given directly into the liver (chemoembolization) to reduce tumors to a size that may make surgery possible. This may also be done without chemotherapy (bland emoblization) in some cases, using ethanol instead. Patients in remission must be monitored closely for potential recurrence. Cryotherapy, or freezing the tumor, and radiofrequency ablation ( RFA), using radio waves to destroy the tumor, may be used to treat some cases of liver cancer. Radiation therapy can be given in various ways, but has its limitations due to the liver's low tolerance to radiation. When used, the role of radiation is to alleviate symptoms outside of the liver or to relieve pain within the liver by shrinking the tumor. Radioembolization therapy uses substances to cut off the blood supply to the tumor. A liver transplant may be an option for those with both liver cancer and cirrhosis. Although this procedure is risky, it offers some chance of long-term survival. Advanced liver cancer has no standard curative treatment. Chemotherapy and low-dose radiation may control the cancer's spread and ease pain, however these are of modest benefit in this type of cancer. Most patients receive painkilling medication along with drugs to relieve nausea, improve appetite, and reduce abdominal or lower body swelling. The drug sorafenib ( Nexavar) is the first drug to significantly improve the overall survival with advanced liver cancer and is considered the drug of choice for such patients. People with advanced liver cancer may choose to join clinical trials testing new approaches to treatment.