Hepatocellular (Liver) Cancer
Adult

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Emergency Referrals

Useful Management Information

Refer patients with new liver lesions (without signs of critical organ dysfunction) with suspected primary liver cancer through local gastroenterology / hepatology pathway for further investigation. For undifferentiated liver lesions (for example suspected metastatic disease from a colorectal or upper gastro-intestinal tract primary site) please through local surgical pathway for further investigation.
If the referring clinician organises a biopsy – please ensure a core or excisional biopsy (not a FNA) is performed
Depending on their age and comorbidities patients with some stages of primary hepatocellular cancer may be considered for Liver transplantation, surgery or for other treatment techniques either as a bridge to transplantation or as primary treatment, such as TACE, or SBRT. Patients with multifocal disease not suitable for transplant or local therapies may be considered for systemic therapy with monoclonal antibody therapy, or an oral tyrosine kinase inhibitor therapy or suitable clinical trials if available. The referral for initial assessment should be made to the Gastroenterology / Hepatology service, not medical oncology.
Serum tumour bio-markers such as CEA, CA19.9 or others should not be used as diagnostic tests, however a serum AFP is indicated for a suspected diagnosis of Hepatocellular carcinoma.
For women and men who have not completed their family, fertility preservation needs to be discussed
For patients with incurable (metastatic or recurrent) cancer consider the following:
documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the Women's and men's prognosis and their understanding of their prognosis
whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
specific patient goals and values that may impact on treatment choices
whether the patient has been referred to a palliative or supportive care service
Quick reference guide

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Patients with a history of cirrhosis of the liver from any cause or history of hepatitis B for monitoring / screening for the development of Hepatocellular carcinoma should be referred to the Gastroenterology / Hepatology service . Patients with suspected primary Liver cancer should be referred to the Hepatology / Gastroenterology team for evaluation and further investigation. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input. Patients are usually referred from the MDT meeting after thorough evaluation for appropriate therapies such as Transplant, surgery, Trans-arterial chemo-embolisation, Stereotactic body radiotherapy, Radiologically guided ablation techniques, or Systemic therapies. Patients for Trans-arterial chemo-embolisation therapy prior to surgery or as primary management (usually referred by the Hepatologist or Surgeon after MDT), for optimum care, patient should be seen within 4 weeks. Metastatic or Multifocal hepatocellular cancer (De novo or following prior treatment for known disease) and has tissue confirmation (usually referred by the Hepatologist or Surgeon after MDT)
Category 2 (appointment within 90 calendar days)	Transfer of care from another health service
Category 3 (appointment within 365 calendar days)	No category 3 criteria
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Detailed history of present signs and symptoms
Past medical history/pertinent social history
Current medications and allergies
Histology report
FBC results
U&E results
LFT results
LDH results
Liver imaging reports

Additional Referral Information

Other available imaging
Endoscopy report if available

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Not Available

Internal Referrals

Medical Oncology (E-Blueslips)

Fax

(07) 5687 4497

Post

Cancer Referral Centre,
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

(07) 5687 2708

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Marcin Dzienis

Medical Director Radiation Oncology (ICON Cancer Care)

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Hepatocellular (Liver) CancerAdult