Patients may experience a variety of symptoms including pain in the upper right abdomen, swelling, nausea, jaundice or fever. A physical exam and blood tests may be used in initial diagnoses. Additionally, doctors may recommend positron emission tomography-CT (PET-CT) scan, magnetic resonance imaging (MRI) or ultrasound. In some cases an angiogram, which is an X-ray that shows the blood vessels in the liver, is used to identify the tumor as well. A liver tumor biopsy may be needed to confirm the diagnosis. Doctors then determine the stage – or extent of the disease – by establishing how big the tumor is and how much it has spread.