STEP 2: Presentation, initial investigations and referral

Investigate the following signs, symptoms or results:

right upper-quadrant abdominal pain or discomfort
a hard lump on the right side of the abdomen
significant weight loss
abnormal liver function tests
worsening liver failure (jaundice, ascites, portal hypertension)
constitutional symptoms including night sweats and anorexia.

Initial investigations include:

ultrasound of the liver
assessment of tumour marker AFP
liver function tests, full blood examination, urea and electrolytes
investigations for causes of underlying liver disease including viral makers, alcohol abuse, iron overload and fatty liver
quad-phase CT of the liver (if appropriate).

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.

Communication

The GP’s responsibilities include:

explaining to the patient and/or carer who they are being referred to and why
supporting the patient and/or carer while waiting for specialist appointments
informing the patient and/or carer that they can contact Cancer Council on 13 11 20.

Checklist

Signs and symptoms recorded

Supportive care needs assessment completed and recorded, and referrals to allied health services actioned as required

Patient notified of support services such as Cancer Council 13 11 20

Referral options discussed with the patient and/or carer including cost implications

Timeframe

Conduct tests within 2 weeks of a patient presenting with symptoms.

Patients should see a specialist linked to a multidisciplinary team within 2 weeks of GP referral.