Knowing Your Liver Cancer Care Team: From Diagnosis to Recovery

Having a team of dedicated professionals by your side is essential as you navigate your journey through cancer treatment. From the very first day when you seek answers for symptoms that may be signs of cancer, your care team is there to guide you. Through diagnosis, treatment and recovery, each member of your care team works together to provide you with comprehensive care and support.

This article aims to help you understand the roles of each member on your cancer care team and how they communicate with each other.

Doctors of different specialized skills and techniques form the core of your cancer care team. Often, you’ll have more than one doctor involved in your care, whether it’s during diagnosis, active treatment, or palliative care. Their combined expertise ensures you receive holistic cancer care.

Primary care physicians or doctors manage your overall health beyond cancer-specific treatments. They are often the first doctors you consult when cancer symptoms arise. They may be your family doctor, general practitioner, or a specialist you see for routine health check-ups, such as a gynecologist. If they detect potential cancer signs during a check-up, they will refer you for further investigations. They help address other medical needs and monitor your general well-being. As part of the cancer care team, they manage all aspects of your health after active treatments, including monitoring signs of cancer progression.

Pathologists are medical doctors specializing in diagnosing cancer by examining tissue samples under a microscope. They prepare a detailed histopathology report based on the biopsy of liver tumors. This report provides essential information, including

• The type of liver cancer, such as hepatocellular carcinoma or cholangiocarcinoma
• The grade of cancer cells which indicates how aggressive they appear
• Whether cancer cells are found in nearby blood vessels or lymph node
• Specific biomarkers or genetic mutations present in the cancer (which can guide targeted therapies)

Though you may not meet the pathologists, your diagnosing or treating doctor will review this report with you, explaining its findings and how they shape your treatment plan.

Medical oncologists are central to cancer care, focusing on treatments like chemotherapy, immunotherapy and targeted therapy. They work closely with other doctors to develop a treatment plan tailored to the type and stage of cancer, as well as pre-existing health conditions you have. Depending on your specific case, the treatment may be planned as

• Neoadjuvant therapy
• Adjuvant therapy
• Combination therapy such as chemoimmunotherapy or chemoradiotherapy
• Maintenance therapy

Radiation oncologists specialize in treating cancer with radiation therapy, especially for patients who are not suitable candidates for surgery due to the location or extent of cancer, as well as the patient’s overall health or age. Additionally, they administer radiation therapy to help relieve symptoms and reduce pain in palliative care, improving the quality of life for those with advanced cancer.

Surgeons or surgical oncologists perform biopsies and surgeries to remove tumors.

Hepatologists or gastroenterologists are specialists in the digestive system, with hepatologists focusing on the liver. Many liver cancer patients often deal with pre-existing liver issues like cirrhosis, which is a major risk factor for liver cancer. Surgeons and medical oncologists sometimes collaborate with hepatologists to effectively manage liver health throughout cancer treatment. Doctors specializing in hepatopancreatobiliary care may be involved if the cancer affects tissues or organs surrounding the liver, such as the pancreas, gallbladder and bile ducts.

Many liver cancer treatments are determined based on the Child-Pugh score and other factors. Patients in advanced stages with severe liver dysfunction (Child-Pugh class C or decompensated cirrhosis) often face limited treatment options. To support these patients, hepatologists work closely with oncologists to enhance liver function, which can make more treatment options viable and improve overall outcomes. Hepatologists will also continue to monitor liver health after active treatments for the cancer.

“When we’re dealing with HCC, we are dealing with two diseases at once — the liver impairment and the cirrhosis and the cancer itself… You can’t manage HCC without also managing the cirrhosis. You need to have both.” — Dr Manish Shah, Weill Cornell Medicine New York.

Nurses often serve as your main point of contact and coordinator of your care. They are an essential part of your cancer care team, providing care across multiple settings and stages of treatment.

Outpatient nurses support patients through treatments that don’t require hospitalization, such as chemotherapy, immunotherapy, or other outpatient procedures. Working closely with doctors, they help develop personalized treatment plans and communicate them to patients. They also coordinate necessary medications and arrange for diagnostic tests. They are skilled in administering medications, monitoring for side effects, and providing guidance on managing symptoms and side effects at home.

Perioperative nurses work closely with the surgical team to support patients before, during, and after surgery. They assist in preparing patients for surgery, explaining the process and answering any questions they may have. Perioperative nurses work in pre-surgery centers, operating rooms or procedure rooms and recovery wards. They help monitor recovery, manage pain, and offer guidance on wound care and physical activity. They also communicate discharge instructions and sometimes follow up with a call during home recovery to check on the patient's progress.

Inpatient nurses provide bedside care for patients admitted to the hospital. Often, they are involved in intensive treatments and post-surgery recovery, including in intensive care units (ICUs). They monitor vital signs, assess response to treatments, administer medications, and assist with patients’ daily activities during hospitalization. Inpatient nurses are attentive to changes in patients’ condition and coordinate with doctors and other specialists to address any immediate needs.

Hospice nurses specialize in providing end-of-life care to patients with advanced cancer. They focus on comfort, help manage chronic symptoms and provide emotional support to cancer patients.

Research nurses help guide patients through the clinical trial process by coordinating enrolment, explaining study details and ensuring compliance with the trial’s protocols. They serve as a bridge between the patients and the doctors, and the research team. They may also assist with data collection.

Other than delivering basic patient care, nurses:

• Refer patients to additional resources, such as social workers, financial aid, or transportation to treatment centers
• Offer educational guidance to help patients and caregivers understand complex information about their diagnosis and treatments
• Provide emotional support to both patients and their families, help to manage any anxieties or concerns during hospital stays
• Are trained to manage complex needs of cancer patients

Beyond doctors and nurses, a range of specialists contribute to your care, addressing physical, psychological, and practical needs.

Pharmacists ensure medications are administered correctly and educate patients about potential side effects and interactions with other medications.

Radiographers or radiology technologists perform imaging scans, such as X-rays, MRIs, and CT scans, which are essential for diagnosing, staging, and monitoring cancer.

Nutritionists and dietitians guide dietary choices, helping patients maintain strength, manage side effects, and adjust to treatment-related changes in appetite or digestion. Good nutrition is particularly important in liver cancer, where dietary choices can impact liver health.

Genetic counsellors help patients understand the genetic aspects of cancer. They offer genetic testing, which can reveal whether you or your family members may be at higher risk of certain cancers.

Psychologists provide mental health support, helping patients manage anxiety, depression, and the emotional stress that often accompanies a cancer diagnosis.

Social workers assist with practical challenges, from arranging transportation to treatment appointments to helping with financial aid or insurance paperwork. They can also connect patients and families with community resources and support groups.

Radiation therapists work under the guidance of radiation oncologists to deliver precise doses of radiation therapy. They’re involved in every radiation session, ensuring the treatment is both accurate and comfortable.