The multidisciplinary team should manage diagnosis, staging and treatment planning where possible.

Diagnosis

The following sequence of investigations is suggested:

• four-phase contrast-enhanced liver CT scan
• MRI with contrast in patients who cannot tolerate appropriate CT contrast or where diagnostic uncertainty remains after CT scan
• contrast-enhanced ultrasound in select cases where CT and MRI are not suitable (e.g. poor renal function).

If diagnostic uncertainty still remains, consider a liver biopsy.

Staging

Staging should use validated staging protocols such as the Barcelona Clinic Liver Cancer guidelines.

Staging parameters include radiological imaging (tumour size, number and location of lesions, metastases and vascular invasion), Eastern Cooperative Oncology Group (ECOG) status and a liver function assessment using the Child–Pugh or a similar scoring system.

Treatment planning

Within 2 weeks of finding a suspected HCC, refer the patient to a specialist multidisciplinary team where possible.

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.

Communication

The lead clinician’s (1) responsibilities include:

• discussing a timeframe for diagnosis and treatment options with the patient and/or carer
• explaining the role of the multidisciplinary team in treatment planning and ongoing care
• encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
• providing appropriate information and referral to support services as required
• communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from MDMs.

Checklist

Timeframe

Complete diagnostic investigations within 4 weeks of the initial referral.