Establish intent of treatment

• Curative
• Anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
• Symptom palliation.

In many cases the severity of the co-existing liver disease affects the treatment options and needs to be treated appropriately.

Surgery – resection or transplant

Only a small number of cases are suited to surgery. A resection may benefit patients with compensated liver disease. A liver transplant may benefit patients who also have cirrhosis, including those with decompensation, and for patients with a tumour volume within accepted international guidelines.

Local ablative therapies

Radiofrequency ablation, microwave ablation, percutaneous ethanol, percutaneous acetic acid injections, stereotactic radiation therapy or image-guided cryoablation may be appropriate.

Regional therapies

Transarterial chemoembolisation, transarterial embolisation or selective internal radiation therapy may be appropriate.

Localised therapies

These are the most common treatment for early-stage HCC and have curative intent.

They may benefit patients:

• with unresectable disease (due to the size or location of the tumour)
• with small tumour(s) (lesions 5 cm or smaller)
• awaiting liver transplant
• with small, recurrent tumours.

Treating advanced HCC

The standard treatment for patients with advanced HCC is systemic therapies. First-line approved systemic therapy in Australia for advanced HCC is either sorafenib or lenvatinib. Other combination therapies are being evaluated.

Palliative care

Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis. For more, visit the Palliative Care Australia website.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• communicating the treatment plan to the patient’s GP
• helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.

Checklist

Timeframe

Begin treatment within 4 weeks of the multidisciplinary meeting.