2.3 Initial referral

2.3 Initial referral

If a patient’s general practitioner suspects a cancer diagnosis but cannot confirm it, they must refer the patient to a specialist (gastroenterologist, hepatologist, oncologist or hepato-pancreato-biliary (HPB) surgeon) to confirm the diagnosis.

If the general practitioner confirms an HCC diagnosis with initial tests including a quad-phase liver CT scan, the patient should be referred to a specialist multidisciplinary team where possible (patients treated by multidisciplinary teams have better outcomes). If this is not available, patients should be referred to a gastroenterologist, hepatologist, oncologist or HPB surgeon who is affiliated with or who has access to a multidisciplinary team and MDMs.

Patients should be enabled to make informed decisions about their choice of specialist and health service. General practitioners should make referrals in consultation with the patient after considering the clinical care needed, cost implications (see referral options and informed financial consent), waiting periods, location and facilities, including discussing the patient’s preference for health care through the public or the private system.

Referral for suspected or diagnosed HCC should include the following essential information to accurately triage and categorise the level of clinical urgency:

  • important psychosocial history and relevant medical history that includes comorbidities
  • family history, current symptoms, medications and allergies
  • results of current clinical investigations (imaging and pathology reports)
  • results of all prior relevant investigations
  • notification if an interpreter service is required.

Many services will reject incomplete referrals, so it is important that referrals comply with all relevant health service criteria.

If access is via online referral, a lack of a hard copy should not delay referral.

The specialist should provide timely communication to the general practitioner about the consultation and should notify the general practitioner if the patient does not attend appointments.

Aboriginal and Torres Strait Islander patients will need a culturally appropriate referral. To view the optimal care pathway for Aboriginal and Torres Strait Islander people and the corresponding quick reference guide, visit the Cancer Australia website. Download the consumer resources Checking for cancer and Cancer from the Cancer Australia website.

The patient should be seen by a specialist linked to multidisciplinary team within two weeks of the general practitioner referral.

The multidisciplinary team should have a rapid access program or contact person to set up the appointment. This is commonly the nurse coordinator for the service.