As someone living with hepatocellular carcinoma (HCC), you need to know all you can about your short and long-term treatment options. This doctor discussion guide will help start the conversation with your healthcare team — and keep it going as you work your way through treatment.

Questions about hepatocellular carcinoma

What stage is it?

How is my liver functioning?

Why it matters

Staging indicates if the cancer is localized or regional, or has spread to distant sites. Cancer stage and liver functioning can give you some idea of your general outlook. These factors also help your doctor determine which treatments are best for you.

Questions about surgery

What is the goal of this surgery?

What are the potential risks and side effects?

Where and when will the surgery be done?

What will recovery be like?

What happens if I don’t opt for (or can’t have) surgery?

Why it matters

Surgical resection or liver transplantation offer the best hope for long-term survival.

If your liver is still healthy and the disease is in its early stages, you can have surgery to remove the tumor and part of the liver (partial hepatectomy). This may not be an option if your liver isn’t functioning well, due to cirrhosis.

A liver transplant is possible in some cases, but not if the cancer has spread to distant organs. There’s also limited availability of liver donors. If you do have a liver transplant, you’ll be taking antirejection drugs for the rest of your life.

These questions can help you plan for surgery and recovery, plus any long-term implications.

Questions about targeted drug therapy

What is the goal of this treatment?

Why do you recommend this particular drug?

How will I take it?

What are the short-term risks, side effects, and drug interactions?

Can we do anything to ease those side effects?

Are there any long-term effects?

Why it matters

Targeted drugs can go after cancer cells without harming healthy cells. That’s why they tend to have fewer side effects than chemotherapy. And they can be helpful when the cancer has spread outside the liver.

There are two targeted therapies approved for people with HCC.

Sorafenib (Nexavar) serves two purposes. It stops tumors from forming new blood vessels, which is something they need to keep growing. It also destroys certain proteins on cancer cells that foster growth. Even if sorafenib works well initially, it can eventually lose its effectiveness.

Regorafenib (Stivarga) works in much the same way. It’s approved for use in people previously treated with sorafenib.

A third drug, nivolumab (Opdivo), was approved in 2017 for treatment for people with HCC who have already tried sorafenib. It works by activating your immune system to attack and kill the cancer cells. Studies show promising results in treating advanced liver cancer.

Each of these powerful medications has potential risks and side effects. You’ll want to understand how to take these medications and what to expect.

Questions about radiation therapy

What is the goal of radiation therapy?

Where will I get treatment?

How many sessions will it take?

Will I need someone to come with me?

What are the potential risks and side effects, and what can we do about them?

Why it matters

Radiation therapy uses high-energy X-rays to destroy cancer cells. Radiation can easily damage the liver, so it’s used sparingly for liver cancer. It’s usually given five days a week for a few weeks, so some planning is in order.

Questions about ablative techniques

What is the goal of this treatment?

How is the procedure performed?

What are the potential side effects?

Is there a recovery period?

Why it matters

There are several ablative techniques used to destroy liver cancer cells. Radiofrequency and microwave ablation use extreme heat. Cryoablation uses extreme cold in the form of liquid nitrogen. And alcohol can also be injected directly into a liver tumor to destroy cancer cells.

These techniques may be performed during open surgery, laparoscopically, or by injection through the skin into the liver.

Questions about chemotherapy

What type of chemotherapy are you recommending and why?

How many treatments will I need?

Where will I go for treatment?

What are the potential risks and side effects now and in the long term?

Can side effects be reduced or treated?

Will I need someone to come with me?

Why it matters

Systemic chemotherapy (given intravenously) for advanced HCC is not shown to improve survival. But chemotherapy drugs can sometimes be injected directly into a liver tumor for treatment.

Questions about clinical trials

Why it matters

Clinical trials help pave the way for new treatments. They can also provide access to experimental therapies that you can’t get anywhere else.

Trials generally have strict criteria, and they may take up more of your time than standard treatment. Your oncologist can provide information about clinical trials for which you may qualify. You’ll want to weigh all the pros and cons carefully.

Questions about other treatments

Why it matters

Palliative care, or supportive care, focuses on symptom relief. Palliative care specialists can work with your oncology team to help improve quality of life during treatment.

Other complementary treats such as massage, acupressure, and music therapy may also be helpful, particularly in managing some of the side effects related to treatment. Your doctor can help figure out which of these therapies is appropriate and won’t interfere with your other treatment. They can also refer you to qualified practitioners.

Questions about lifestyle changes

Why it matters

You’ll probably be advised to stop consuming alcohol, which can damage your liver. Your doctor can also make specific suggestions about diet, exercise, and other factors that play a role in your overall health. Certain changes may also help improve side effects of treatment.

If you don’t understand the answers, ask follow-up questions.

It’s a good idea to write down questions in advance of your visit and to take notes while you’re there. It’s also helpful to have a family member or a friend with you at the visit to help remember some of the answers the doctors provide. Oncologists expect questions and understand your need for clarification.