Liver cancer/HCC
Liver cancer is a broad term and can be broken down into primary and secondary liver cancer. Primary liver cancer is cancer that starts in the liver. Secondary (metastatic) liver cancer is cancer that has started elsewhere in the body and has travelled (metastasised or formed ‘mets’) to the liver. The information here will be about primary liver cancer.
What is cancer?
Cancer is a disease of the body’s cells, where they grow abnormally and without any control. Cancers are usually named after the organ or type of cell where the cancer starts. Liver cancer starts in the cells of the liver.
Primary liver cancer
Liver cancer is the fifth most common cancer worldwide and is the second most common cause for cancer related death. The main types of primary liver cancer are;
1 – Hepatocellular Carcinoma (HCC)
2 – Cholangiocarcinoma (CCA)
3 – Fibrolamellar Liver Cancer
4 – Hepatic Angiosarcoma
5 – Hepatoblastoma (occurs in children)
1 – Hepatocellular Carcinoma (HCC), also known as Hepatoma, is the most common type of primary liver cancer and begins in the hepatocytes of the liver. It accounts for approximately 90% of cases. Therefore the information on this website will mainly focus on HCC.
2 – Cholangiocarcinoma (CCA), also known as bile duct or biliary tree cancer, is the second most common type of primary liver cancer.
3 – Fibrolamellar Liver Cancer, is a rare type of primary liver cancer, which mainly affects adolescents and young adults.
4 – Hepatic Angiosarcoma, is a rare primary cancer of the liver affecting the inner lining of the blood vessels. It accounts for approximately 2% of primary liver cancer cases.
5 – Hepatoblastoma, is a primary liver cancer predominantly seen in childhood, mainly affecting children under the age of 3 years old.
Hepatocellular Carcinoma (HCC)
HCC is the most common primary liver cancer and accounts for approximately 90% of all primary liver cancer cases worldwide.
Hepatocelluar carcinoma (HCC)
Causes of HCC
The main risk factor for developing HCC is liver disease with associated liver cirrhosis. Having cirrhosis does not mean you will definitely develop HCC, but we know that people with cirrhosis have a higher risk (1-8%) for developing this primary liver cancer.
Certain types of liver disease have a stronger link with the development of HCC these include; viral hepatitis B and C, excessive alcohol consumption, fatty liver disease and haemochromatosis.
Aside from liver disease and cirrhosis, other risk factors for developing HCC include;
• obesity
• type 2 diabetes
• heavy smoking, which has an increased risk if the person also drinks excessive amounts of alcohol or has hepatitis B or C.
Symptoms of HCC
It is not uncommon to have no symptoms of primary liver cancer, especially in the early stages of the disease. If you do notice any symptoms, they tend to be vague and can be easily mistaken for or attributed to other conditions. These include;
• fatigue / tiredness
• weakness
• loss of energy
• loss of appetite
• nausea and vomiting
• weight loss
• pain or discomfort in the right upper part of your tummy
• itchy skin
• yellowing of the skin and eyes
• dark urine and pale faeces
• Fluid build-up in the belly – (ascites)
• Brain fog / confusions (hepatic encephalopathy)
Diagnosis
Primary liver cancer is usually diagnosed following a clinical assessment with a doctor. This may begin with your GP or a doctor in a hospital. The doctor will take a thorough medical history, noting any current symptoms you are experiencing, as well as performing a clinical examination. The doctor will also organise blood tests and scans of your abdomen (usually an ultrasound in the first instance)
Blood tests will provided information about the general health of your liver. A tumour marker called alpha-feto protein (AFP), which is found in the blood, will also be measured. AFP can be elevated in patients with HCC. However a negative AFP blood test does not outrule HCC and AFP can be elevated for reasons other than HCC. If you are undergoing treatment for HCC, monitoring the AFP level can help to indicate if a treatment is working.
If the tests suggest a tumour may be present, you will be referred to see a specialist doctor who will arrange for your liver to be looked at more closely, usually with a CT or MRI scan. If the imaging and blood tests do not confirm the cancer diagnosis, a liver biopsy may be required to get a sample of the tumour cells. These will then be looked at under the microscope by a specialist Histopathologist.
A liver biopsy is not required for all liver cancer diagnoses. If a patient has liver cirrhosis, HCC can be diagnosed on CT or MRI scan alone.
Tests and Investigations
During the course of your diagnosis, treatment and follow-up for HCC and liver cancer, you will undergo various tests and investigations. These include (but are not limited to);
• Blood tests
• Ultrasound (US) scan of your abdomen / liver
• Computerised Tomography (CT) scan
• Magnetic Resonance Imaging (MRI) scan
• Liver Biopsy
• Laparoscopy
Blood tests
A nurse, doctor or phlebotomist will take a sample of your blood from a vein in your hand or arm. This may take a couple of minutes depending on how much blood is required to carry out all the tests. A tourniquet (tight band) is usually placed on the upper arm to help with the blood flow. You will feel a slight pricking or scratching when the needle goes in, but it shouldn’t be painful. Once finished, some pressure will be applied to the site for a few minutes using cotton wool. A plaster may then be applied.
Ultrasound (US) scan
An US scan is a painless test that uses sound waves to generate a picture of the organ or part of the body it is scanning. An US Abdomen or liver will show the condition of your liver, bile ducts and gallbladder. If it highlights anything worrisome, you should be referred for a CT or MRI scan and to a specialist liver unit for further review.
Computerised Tomography (CT) scan
A CT scan gives a detailed pictures of the bones, blood vessels and soft tissues inside your body. It gives more information than an ordinary X-ray. The CT scanner takes images of the body from different angles and recreates them in the computer to develop a 3D image of the inside of your body. You may be given a special drink or an injection with contrast to help to show up certain parts of the body. If you have a liver cancer, it can show the size and location of it and if it has spread to other parts of the body. For this scan you will lie on a table and pass through a doughnut shaped machine. The scan will take 20 – 30 minutes.
Magnetic Resonance Imaging (MRI) scan
An MRI scan uses strong magnetic fields and radio waves to generate detailed images of the organs and soft tissues inside the body. An MRI scan may be used if more detailed information is required than can be obtained from an US and CT scan. During the test you will lie in a tunnel-like machine and it can be quite noisy. The radiographer may give you headphones to wear to help with the noise. If you are afraid you will feel claustrophobic let your radiographer know beforehand. You may also be given an injection with contrast to help to show up certain parts of the body.
It is very important that you do not wear any metal on your body for this scan i.e. no jewellery or hair clips. If you have any medical devices in your body e.g. a pacemaker or pins, let the MRI department know as you may not be suitable for this test.
Liver Biopsy
A liver biopsy is not always required for diagnosing primary liver cancer as it may be diagnosed from scans alone. However, in some circumstances, information about your liver and how healthy and functional it is may be needed. If this information cannot be obtained through scans and blood tests you may require a liver biopsy. Alternatively, if you are taking part in a clinical trial, a biopsy may be needed.
For a liver biopsy you will have to fast (not eat) for a few hours before this test. The doctor will insert a long thin needle into your liver either through your skin (percutaneous) or into a vein, guided by ultrasound (transjugular). Alternatively, they may take the sample using keyhole surgery (laparoscopic) under general anaesthetic.
After a liver biopsy you will need to stay in hospital for a few hours, or sometimes overnight. This is so you can recover from any sedation or anaesthetic you may have been given. The team will also want to monitor you as there is a small risk of bleeding after this procedure. Your doctor will talk to you about any risks involved.
Laparoscopy
A laparoscopy involves the insertion of a tiny camera with a light on the end of a flexible fibre optic tube, into your abdomen through a small cut in your skin, to take pictures of your liver and abdominal cavity. This is done using a keyhole technique. If required, the surgeon may also take a biopsy at this time. The procedure is usually performed under a general anaesthetic and may involve an overnight stay in hospital.
Test Results
Once all of the tests have been done, the results will be reviewed and discussed by the specialist multidisciplinary team (MDT). The MDT consists of consultant Hepatologists, Liver Transplant Surgeons, Oncologists, Radiologists, Interventional Radiologists, Histopathologists and Specialist Liver Cancer Nurses. The MDT meet regularly to discuss each person’s individual case at the multidisciplinary team meeting (MDM).
At the MDM the MDT decide on the stage (size, number of tumours and location) of the cancer and a consensus decision is made on the recommended treatment options for each person’s individual case.
Staging
Staging can be difficult to understand, and no two patients are the same. Staging systems are used to help your medical team to decide on the most appropriate treatment options to discuss with you. A combination of staging systems are used in their decision making. These include;
• TNM Classification
• BCLC Staging Algorithm
• CTP Score
• ECOG Score
TNM Classification
This refers to the size of the tumour (T), if the cancer has spread to your lymph nodes (N), and if the cancer has spread to other parts of your body (M for metastasis).
Your doctor often uses the TNM information to give your cancer a number stage – from 0 to 4. A higher number, such as stage 4, means a more advanced cancer. Some stages are further divided into stage A and B. In general, the lower the number, the less the cancer has spread.
Barcelona Clinic Liver Cancer (BCLC) Staging Algorithm
Another type of staging used specifically for HCC is the BCLC staging system. It looks at liver function as well as the size and number of tumours. It has 5 stages:
Stage 0 - One small tumour less than 2cm. The person is well and has normal liver function.
Stage A - One tumour less than 5cm, or 2-3 smaller tumours none bigger than 3cm. The person is well and has normal liver function.
Stage B - There are many tumours in the liver. The person is well and has normal liver function.
Stage C - The size and number of tumours may vary but the cancer may have spread to nearby blood vessels and/or lymph nodes. It may also have travelled to other parts of the body. The person is well and has normal liver function.
Stage D - There is severe damage to the liver. The person is not well at all. They can have any number of tumours.
The Child Turcotte Pugh (CTP) Score
The CTP score has 3 classes that describe how well your liver is working (liver function) in people who have liver cirrhosis. This system considers your blood test results, the presence of fluid (ascites) in your abdomen and brain function (hepatic encephalopathy).
Class A: The liver is working normally
Class B: Mild to moderate liver damage
Class C: Severe liver damage
Eastern Co-operative Oncology Group (ECOG) Score for Performance status (PS)
Performance status (PS) is a scale to rate how well and physically fit you are:
• PS 0 – you are fully active and can do much the same as you did before your diagnosis.
• PS 1 – you cannot do heavy physical work, but can do everything else.
• PS 2 – you are up and about more than half the day. You can look after yourself but you can’t work.
• PS 3 – you are in bed or a chair for more than half the day. You can look after yourself to some extent, but need help.
• PS 4 – you are in bed or a chair all the time and need complete care
Treatment
Liver cancer can be treated using surgical and non-surgical treatments. The MDT will recommend a treatment pathway for you based on the information they have received from your tests and investigations, the staging of the cancer and the background level of your liver function.
The type of treatment they recommend will depend on factors including:
• The stage of the cancer
• The size of the tumour
• The exact location of the cancer
• How well your liver is working (liver function)
• Your age and general health
Surgical Treatments
For early-stage primary liver cancer, surgery is the most common and effective treatment. However, this will depend on where the tumour is and how well your liver is working.
There are two main types of surgery:
1. Liver Resection - Removal of part of the liver
2. Liver Transplant - Removal of the whole liver and replacement with a healthy donor liver
Your multidisciplinary team will decide if you are suitable for surgery. This is usually based on the size and location of the tumour or tumours, how healthy the rest of your liver is and your overall general health. The aim of surgery is to completely remove the tumour and the tissue close to it. It can be considered a cure early-stage liver cancer.
1 – Liver Resection
Liver resection is an operation to remove part of your liver. How much is removed depends on the size of the tumour, where exactly it is in the liver and how well the rest of your liver is working. The removal of a whole lobe is called a lobectomy or hemi-hepatectomy.
This surgery is not suitable for everyone, and your team will take many factors into consideration including:
• Are you fit for surgery?
• What size is the tumour?
• Has it spread into the blood vessels?
• Is your liver fairly healthy with little or no cirrhosis?
The operation may be done using keyhole (laparoscopic) surgery which is a series of small cuts in the abdomen, or open surgery (laparotomy) which has one long cut in the abdomen. Advances in surgical techniques mean robotic liver surgery may be used to reach and remove some liver tumours using a minimally invasive approach.
Liver surgery is a major operation and risks associated with it include, infection, bleeding and bile leak. There is also a risk that some of the cancer cells have escaped undetected before the surgery. This means there is the possibility that the cancer may come back despite the operation.
It is important to remember that if the HCC has developed in a liver with cirrhosis, there is a risk of a new, separate liver cancer developing in the remaining liver tissue.
2 – Liver Transplant
A liver transplant means removing your own liver and replacing it with a healthy donor liver. This operation is used for some primary liver cancers, but it is not suitable for everyone. There are many considerations:
• Are you well enough surgery?
• Do you have cirrhosis and how severe is it?
• What is your background liver disease and do you meet the relevant transplant criteria?
(e.g. no alcohol intake for at least 6 months and commitment to lifelong abstinence)
• What is the extent of tumour burden and is it within the liver cancer transplant criteria?
• Has it grown into blood vessels or spread outside the liver?
• Has the tumour progressed in the time waiting for transplant?
St. Vincent’s University Hospital (SVUH) is home to the National Liver Transplant Unit, in Ireland. If you are being considered for a liver transplant, you will be referred to SVUH for multidisciplinary team (MDT) review. Your case will be discussed at the weekly multidisciplinary team meeting and you will be brought up to the clinic there for review. If you are being considered for a liver transplant, you will have regular meetings with the liver transplant team and coordinators.
Liver Transplant Assessment
The liver transplant assessment may be carried out as an inpatient, an outpatient or in some cases, as a combination of both. It is important that you identify a support person to help you during the liver transplant process.
The assessment phase of liver transplantation involves undergoing a series of tests and investigations, as well as meeting the members of the MDT.
Tests include (but are not limited to); blood tests, chest x-ray, pulmonary function tests, electrocardiograph (ECG),cardiac echo, ultrasound scan, CT scan, 24 hour urine collection, dental x-ray.
Members of the MDT who you will meet; Nursing Staff, Surgeons, Hepatologist’s, Anaesthetist’s, Transplant Coordinator, Dentist, Medical Social Worker, Pharmacist, Dietician, Psychiatrist and Physiotherapist.
Once the assessment phase is complete, the MDT will review the results and discuss with you if liver transplantation is the best treatment for your liver cancer.
Waiting for a Liver Transplant
If it is decided that a liver transplant is the best treatment option for you, an appointment will be arranged for you to meet with a Liver Transplant Coordinator for an education session about going on the liver transplant waiting list. A donor liver is matched with a recipient based on blood group, weight and model for end stage liver disease (MELD) score (this is a score which measures how sick your liver is and how urgently you need a liver transplant).
Waiting for a liver transplant can be a difficult time for you and your family as it is the time of least activity. The waiting times can range from weeks and months to years.
While you are waiting for your liver transplant, you may receive ‘bridging’ treatments with thermal ablation or TACE, to ensure your cancer burden stays stable and does not go outside criteria. The liver transplant team will explain this to you.
The Liver Transplant Operation
When a donor liver has become available for you, the liver transplant coordinator will contact you with clear instructions for coming to the hospital. You will meet some members of the MDT again at the time of your admission. Everything will be explained to you as you are prepared for your operation.
After your Liver Transplant
After your operation, the average stay in hospital is approximately 1 – 2 weeks. During this time you will be looked after in the Intensive Care Unit, the High Dependency Unit and on the ward. You will have some drips and drains following the operation. You will be reviewed regularly by the medical and surgical transplant teams, to ensure you are healing and recovering well. You will be commenced on immunosuppressant medications to help your body from rejecting the new liver. The nurses on the ward will educate you about your new medications, including when and how to take them properly. After discharge, you will be reviewed regularly in the out-patient clinics to ensure you continue to recover well. Once you go home, it will take some time for life to return to normal, but the transplant team will be on hand to support you and any questions you may have.
Non-surgical Treatments
Non-surgical treatments are used to reduce the growth of the cancer if surgery is not an option. The main types of non-surgical treatments are;
1. Thermal Ablation
2. Embolisation
3. Radiation
4. Targeted Therapy
5. Immunotherapy
6. Clinical Trials
7. Palliation
1 – Thermal Ablation
Thermal ablation is a treatment using heat to destroy the cancer cells. It can be used if surgery isn’t suitable or if the tumour is very small. There are 2 main types of thermal ablation:
• Radiofrequency ablation
• Microwave ablation
Both types of ablation use an electric current to destroy the cancer cells in the liver. A needle-type probe is guided into the tumour using an ultrasound scan or CT scan. This probe heats the tumour and destroys (ablates) it. This procedure takes about 30 minutes and is usually done under general anaesthetic. You will probably be kept in hospital overnight following the procedure.
Surveillance after your procedure will either be a CT or MRI scan 8-12 weeks afterwards to see how effective the thermal ablation was.
There are other types of ablation not used so often. These include:
• Percutaneous ethanol injection – ethanol is injected directly into the tumour to kill the cancer cells
• Cryoablation – uses extremely cold temperatures to destroy the cancer cells
• Laser ablation - uses a narrow, thin beam of light to destroy cancerous cells
• Irreversible electroporation (IRE), sometimes known as NanoKnife – uses electrical currents to destroy cancer cells
Your doctor or nurse will explain these treatments to you in detail if they feel they are an option for you.
2 – Embolisation
The liver has two main blood vessels that supply it with blood, oxygen and nutrients: the portal vein and the hepatic artery. The hepatic artery supplies blood to the cancer, the portal vein supplies blood to the healthy liver cells. Embolisation involves cutting off the hepatic artery blood supply to the tumour, killing the cancerous cells. Transarterial embolization (TAE) and transarterial chemoembolization (TACE) are both examples of embolization techniques.
• Trans-arterial embolization (TAE) involves injecting the hepatic artery with tiny beads, this stops the cancer from growing by blocking off its blood supply.
• Trans-arterial chemoembolisation (TACE) is very similar to TAE, except chemotherapy drugs are injected directly into the liver. The blood flow is also blocked (embolisation) so that the chemotherapy can stay longer in the liver and kill the cancer cells.
You will need to fast (not eat) from the night before the procedure. On the day of the procedure you will have a drip for fluids and antibiotics to prevent infection.
The TAE / TACE will be done in the Interventional Radiology department. The radiologist will put a fine tube through a cut (incision) made in your wrist or groin. With the help of an X-ray, the tube will be guided to your liver and the treatment will take place. All of this is done under conscious sedation and local anaesthetic - it shouldn’t hurt. It usually takes about 1-2 hours. It's normal to stay in hospital overnight after this procedure.
Surveillance after your procedure will either be with a CT or MRI scan 8-12 weeks afterwards to see how effective the TACE was.
3 – Radiation
The main type of radiation used to treat primary HCC is Selective internal radiation therapy (SIRT). Less commonly, stereotactic radiotherapy can also be used. More so in the management of metastatic liver cancer.
Selective internal radiation therapy (SIRT)
Selective internal radiation therapy (SIRT) is a type of internal radiotherapy. It is usually used to control cancer in the liver that cannot be removed by surgery. SIRT is sometimes called radioembolisation or trans-arterial radioembolisation (TARE).
SIRT is completed in 2 separate admissions. First, you will have a planning angiogram (Part 1) to give your doctor more information about your liver and to see if your body is suitable for internal radiotherapy. This is done by guiding a thin tube to your liver through a blood vessel in your wrist or groin. Then dye is injected through this tube and a series of X-rays show that the dye is travelling along the blood supply to their liver. If there is no escape of the dye to any other part of your body, you are suitable for SIRT and will progress to Part 2.
After 1-2 weeks, you will have SIRT (Part 2). This involves another angiogram, but this timetiny radioactive beads will be injected into the liver, guided by the dye showing the blood supply to the tumour in the liver. These radioactive beads give off radiation and damage the cancer cells with minimal impact on the surrounding healthy liver tissue. The beads will continue to emit radiation over several weeks after treatment, until the radiation levels decrease. Your team will discuss radiation precautions to take at home if you are deemed suitable for SIRT.
If after the planning angiogram (Part 1) you are not deemed a suitable candidate for SIRT, your team will discuss alternative treatment options with you.
Stereotactic Radiotherapy
Radiotherapy uses high-energy rays to destroy cancer cells. It is not often used as a treatment for primary liver cancer. You are most likely to have it to control the cancer if it has spread to other parts of the body such as the bones. You may have stereotactic radiotherapy if your cancer did not respond well to ablation or chemoembolisation.
Stereotactic radiotherapy uses smaller, more precise radiation beams than standard radiotherapy. These beams are targeted at your tumour from several angles, which combine to give a high dose of radiation. It may be used for small tumours that are not suitable for surgery.
The most common side-effects when the liver is being treated are:
• Diarrhoea
• Tiredness
• Nausea and vomiting
• Loss of appetite
• Temperature
• Pain
• Skin sores or irritations
How severe these side-effects are will vary from person to person. Most side-effects develop during or shortly after your treatment and can usually be managed with simple medications.
4 – Targeted Therapy
Targeted therapies are drugs that work by ‘targeting’ certain parts of cancer cells that make them different from other cells. In other words, they take advantage of differences between normal cells and cancer cells.
Different drugs work in different ways. For example, they can:
• Block or turn off chemical signals that tell cancer cells to divide and grow
• Change proteins in the cancer cells so the cells die
• Stop making new blood vessels to feed the cancer cells
• Carry toxins to the cancer cells to kill them
• Help your immune system to fight cancer
Sorafenib (Nexavar) and Lenvatinib (Lenvima) are medications known as tyrosine kinase inhibitors (TKIs). These are sometimes used to treat metastatic (advanced) HCC. TKIs help stop the growth of cancer cells by blocking the enzyme tyrosine kinases which helps cells to grow and divide. TKIs are usually given as tablets.
The side-effects of Sorafenib and Lenvatinib may include skin rash, diarrhoea, fatigue and high blood pressure. These side-effects can usually be managed without having to stop treatment.
New targeted therapies are being developed all the time and existing therapies are being used in new ways.
5 – Immunotherapy
Immunotherapy drugs are occasionally prescribed for advanced or metastatic liver cancer. These help the body’s natural defences or immune system to fight cancer cells. Our immune system can often be the most effective weapon to clear cancer cells from our body, but sometimes cancer cells find a way of hiding from the immune system. This allows a tumour to develop or spread. Immunotherapy treatment helps your immune system to work better to destroy cancer cells.
If immunotherapy is a treatment option for you, your doctor and nurse will explain it to you in more detail and tell you about any likely side-effects. Always tell your doctor or nurse straight away if you don’t feel well or if you are having any symptoms that are troubling you.
6 – Clinical Trials
Your treating team may discuss with you the possibility of taking part in a clinical trial. Clinical trials are research studies that try to find new or better ways of treating cancer or reducing side-effects. If you decide to take part in a clinical trial, instead of the standard treatment for the cancer, you may get a new trial drug, or you may get the existing treatments, but they are used in different ways e.g. a different dose, or combining different treatments together. You will be monitored very closely while on the trial and it may involve extra test and hospital appointments. The team in the clinical trial department will explain all of this to you before you commence the trial.
If you decided not to take part in a clinical trial which is offered to you, your care will not be affected and the team will manage you and your cancer with the most appropriate treatment pathway.
7 – Palliation
Depending on the stage of your illness and the severity of your symptoms the doctor may discuss palliative care with you. The palliative care team are experts in managing the symptoms of advanced liver disease and metastatic cancer. These symptoms may include: pain, breathlessness, nausea, fatigue, fluid build-up in the abdomen (ascites) or brain fog (hepatic encephalopathy).
Palliative care also offers emotional support and comfort to patients and their families. Palliative care includes end-of-life care, but your doctor may also recommend palliative care earlier in your illness, to help to relieve symptoms and improve your quality of life.
The palliative care team can include specially trained doctors, nurses, social workers, physiotherapists, occupational therapists, complementary therapists, chaplains and counsellors. Palliative care can be arranged by your family doctor (GP), public health nurse or by the hospital. Palliative care is a free service for all patients with advanced cancer. You don’t need medical insurance.
You do not need health insurance. Palliative care can be given in a hospice or community hospital or in your own home.
You may go to a hospice for a day or two to get treatment for your symptoms or you may stay at the hospice in the later stages of your illness.
After Treatment – Surveillance / Follow-up
The purpose of follow-up is to:
• Help with any side-effects that you may have
• Check for signs of new side-effects that may develop after you have finished treatment
• Check for signs of the cancer coming back (recurrence)
After your cancer treatment has ended you will be reviewed regularly by the team. This is called follow-up. Your level of follow-up will be decided by the type of treatment pathway you are on. All follow-up will involve regular review in clinic with your consultant, blood tests and scans.
If you have had any treatment for your cancer surveillance of your liver will be required with either CT or MRI imaging. Usually it is with the type of scan that best detailed your liver cancer when it was first diagnosed i.e. CT or MRI scan. These scans are usually conducted every 3 months for the first 2 years. The scans are discussed at the MDM by the MDT. You will be brought back to the clinic then to discuss the results and the next steps in the management of your care.
If the cancer remains treated, these visits will become further apart until you are reviewed every 6 months or 1 year. Follow-up will continue lifelong.
Support and Advice
If you have any further questions about your liver cancer, you can speak with your doctor or nurse in the hospital. Some other useful resources available can be found on The Irish Cancer Society website.