Follow-up after treatment for liver cancer

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Follow-up after treatment is an important part of cancer care. Follow-up for liver cancer is often shared among the cancer specialists (oncologists), liver specialists (hepatologists) and your family doctor. If you have a liver transplant, your transplant team will also be involved in your follow-up care. Your healthcare team will work with you to decide on follow-up care to meet your needs.

Don’t wait until your next scheduled appointment to report any new symptoms and symptoms that don’t go away. Tell your healthcare team if you have:

  • pain or an increase in pain
  • swelling in the abdomen (called ascites) or legs (called edema)
  • vomiting
  • yellowing of the eyes and skin (called jaundice)
  • confusion

The chance that liver cancer will come back (recur) is greatest within 2 years, so you will need close follow-up during this time.

Schedule for follow-up visits

The first follow-up visit after any type of treatment for liver cancer is based on the type of treatment you had.

Liver resection or radiofrequency ablation (RFA)

If you had a liver resection or radiofrequency ablation (RFA), the first follow-up visit is 4 weeks after treatment. Then follow-up visits are scheduled every 3 to 6 months for 2 years, then every 6 to 12 months.

Transarterial chemoembolization (TACE)

If you had transarterial chemoembolization (TACE), the first follow-up visit is 4 to 6 weeks after treatment. Then follow-up visits are scheduled every 3 months.

Targeted therapy

If you are being treated with targeted therapy, you will have follow-up visits at least every 4 weeks.

Liver transplant

If you had a liver transplant, you will be followed by your transplant team. They will schedule tests and visits for follow-up care at the transplant centre or with your family doctor.

During follow-up visits

During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you're coping.

Your doctor may do a physical exam, including:

  • feeling the abdomen to check if the liver or spleen is larger than normal
  • feeling the abdomen for a buildup of fluid (called ascites)
  • looking at the skin and eyes for yellowing (called jaundice)
  • checking for swelling in the legs (called edema)
  • looking for skin problems such as a rash or peeling and asking if you have itchy skin

Tests are often part of follow-up care. You may have:

  • a CT scan or an MRI of the liver and other parts of the abdomen to look for cancer that may remain after treatment or that has spread
  • blood chemistry tests, including liver function tests to see how well your liver is working
  • blood tests to check tumour marker levels of alpha-fetoprotein to see if they lowered after treatment

If the cancer has come back, you and your healthcare team will discuss a plan for your treatment and care.

Questions to ask about follow-up

To make the decisions that are right for you, ask your healthcare team questions about follow-up.

Expert review and references

  • Kelly W Burak, MD, FRCPC, MSc(Epid)
  • Vincent Tam, BSc(Hon), MD, FRCPC
  • Arora A, Kumar A . Treatment response evaluation and follow-up in hepatocellular carcinoma. Journal of Clinical and Experimental Hepatology. 2014.
  • European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer . EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Journal of Hepatology. 2012.
  • Marrero JA, Kulik LM, Sirlin CB, et al . Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases . Hepatology . 2018 : 68(2):723–750 .
  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers (Version 3.2021). 2021.
  • Sherman M, Burak K, Maroun J, Metrakos P, Knox JJ, Myers RP, Guindi M, et al . Multidisciplinary Canadian consensus recommendations for the management and treatment of hepatocellular carcinoma. Current Oncology. 2011: