Care pathway for liver cancer

A tumor found in the liver is often a metastasis, as many cancers spread to the liver. Hepatocellular carcinoma develops from liver cells and is usually asymptomatic for a long time. Often symptoms do not appear until the tumor stretches the fibrous capsule of the liver or when the cancer spreads elsewhere. 

Symptoms of hepatocellular carcinoma include pain in the upper abdomen, loss of appetite, feeling full, and nausea. More advanced liver cancer can cause weight loss, fever, and itchy skin. 

Liver cancer may be suspected due to, for example, abnormal blood counts. Liver cancer is often discovered by chance during imaging examinations of the upper abdomen for other reasons. 

If you are suspected of having a cancerous tumor that originates from the liver, your primary care physician will refer you to HUS for further examination. 

When your referral arrives at HUS, we will assess the need for further examinations based on it. If liver cancer is suspected, we sometimes instruct additional examinations to be carried out in primary health care. After the necessary further examinations, we will start planning your treatment.  

When hepatocellular carcinoma is suspected, we first take blood tests in specialized medical care to determine liver function, among other things. Some liver cancers secrete alpha fetoprotein (AFP) into the bloodstream, and the increase in the concentration of this protein in the blood strengthens the suspicion of liver cancer.  

Imaging examinations provide us with more information about the size of the cancerous tumor, its location, and possible extent. If necessary, we will take a biopsy of a suspicious metastasis to confirm the suspicion of hepatocellular carcinoma. If the imaging finding is consistent with liver cancer, a biopsy does not necessarily need to be taken.

At the appointment, the physician will go through the examination results and treatment plan with you. The nurse will provide you with written instructions and, if necessary, additional information on the practical implementation of treatment and its adverse reactions.

If hepatocellular carcinoma has not metastasized outside the liver or to other parts of the liver, it is referred to as localized hepatocellular carcinoma. Treatment of localized hepatocellular carcinoma typically includes surgery or local treatments.

After surgeries and procedures, your condition will be monitored with imaging examinations and blood tests. Liver cancer can recur or grow to a completely new location even years after treatment. For this reason, the follow-up is intensive and we treat new metastases where possible.

If you do not have an underlying liver disease, your follow-up can usually be ended at five years. Otherwise, follow-up is often permanent.

Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the illness or cancer treatments. We help treat difficult symptoms and offer conversational support. 

A decision on palliative, i.e. symptomatic, treatment is made when the focus of your treatment shifts from slowing down the progression of cancer to managing the symptoms. In this case, treatment aims to alleviate symptoms and, as far as possible, to ensure a good and active life with the illness until death. Typically, at this stage, your care responsibility is transferred to the palliative care unit or to the palliative outpatient clinic or a hospital-at-home unit in your area.

If the hepatocellular carcinoma has not recurred during the five-year follow-up period, the monitoring of your cancer can be discontinued. If the cancer is caused by cirrhosis, your follow-up will continue in primary health care according to an individual plan.