• 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.
• Hepatitis B and C as cancer causes: Two viruses cause most liver cancer worldwide.
• Child-Pugh score: A score of how well a damaged liver is still working, from five simple measures (bilirubin, albumin, clotting, fluid in the abdomen, confusion).
• Cirrhosis: Permanent scarring of the liver after years of damage from hepatitis B or C, alcohol or fatty liver disease.
• Child-Pugh and ALBI liver-function scores: Scores for how well the liver still works; in liver cancer they decide whether a patient can tolerate treatment at all.
• Dosimetry: Measuring how much radiation dose each organ and tumour actually received from a radioactive drug.
• 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.
• Portal vein tumour thrombus (macrovascular invasion): Liver cancer growing into the main vein that brings blood from the gut to the liver.
• Microwave ablation (MWA): Like radiofrequency ablation but using microwaves, which heat faster and larger volumes and are less affected by nearby blood vessels.
• Microenvironment and inflammation: tumours as wounds that do not heal: A tumour is not a lump of cancer cells but a tissue: fibroblasts, vessels and immune cells, recruited by the signals a wound uses and never told to stop.

Biomarker results to ask for: AFP, GPC3 (trials), Child-Pugh / ALBI liver function, AFP (prognosis; ≥400 ng/mL for ramucirumab), BCLC stage and performance status, Portal vein tumour thrombus, HBV/HCV status, AFP-L3 and DCP (GALAD score).

Scans and tests linked to this cancer: HCC surveillance in cirrhosis (ultrasound + AFP), Quantitative imaging biomarkers (RECIST, PERCIST, SUV, ADC), Serum tumour markers: proper use and misuse, Ultrasound, X-ray radiography and fluoroscopy, Dual-energy and spectral CT.

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

• Prevention: Universal HBV vaccination; antiviral suppression of HBV; direct-acting antiviral cure of HCV; alcohol and metabolic risk reduction. (Hepatitis B and C as cancer causes, HPV & HBV vaccination)
• Early: Resection, ablation, transplant. (Thermal ablation (RFA, microwave, cryo), Focused ultrasound & histotripsy)
• Intermediate: TACE/TARE ± systemic therapy. (Radioligand therapy (beta emitters))
• Very early / early (BCLC 0-A): Ablation (RFA/microwave) for ≤3 cm; resection for preserved liver function; transplantation within Milan or downstaged criteria; radiation segmentectomy as an alternative. (Thermal ablation (RFA, microwave, cryo), Liver transplantation for cancer (Milan criteria and beyond), Radioembolisation (TARE / SIRT, yttrium-90), BCLC staging)
• Intermediate (BCLC B): TACE (conventional or DEB-TACE) or TARE; systemic therapy for high tumour burden or TACE-refractory disease; TACE + durvalumab-bevacizumab or STRIDE + lenvatinib prolong PFS (OS unproven). (Transarterial chemoembolisation (TACE), Radioembolisation (TARE / SIRT, yttrium-90), EMERALD-1, LEAP-012, EMERALD-3)
• Adjuvant after resection/ablation: No approved adjuvant therapy; IMbrave050 benefit not sustained. Surveillance imaging every 3-6 months. (IMbrave050)
• Advanced: Atezolizumab-bevacizumab, durvalumab-tremelimumab, or nivolumab-ipilimumab. (Atezolizumab, Durvalumab, Nivolumab, Ipilimumab)
• Advanced (BCLC C), first line: Atezolizumab + bevacizumab (IMbrave150), STRIDE tremelimumab + durvalumab (HIMALAYA), or nivolumab + ipilimumab (CheckMate 9DW); lenvatinib or sorafenib if immunotherapy is contraindicated (transplant, active autoimmune disease). (IMbrave150, HIMALAYA, CheckMate 9DW, Atezolizumab, Durvalumab, Tremelimumab, Nivolumab, Ipilimumab, Lenvatinib, Sorafenib)
• Portal vein tumour thrombosis: Systemic immunotherapy; Y-90 radioembolisation where TACE is contraindicated; radiotherapy to the thrombus in selected patients. (Radioembolisation (TARE / SIRT, yttrium-90), SBRT / SABR (stereotactic radiotherapy))
• Advanced, second line and beyond: After immunotherapy: lenvatinib, sorafenib, cabozantinib or regorafenib by extrapolation (no dedicated phase 3); ramucirumab if AFP ≥400 ng/mL; clinical trials. (Cabozantinib, Regorafenib, Ramucirumab, Lenvatinib, RESORCE, CELESTIAL)
• Surveillance: Six-monthly ultrasound ± AFP in cirrhosis and high-risk HBV carriers; abbreviated MRI where ultrasound is inadequate. (HCC surveillance in cirrhosis (ultrasound + AFP), Ultrasound, Alpha-fetoprotein (AFP))

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