What questions should I ask my oncologist about locally advanced Liver Cancer

Questions to Ask Your Oncologist About Locally Advanced Liver Cancer

Based on current medical guidelines, here are important questions organized by topic to help you understand your treatment options and make informed decisions with your care team.

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UNDERSTANDING YOUR DIAGNOSIS & STAGING

1. Can you explain my specific stage and what "locally advanced" means for my case? This helps you understand whether the cancer is confined to the liver or has spread beyond it.

2. What imaging tests confirm my diagnosis, and do I need a biopsy? According to NCCN Guidelines, diagnosis typically uses multiphasic CT or MRI scans. Understanding your imaging results helps you grasp the extent of disease.

3. What is my liver function status (Child-Turcotte-Pugh score)? This is critical because liver function determines which treatments are safe for you. The NCCN Guidelines emphasize that liver function assessment guides all treatment decisions.

4. Do I have cirrhosis or portal hypertension, and how does this affect my treatment options? These conditions significantly impact what therapies your doctor can recommend.

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TREATMENT OPTIONS & DECISION-MAKING

1. Am I a candidate for surgical resection (removing part of the liver)? According to NCCN Guidelines, resection is considered a curative option when feasible. Ask about the risks and benefits specific to your situation.

2. Should I be evaluated for liver transplantation? The NCCN Guidelines recommend that all patients with HCC should be evaluated for potential curative therapies, including transplant. Ask if you meet Milan criteria or could benefit from downstaging therapy.

3. What locoregional therapy options are available to me? These are local treatments that target the tumor directly. According to NCCN Guidelines, options include:

   • Ablation (radiofrequency or microwave) - uses heat to destroy tumors
   • Arterially directed therapies (TACE, chemoembolization, or Y-90 radioembolization) - delivers treatment directly through blood vessels feeding the tumor
   • Radiation therapy (SBRT) - focused radiation beams

4. Which locoregional therapy do you recommend for my specific tumor size, location, and liver function—and why? The choice depends on factors like tumor size (tumors ≤3 cm may be treated with ablation alone; larger tumors may need arterially directed therapy).

5. If locoregional therapy is recommended, what is the goal—cure or disease control? This affects how you understand success and follow-up monitoring.

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SYSTEMIC THERAPY (CHEMOTHERAPY & IMMUNOTHERAPY)

1. Do I need systemic therapy (drugs that work throughout the body), and if so, when would it start? According to NCCN Guidelines, systemic therapy is an option for patients with liver-confined, unresectable disease or extrahepatic (spread beyond liver) disease.

2. What are my first-line systemic therapy options? Current NCCN Guidelines list these as preferred options:

   • Atezolizumab plus bevacizumab (immunotherapy + anti-angiogenic therapy)
   • Tremelimumab plus durvalumab (dual immunotherapy)
   • Durvalumab, lenvatinib, sorafenib, or tislelizumab (other category 1 options)

3. What do these drugs do, and what are the expected side effects? Understanding the mechanism helps you know what to expect and why monitoring matters.

4. How will we measure if treatment is working? Ask about imaging schedules and what response looks like. NCCN Guidelines recommend imaging every 3-6 months initially, plus AFP (alpha-fetoprotein) blood tests.

5. What happens if my cancer progresses on first-line therapy? According to NCCN Guidelines, subsequent-line options include cabozantinib and regorafenib, or re-trying first-line agents if not previously used.

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COMBINATION APPROACHES

1. Could I benefit from combining locoregional therapy with systemic therapy? Some patients receive both approaches—for example, locoregional therapy followed by systemic therapy if residual disease remains.

2. Are there clinical trials available for my stage of disease? Ask specifically about trials testing new combinations or newer drugs. Clinical trials are always listed as an option in NCCN Guidelines.

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SURVEILLANCE & FOLLOW-UP

1. What is my surveillance plan after treatment? According to NCCN Guidelines, surveillance typically includes:

   • Imaging (multiphasic CT or MRI) every 3-6 months for 2 years, then every 6 months
   • AFP blood tests on the same schedule
   • Continued surveillance for at least 5 years

2. How long will I need follow-up imaging and blood tests? This helps you plan for ongoing care and understand the importance of adherence.

3. What signs or symptoms should prompt me to contact you between appointments? Know the warning signs that need urgent evaluation.

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YOUR SPECIFIC SITUATION

1. Based on my complete clinical picture (tumor size, location, liver function, overall health), what is YOUR recommended treatment plan and why? This is the key question—your oncologist will synthesize all factors to recommend the approach most likely to help you.

2. What are the realistic goals of treatment—cure, prolonged survival, or symptom control? Understanding realistic expectations helps you make decisions aligned with your values.

3. What support services are available (nutrition, palliative care, mental health)? Locally advanced cancer often benefits from a multidisciplinary team approach.

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PREPARING FOR YOUR CONVERSATION

Bring to your appointment:

• A list of your current medications and supplements
• Recent imaging reports (or request copies)
• Pathology report if you have one
• A notebook to write down answers
• A trusted person to listen and help you remember information

After your appointment:

• Ask for written summaries of treatment recommendations
• Request copies of all imaging and pathology reports
• Ask for contact information for questions between visits

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KEY TAKEAWAY

According to NCCN Guidelines for Hepatocellular Carcinoma, the choice of treatment depends on:

• Extent of disease (size, location, number of tumors)
• Hepatic reserve (how well your liver is functioning)
• Institutional capabilities (what your center specializes in)
• Your overall health and preferences

Your oncologist will determine the most appropriate approach for YOUR specific case based on the complete clinical picture.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.