Follow-up after treatment for liver cancer

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.

Kelly W Burak, MD, FRCPC, MSc(Epid)
Vincent Tam, BSc(Hon), MD, FRCPC

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