Why does liver function show normal, but advanced liver cancer is detected? Are liver function tests worthwhile?

Mr. Xu, 56, was recently diagnosed with liver cancer. The doctor told him that it had developed into an advanced stage. This result made Mr. Xu unable to believe it.

Mr. Xu said that he insists on physical examination every year, among which the examination of liver function has always been normal< /strong>, there were no abnormal arrows on the checklist, but the sudden diagnosis of liver cancer really made Mr. Xu unacceptable. Is it a waste of money to spend money on liver function tests?

1. Why is the liver function normal but advanced liver cancer is detected?

Clinical examination of liver function mainly relies on blood drawing, and biochemical tests. Test methods to detect indicators related to liver function and metabolism, including white blood cell ratio, albumin, globulin, and hepatocytes Destructive related indicators such as bilirubin, alanine aminotransferase and aspartate aminotransferaseetc.

Many people think that a normal liver function test can represent a healthy liver, but this is actually a misunderstanding.

Professor Chen Ping from the Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Hospital pointed out that liver function Under normal circumstances, there is still the possibility of developing liver cancer.

Because normal liver function only means that there is no inflammation and necrosis of liver cells when blood is drawn, but if the liver has hardened or before There has been inflammation, and the inflammation has stopped when the blood is drawn, and it can also appear “normal”.

In the early and middle stages of liver cancer, liver cancer cells have not spread, It may just be that the tissue surrounding the cancer cell is invaded and compressed, and the transaminases results are slightly elevated, or it may remain normal.

Professor Song Tianqiang, director of the Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Hospital, also emphasized that hepatitis B is a An important factor in the induction of hepatitis B virus, due to the long incubation period of hepatitis B virus, if hepatitis B virus carrier is in the liver immune tolerance period, the basic condition of the liver is good and there is no liver damage< /strong>, then liver function tests are likely to show normal.

In addition, the liver is a very “strong” organ with strong reserve function and regeneration ability. The early symptoms of liver cancer are not obvious, and it is difficult to detect liver cancer through liver function tests, so it is often It is easy to be ignored by patients and delay the treatment.

and abnormalities are not necessarily sick. The most important are aspartate aminotransferase and alanine aminotransferase.

In general, elevated levels of these two transaminases are indicative of liver abnormalities, but this elevated result is sometimes It will be affected by factors such as drinking, excessive exercise, poor sleep, abnormal heart, etc., so when you get the test report, you should consult the doctor’s opinion, and don’t be confused.

Second, is it worth doing liver function tests?

Liver function test can reflect the abnormality of our liver’s synthesis, metabolism, detoxification, and digestive functions , although it cannot determine liver cirrhosis, liver cancer and other problems, it can still help most people evaluate the health of the liver, so it is worth doing.

Generally speaking, we need to pay attention to three indicators of liver function test. If these three indicators are normal, it means that our liver is still healthy.

Transaminases:A variety of aminotransferases, such as aspartate aminotransferase and alanine aminotransferase, are required for metabolism in the liver.

If the value of transaminase is elevated during the physical examination, it often indicates that the liver has been damaged. This is because hepatocyte membrane after liver damage Incomplete, enhanced permeability, resulting in more transaminase influx into the blood, resulting in elevated transaminase during detection.

Bilirubin: Normally, red blood cells ruptureinto indirect bilirubin, which is then converted into direct bilirubin in the liver and excreted with excretion.

However, if liver function is damaged, direct bilirubin excretion will be affected. Once accumulated in the blood, bilirubin will increase, and < strong>The higher the bilirubin value, the more severe the damage to liver function. If only direct bilirubin is elevated in the results, it generally indicates that the bile duct is blocked.

Protein content:Protein synthesis is also carried out in the liver. A normal value indicates that the synthesis function of liver proteins is abnormal.

In short, liver function test is only one of the auxiliary tests for clinicians to judge the disease. For the complete condition of the liver, it is still necessary to cooperate with other tests such as imaging.

Third, early detection of liver cancer, remember two points

1. High-risk groups conduct two regular examinations every six months

Professor Shi Ming from Sun Yat-sen University Cancer Center pointed out that high-risk groupsIt is necessary to do alpha-fetoprotein and B-ultrasound every six months, the detection rate of early liver cancer can reach 80%.

It is recommended not to choose only one of the two items. Only abdominal B-ultrasound examination has limitations, and the nature of the liver mass cannot be determined. It is easy to misdiagnose large liver cancer and super large liver cancer. And only alpha-fetoprotein is easy to miss diagnosis, because about 30%-40% of patients diagnosed with liver cancer have no elevated results.

“Standards for Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)”Summary of high-risk groups for liver cancer include: hepatitis B, hepatitis C Infected patients, patients with nonalcoholic steatohepatitis, patients with cirrhosis due to other causes, people with a family history of liver cancer, people who drink excessively, especially adult men over 40 years old.

2. Remember 5 physical symptoms strong>

The early symptoms of liver cancer are relatively insidious and easily confused with digestive system diseases. He Qiang, head of the Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, said that the following symptoms should be vigilant.

①Loss of appetite;②abdominal pain (mainly epigastric pain);③abdominal mass;④fatigue,asthenia;⑤unexplained weight loss

A normal liver function test result does not mean that the liver must be healthy. The diagnosis of liver cancer often requires alpha-fetoprotein and B-ultrasound Both inspections, especially for high-risk groups of liver cancer, are necessary for regular inspections and attention to physical abnormalities.


[1] “Normal liver function” , but was told – advanced liver cancer! The doctor told these truths…”. Cancer Friends Association of the Medical Community. 2021-04-15

[2] “The three indicators during the physical examination were normal, congratulations, the liver is very healthy! “. Digestive World. 2019-10-10

[3] “Why Doctors | He Qiang: Why should we pay attention to these five symptoms in early detection of liver cancer? “. The First Affiliated Hospital of Sun Yat-sen University. 2021-03-19

[4] Notice of the General Office of the National Health Commission on Printing and Distributing the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition). Medical Administration and Hospital Administration .2022-01-21

Without the author’s permission, reprinting is prohibited