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Living with cancer· Appointment prep

Appointment sheet: Intermediate hepatocellular carcinoma (BCLC B)

One page to bring and write on: your details, the questions for Intermediate hepatocellular carcinoma (BCLC B) plus your own, the words you may hear, what to bring, the treatments the standard of care names, and room for the answers and agreed next steps. What you type stays in this browser. Print it or save it as a PDF. New to all this? Start with the first 60 days. Orientation, not medical advice.

Tick the questions to print

All of this cancer's questions start ticked. Untick what does not apply; ticks are kept in this browser. .

Your own questions

Shared with the prep pack, so questions you add there appear here too.

Print or save as PDF

Use (or Ctrl+P, Cmd+P on a Mac). To keep a copy, choose Save as PDF as the destination in the print dialog. Only the sheet prints; the controls stay on screen. Your typed notes print where you typed them; empty fields print as ruled lines to write on.

Appointment sheet

Intermediate hepatocellular carcinoma (BCLC B)

Prepared with OnCo (onco.cc/prep/hcc-intermediate/). Orientation, not medical advice; your team knows your case.

My details

Name
Date of appointment
Hospital and clinician
Who is coming with me

What I know, what is unclear, changes to discuss

Saved in this browser
What I know so far
What is unclear to me
Changes since last time

My questions

17 on the sheet
Newly diagnosed
  1. 1.What is my exact diagnosis, stage, and grade, and which tests established them?
  2. 2.Which biomarkers have been tested on my tumour (for example Tumour number and size, Child-Pugh and ALBI liver function before and after each embolisation, Alpha-fetoprotein response, Modified RECIST response on contrast imaging, Absence of macrovascular invasion and extrahepatic spread), and what were the results?
  3. 3.Which subtype is my cancer, and does that change the recommended treatment?
  4. 4.Is germline (inherited) genetic testing recommended for me or my family?
Well-defined nodules, preserved liver function
  1. 5.For my situation (well-defined nodules, preserved liver function), which of the standard options do you recommend and why?
TACE plus systemic therapy
  1. 6.For my situation (tace plus systemic therapy), which of the standard options do you recommend and why?
  2. 7.Am I a candidate for Durvalumab, Bevacizumab, Lenvatinib or related drugs, and what side effects should I expect?
  3. 8.How do the results of EMERALD-1 and LEAP-012 apply to someone like me?
High burden or diffuse disease
  1. 9.For my situation (high burden or diffuse disease), which of the standard options do you recommend and why?
  2. 10.Am I a candidate for Atezolizumab, Bevacizumab, Durvalumab or related drugs, and what side effects should I expect?
  3. 11.How do the results of IMbrave150 and HIMALAYA apply to someone like me?
Within transplant criteria after downstaging
  1. 12.For my situation (within transplant criteria after downstaging), which of the standard options do you recommend and why?
Any stage
  1. 13.Are there clinical trials I could join, for example of EMERALD-3, TACE + immunotherapy/anti-VEGF, Radioembolisation (TARE / SIRT, yttrium-90), Durvalumab?
  2. 14.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 15.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 16.I read that “No overall survival gain yet shown for TACE combinations”. How does that affect my plan?
  5. 17.I read that “Which patients should skip embolisation and go straight to systemic therapy”. How does that affect my plan?

The words I may hear

  • Bridging therapy: Treatment given to keep a fast-growing cancer in check during the weeks between deciding on CAR-T (or transplant) and actually receiving it, while the cells are being manufactured or a donor found.
  • BCLC staging: The liver-cancer staging system that combines tumour size, liver function and fitness to recommend treatment: ablation or surgery, transplant, TACE, or drugs.
  • TACE (transarterial chemoembolisation): Threading a catheter into the artery feeding a liver tumour and injecting chemotherapy plus particles that block the blood supply, starving and poisoning it at once.

Tests and results to bring

Within transplant criteria after downstaging: Chemoembolisation or radioembolisation as a bridge, then liver transplantation.

Biomarker results to ask for: Tumour number and size (up-to-seven and other burden criteria), Child-Pugh and ALBI liver function before and after each embolisation, Alpha-fetoprotein response, Modified RECIST response on contrast imaging, Absence of macrovascular invasion and extrahepatic spread (defines the stage).

Scans and tests linked to this cancer: MRD / molecular residual disease testing.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

The treatments I may be offered

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.

Answers and next steps

Saved in this browser
What I was told
Agreed next steps, dates and who to call