Medical Oncologist
CION Cancer Clinics
Newer surveillance blood tests: GALAD and liquid biopsy | CION Cancer Clinics
GALAD and liquid biopsy are promising, but neither has replaced the regular liver ultrasound with an AFP test. GALAD combines several blood markers with age and sex into one score. Liquid biopsy looks for tumour DNA in the blood. This page explains what each test measures, how far the evidence has got, and what to ask before you pay for one. At CION Cancer Clinics, our specialists help you understand your own risk and plan regular liver checks that fit it.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- Are GALAD and liquid biopsy better than the usual liver checks?
- What are the newer liver cancer blood tests?
- What do the words on a newer test report mean?
- Someone has offered me one of these tests. What should I ask?
- What people often assume about the new blood tests
- What this page cannot tell you
- Common questions about GALAD and liquid biopsy
The short answer
Are GALAD and liquid biopsy better than the usual liver checks?
They are promising, but neither has replaced the regular ultrasound with an AFP test. GALAD is a score that combines several blood markers with your age and sex. Liquid biopsy looks for traces of tumour DNA in the blood. Both are still being tested in large studies, and guidelines do not yet recommend either one in place of the scan.
Why doctors want something better
Ultrasound is harder to read in a scarred or fatty liver, and its quality depends on the machine and the person holding the probe. AFP (alpha-fetoprotein, a protein some liver cancers release) misses many small tumours. A blood test that found early cancer reliably would be simpler for families travelling from districts to Hyderabad. That is why so much research is going into it. To see why one marker is not enough, read can a blood test alone detect liver cancer?
Who this page is for
This page is for people already under surveillance for primary liver cancer, mainly hepatocellular carcinoma (HCC), usually because of cirrhosis or hepatitis B. It is not about cancer that has spread to the liver from another organ.
If you are under surveillance, keep having your scans while these tests are studied.What is out there
What are the newer liver cancer blood tests?
These are the names you may see in an article, a laboratory brochure or a relative's WhatsApp forward.
GALAD score
The name stands for gender, age, AFP-L3, AFP and DCP. A formula turns these into one risk score. In studies it found more early cancers than AFP alone.
What it needs
- Three separate marker tests from one blood sample
- A laboratory that runs AFP-L3 and DCP
- A doctor who knows how to read the score
AFP-L3 and DCP
The two extra markers inside GALAD. DCP is also called PIVKA-II. Each picks up some tumours that AFP misses. Read AFP-L3 and DCP explained for what each one measures.
Liquid biopsy
A blood test that looks for tiny fragments of DNA shed by a tumour. Some versions look for chemical tags on that DNA, called methylation, that are typical of liver cancer. Early results are encouraging, but the numbers studied are still small.
Multi-cancer screening tests
Some laboratories sell one blood test said to screen for many cancers at once. These were not designed for people with cirrhosis. They are not a substitute for liver surveillance.
A negative result does not mean the liver is clear.Not sure whether this applies to you?
Ask an oncologistOn your report
What do the words on a newer test report mean?
- Biomarker
- Anything in the blood that can be measured and hints at a disease. AFP is a biomarker. So is tumour DNA.
- Sensitivity
- How often the test is positive when cancer really is there. A test with low sensitivity misses tumours.
- Specificity
- How often the test is negative when there is no cancer. A test with low specificity causes false alarms and extra scans.
- ctDNA
- Circulating tumour DNA. Small pieces of genetic material released into the blood when tumour cells break down.
- Validated
- Tested in large groups of real patients, in more than one country, and shown to work as claimed. Many newer tests are not yet at this stage.
Before you pay
Someone has offered me one of these tests. What should I ask?
Ask what it adds
Ask whether the test is in addition to your ultrasound or instead of it. If someone suggests dropping the scan, ask why, and get a second opinion before you agree.
Ask what happens if it is positive
A positive result should lead to a triple-phase CT or MRI. Ask who will arrange that scan and how quickly. A test with no clear next step only adds worry.
Ask about the cost
Newer tests are usually quoted separately and are rarely covered by insurance or government schemes. Ask for a written, itemised estimate before the sample is taken.
Bring the result to your oncologist
Whatever the result, take it with your previous scans and AFP reports. CION's oncologists read it alongside your whole history. When a scan is needed, CION arranges it through diagnostic partners.
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Commonly believed
What people often assume about the new blood tests
"A newer, costlier test must be more accurate."
Price says nothing about accuracy. Some newer tests have good early results, and some have very little evidence behind them. The ultrasound with AFP remains the standard that guidelines recommend.
"If my liquid biopsy is negative, I can stop my scans."
No. These tests can miss small tumours, which are the ones surveillance is trying to find. Keep your regular scans unless your own doctor tells you otherwise.
"A positive liquid biopsy means I have liver cancer."
It means a scan is needed. False alarms happen with every screening test. Liver cancer is confirmed by a proper scan and sometimes a biopsy, never by a blood result alone.
"GALAD is the same as a genetic test for the family."
It is not. GALAD measures proteins made now, in one person. It says nothing about inherited risk, and relatives do not need it because one person had it.
Being straight with you
What this page cannot tell you
It cannot tell you whether a particular test sold in India is reliable. Products change quickly, and very few have been studied in Indian patients, where hepatitis B and fatty liver are common causes. The evidence is still thin. Your oncologist or hepatologist is the right person to judge a specific test.
Who this does not apply to
If you have no liver disease, these tests are not recommended for you at all. If you have cancer that has spread to the liver from the bowel, breast or elsewhere, liver cancer markers are the wrong tool; your oncologist will follow the original cancer. People who have already been treated for liver cancer are watched with a follow-up plan of their own, described in AFP after treatment.
What has not changed
For now, the strongest thing you can do is keep every scheduled ultrasound and AFP test, keep your reports together, and act quickly on any change. If you are unsure whether you should be under surveillance, read who needs liver cancer screening.
Questions we are asked
Common questions about GALAD and liquid biopsy
Is the GALAD test available in India?
The markers it needs, AFP-L3 and DCP, are offered by some larger laboratories, and a few will calculate the score. It is not available everywhere, and it is not yet part of routine surveillance. Ask your doctor whether it would change anything for you before ordering it.
Can GALAD replace my ultrasound?
Not at present. Studies are testing whether it could work alongside or instead of ultrasound, but guidelines still recommend the scan. Some doctors may add GALAD when the ultrasound is hard to read, such as in a very fatty or scarred liver.
What is a liquid biopsy for liver cancer?
A blood test that looks for DNA released by tumour cells. In liver cancer it is mainly a research tool for early detection. It is also being studied for tracking treatment. It is not a replacement for a tissue biopsy or a scan when a diagnosis is needed.
Is a liquid biopsy worth paying for?
For routine liver surveillance, most people do not need one. The money is usually better spent on keeping every scheduled scan. If one is suggested, ask what decision it would change. If nobody can answer clearly, it probably is not worth it for you.
Is the test covered by insurance or Aarogyasri?
Newer marker tests and liquid biopsy are rarely covered by insurance policies or government schemes. Scheme rules change often, so check with your insurer or the scheme desk at the time. Standard surveillance scans are more likely to be covered.
Do these tests work in fatty liver disease?
They are being studied in fatty liver disease because ultrasound is often harder to read there. Results so far are mixed and the evidence is still building. Do not change your surveillance plan on the basis of one study you have read.
Will these tests tell me my risk of liver cancer?
They look for signs of a tumour already present. Your risk depends mainly on whether you have cirrhosis, hepatitis B or C, and other liver conditions. Your doctor works that out from your history and scans, not from these tests.
Who can tell me whether I need one?
An oncologist or hepatologist who knows your liver history. Bring your previous ultrasounds, AFP results and hepatitis reports. Call the CION helpline if you are not sure who to see, and someone will guide you to the right clinic.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- American Cancer Society — Can Liver Cancer Be Found Early?
- American Cancer Society — What's New in Liver Cancer Research?
- National Cancer Institute — Tumor Markers
- AASLD — Practice Guidelines
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Can a blood test alone detect liver cancer?Why one marker is never enough on its ownAFP-L3 and DCP: the other liver markersThe two markers inside the GALAD scoreUltrasound plus AFP: why bothThe surveillance standard these tests are measured againstWho needs liver cancer screening?Check whether surveillance applies to you at all
Talk to us
Has someone suggested a new liver blood test?
Bring the offer, your past scans and your AFP reports, and a CION oncologist will tell you honestly whether the test would change anything for you. One helpline serves every CION centre.