Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Hepatocellular Carcinoma (HCC) Working Group.

Timeframes for care

Step in pathway

Care point


Screening – Patients deemed at risk of HCC should participate in screening and follow the National Hepatocellular Carcinoma Consensus Statements

Presentation, initial investigations and referral

Signs and symptoms

Presenting symptoms should be promptly and clinically triaged with a health professional

Initial investigations initiated by GP

Tests should be conducted within 2 weeks of patients presenting with symptoms

Referral to specialist

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

Diagnosis, staging and treatment planning

Diagnosis and staging

Investigations should be completed within 4 weeks of the initial referral

Multidisciplinary meeting and treatment planning

Within 2 weeks of finding a suspected HCC, patients should be referred to a specialist multidisciplinary team where possible; the team should have a rapid access program or contact person


Surgery (resection or transplant)

Treatment should begin within 4 weeks of the MDM

Local ablative therapies

Regional therapies

Localised therapies

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing recurrent, residual or metastatic disease

Step 7: End-of-life care

There is an increasing burden of HCC worldwide, driven by ageing cohorts of people with chronic hepatitis C virus (HCV), the increased burden of non-alcoholic fatty liver disease related to the obesity epidemic, high levels of immigration of people from endemic hepatitis B virus (HBV) countries and suboptimal HBV/HCV screening. These factors, combined with continued low levels of antiviral therapy intervention, lead to a marked increase in HCC cases (Calzadilla-Bertot et al. 2018; Dore 2012; Hong et al. 2015, Mittal & El-Serag 2013).

Viral hepatitis is the leading cause of HCC in Australia. The latest surveillance data indicates that there are more than 170,000 Australians living with chronic hepatitis C and 210,000 with chronic hepatitis B (The Kirby Institute 2019). In 2013, there were more than 1,000 lives lost due to viral hepatitis, many related to liver cancer as a complication of chronic infection with either HBV or HCV (The Kirby Institute 2014).