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.


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.



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.