Medical Oncologist
CION Cancer Clinics
Questions to ask before starting systemic treatment for liver cancer | CION Cancer Clinics
Before starting a drug for liver cancer, ask why this drug, what it is meant to do, whether your liver can take it, and what the full cost will be. Then ask which checks come first and who to call at night. This page gives you the list, explains the pre-treatment checks, and says when a drug is not the right next step. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What should you ask before starting a liver cancer drug?
- Which questions matter most before systemic treatment?
- What has to happen before treatment can start?
- What do the doctors' terms mean in plain language?
- When is a liver cancer drug not the right next step?
- What this page cannot tell you
- Common questions before starting systemic treatment
The short answer
What should you ask before starting a liver cancer drug?
Ask why this drug, why now, what it is meant to do, how you will know it is working, and what it will cost in total. Then ask what checks are needed before the first dose and who to call if something goes wrong at night. Those questions cover most of what families later wish they had asked.
Why the questions are different for liver cancer
In most cancers the doctor weighs the tumour and your fitness. In hepatocellular carcinoma (HCC, the commonest primary liver cancer) there is a third thing: the liver that is left. Many people also have cirrhosis (scarring of the liver) or hepatitis B or C. A drug that suits the tumour may not suit a tired liver, so your questions need to cover both.
Who should ask them
The patient, if they are able, and the family member who will manage appointments and bills. Write the questions down. Take them to the planning visit with your oncologist, and ask someone to note the answers. It is normal to ask the same thing twice.
This page is about drug treatment for primary liver cancer. If cancer spread to the liver from the bowel, breast or elsewhere, the questions follow that cancer's plan.The list to take with you
Which questions matter most before systemic treatment?
Group them under four headings. You do not need every answer on the first day, but you need to know who will give them.
About the choice of drug
- Why this drug and not another option?
- Is the aim to shrink the cancer, slow it, or relieve symptoms?
- Were surgery, ablation or TACE considered?
- Has the tumour board reviewed my scans?
About my liver
- What is my Child-Pugh grade, and does it allow this drug?
- Is my hepatitis B or C controlled?
- Do I need an endoscopy first to check for varices?
- Who is my hepatologist during treatment?
About side effects
- Which side effects are common with this drug?
- Which ones mean I should come in the same day?
- Who do I call out of hours?
- Which of my other medicines must stop or change?
About money and practical life
- What is the total cost, beyond the drug itself?
- Is there a scheme, insurance cover or assistance programme?
- How often will I need to travel for treatment?
- Can I keep working?
Not sure whether this applies to you?
Ask an oncologistChecks before the first dose
What has to happen before treatment can start?
A confirmed diagnosis and a recent scan
A triple-phase CT or MRI, sometimes a biopsy, so the team knows the size and spread of the cancer. CION arranges these through diagnostic partners, and the recent scan becomes the baseline to compare against.
Blood tests of liver function
Bilirubin, albumin and INR show how well the liver is working. They help decide whether a drug is safe, and which one.
Hepatitis B and C status
Active hepatitis B must be controlled with antiviral tablets before and during immunotherapy. A hepatologist or physician decides on these. Read about systemic treatment with hepatitis B still active.
An endoscopy if bevacizumab is planned
Bevacizumab can raise the risk of bleeding from varices (swollen veins in the food pipe). See why the endoscopy comes first.
A plan for checking the response
Ask when the first repeat scan will be done and what result would lead to a change of drug.
Words you will hear
What do the doctors' terms mean in plain language?
- Systemic treatment
- Medicine that travels through the whole body in the blood, as a drip or tablets, rather than treating one spot in the liver.
- First-line
- The first drug treatment chosen. Second-line is what follows if the first stops working or cannot be tolerated.
- Child-Pugh
- A grade of liver function from A, the best working, to C, the most damaged. Most drug trials included people with grade A.
- Response
- How the cancer changes on scans. It may shrink, stay the same, or grow. Staying the same can be a good result.
- Progression
- The cancer has grown or spread despite treatment. It usually means the team discusses a different drug.
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Did you know
Many families hide past drinking or herbal liver tonics from the doctor out of embarrassment. Your oncologist needs to know both, without judgement, because they change which drug is safe and how the liver is watched.
Who this does not suit
When is a liver cancer drug not the right next step?
Drug treatment is usually for cancer that cannot be removed, ablated or treated through the blood vessels, or that has spread outside the liver. If a small cancer was found early, ask first whether a curative treatment such as surgery, ablation or a transplant assessment is still possible. Starting a drug too early can mean a better option is missed.
When the liver is too weak
People with Child-Pugh C function, or who are mostly in bed, often do not benefit from these drugs, and side effects can harm more than help. Good symptom care may then be the kinder and more honest plan. That is a decision to make with your team, not a failure.
When immunotherapy is unsafe
Immunotherapy is usually avoided after a liver transplant, and needs care in people with autoimmune illness. Tablets such as sorafenib or lenvatinib may then be discussed. Read choosing between immunotherapy and tablets for how that choice is made.
Being straight with you
What this page cannot tell you
It cannot tell you which drug is right for you, or how you will respond. That depends on your scans, your blood tests, your liver function and your fitness, read together by your oncologist and the tumour board. No list of questions replaces that review.
It cannot tell you how long you will live
Families often want a number before deciding. Averages from trials describe large groups, not one person, and they can mislead. Ask instead what the team expects the treatment to do, and how you will both know if it is not working.
Where to take your questions
Take them to your oncologist at the planning visit. If you want a second view before starting, that is reasonable, and the page on getting a second opinion explains how. Drug details live on the immunotherapy and targeted therapy pages.
Questions we are asked
Common questions before starting systemic treatment
Is it rude to ask my oncologist so many questions?
No. Good oncologists expect questions and would rather answer them before treatment than deal with confusion later. Bring a written list, ask the most important ones first, and ask who to contact with the rest. A family member taking notes helps a great deal.
Should I ask whether surgery or TACE is still possible?
Yes. Drugs are usually used when local treatments are no longer suitable. Asking whether surgery, ablation or TACE was considered, and why it was not chosen, is a fair question. The answer often explains the whole plan.
Why does my hepatitis B matter for this treatment?
Immunotherapy and other cancer drugs can let hepatitis B flare up, which can damage the liver further. Antiviral tablets keep the virus controlled. Hepatitis B is controlled, not removed, so the tablets usually continue alongside treatment, decided by your hepatologist or physician.
Can I take my herbal liver tonic during treatment?
Tell your oncologist exactly what you take before you start. Some herbal products can injure the liver, and that risk is higher in a liver with cirrhosis. Bring the bottle or packet to the visit. You will not be judged for it.
Which side effects mean I should come in the same day?
Ask your team for their own list. Vomiting blood, black stools, new confusion or drowsiness, yellowing eyes with fever, or severe stomach pain need a hospital the same day. The raised liver enzymes page explains one common blood test change.
How will we know if the drug is working?
Through repeat scans and blood tests, often including AFP (a liver cancer marker). Ask when the first scan will be and what change would lead to a switch. The page on how response is assessed explains the scan reports.
Should I ask about cost before starting?
Yes, and in writing. Ask for an itemised estimate covering the drug, scans, blood tests, day-care and supportive medicines. Ask too whether a scheme, insurance or an assistance programme applies. Knowing early helps avoid stopping treatment midway.
Can I get a second opinion before I start?
Yes. A second opinion is reasonable for any major treatment decision. Bring all scans on disc, the reports and blood tests. CION offers consultations and second opinions, and every plan is reviewed by a tumour board. Call the helpline to arrange one.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- American Cancer Society — Immunotherapy for Liver Cancer
- American Cancer Society — Targeted Drug Therapy for Liver Cancer
- National Cancer Institute — Liver Cancer Treatment
- National Cancer Institute — Side Effects of Cancer Treatment
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Systemic treatment for liver cancer: the options todayThe drugs your questions will be aboutWhy you need an endoscopy before bevacizumabThe check most families do not expectPatient assistance and drug access programmesHelp with the cost question before the first doseQuestions to ask before agreeing to a treatmentWider questions for any liver cancer plan
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