Medical Oncologist
CION Cancer Clinics
Referral letters for liver cancer: what they should say | CION Cancer Clinics
A good referral letter says why you are being sent, what the scans and blood tests showed, how well the liver is working, and what the next doctor should decide. It should travel with every report and the scan images. Liver cancer passes through many specialists, and a vague letter at any handover can cost days. This page gives you a checklist to use before you leave the clinic. At CION Cancer Clinics, our team supports patients and families through symptoms, follow-up and life during and after treatment.
NG
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 a referral letter for liver cancer include?
- Which details should be in the letter?
- How do I make sure I leave with a useful letter?
- What do the words on a referral letter mean?
- What do patients often assume about referral letters?
- What this page cannot tell you
- Common questions about liver cancer referral letters
The short answer
What should a referral letter for liver cancer include?
A good referral letter says why you are being sent, what the scans and blood tests showed, how well the liver is working, and what question the next doctor is being asked to answer. It should come with copies of every report and the scan images themselves.
Why the letter matters so much here
Liver cancer care often moves from a family physician to a gastroenterologist, a hepatologist, a radiologist, an interventional radiologist, an oncologist and sometimes a transplant surgeon. Every time you move, the new doctor starts from the letter in your hand. A vague note that only says "liver SOL, please see" can mean repeated tests, a wasted visit, or a second trip from the district.
It applies to primary and secondary cancer
The same rules apply whether the doctors suspect a cancer that started in the liver or one that spread there from another organ. If the cancer may have spread from somewhere else, the letter should say where the first cancer was and what treatment it has had. Our page on liver metastases on a report explains the difference.
You are allowed to read your own referral letter, and to ask for it to be corrected.The checklist
Which details should be in the letter?
These are the things a liver team looks for first. A letter missing several of them often means starting over.
The reason and the question
Why you are being referred and what the sender wants to know. For example, whether a lesion seen on ultrasound needs a CT, or whether a known tumour can be treated.
What the scans showed
The type and date of each scan, the size and number of any lesions (spots or areas that look different), and whether the portal vein, the main vein into the liver, looks involved.
How the liver is working
Recent results for bilirubin, albumin and INR, any fluid in the abdomen (ascites), and any confusion. If a Child-Pugh score, a grade of liver function, has been worked out, it should be written down.
Also worth including
- AFP, a blood marker linked to liver cancer
- Hepatitis B and C results
- Any known cirrhosis or scarring
The rest of your health
Other illnesses such as diabetes, heart or kidney disease, every current medicine including blood thinners, allergies, and alcohol use. Honest details here keep later treatment safe.
Not sure whether this applies to you?
Ask an oncologistAt the clinic
How do I make sure I leave with a useful letter?
Ask for the letter before you leave
Ask whether it can be written and handed to you that day. Letters sent later by post or courier are often delayed or lost.
Read it while you are still there
Check your name, age and the spelling of the hospital you are going to. Check that the reason for referral is written clearly.
Ask what question it asks
A simple way to put it: "What do you want the next doctor to decide?" If the answer is not in the letter, ask for one line to be added.
Collect the reports and images
Ask for copies of every report and the scan images on a disc or link. Our page on carrying your scans between hospitals explains why the images matter.
Photograph everything
Take a clear phone photo of the letter and each report. If the paper is lost on the way, the photo still lets the next clinic start. Keep them in a single file.
On the letter
What do the words on a referral letter mean?
- SOL
- Space-occupying lesion. Something on the scan that takes up space in the liver. It does not say what it is, and many are harmless.
- HCC
- Hepatocellular carcinoma, the most common cancer that starts in the liver cells themselves.
- Liver metastases
- Cancer that started in another organ and has spread to the liver. It is treated as the original cancer, not as liver cancer.
- CLD or cirrhosis
- Chronic liver disease, or long-standing scarring of the liver. It affects which treatments are safe.
- Triple-phase CT
- A CT scan with dye, taken at three moments as the dye passes through the liver. It is one of the main scans used to look at liver tumours.
- Kindly evaluate and manage
- A common phrase meaning "please assess and take over care". It is polite, but it does not say what question the next doctor should answer.
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Commonly believed
What do patients often assume about referral letters?
"The doctors will send the reports to each other."
Sometimes they do. Often, especially between different hospitals, they do not. Carrying your own copies is the surest way to make sure the next doctor sees them.
"A short letter is fine. The next doctor will repeat the tests anyway."
Some tests may need repeating. Many do not, if the reports and images are complete and recent. A clear letter can save money and days of waiting.
"I should hide the drinking from the letter so we are treated well."
Alcohol history changes which treatments are safe and how the liver is protected. It does not change how you are treated as a person. Doctors need the truth to plan well.
"Without a referral letter, nobody will see us."
Many cancer clinics, including CION, will see you without one. Bring whatever reports you have. A letter helps, but its absence should not stop you seeking an opinion.
Being straight with you
What this page cannot tell you
It cannot tell you what your own letter means for your health. A referral letter is a message between doctors, written in shorthand. The words on it describe what was seen, not a final diagnosis. Ask the doctor who wrote it, or the one receiving it, to explain anything unclear.
It cannot tell you which doctor you need
Whether you should first see a hepatologist, a surgeon or an oncologist depends on the scan and how the liver is working. The page on who does what in the liver team explains the roles, but the sending doctor is the right person to choose.
Who this does not apply to
If the person is vomiting blood, passing black stools, newly confused, or has a fever with a swollen belly, do not wait to sort out a letter. Go to hospital today and take whatever reports you have. Paperwork can follow later.
If you are holding a letter and are not sure where it should go next, call the helpline and read it out. Someone will help you work out the next step.Questions we are asked
Common questions about liver cancer referral letters
Can I ask the doctor to rewrite my referral letter?
Yes. If something is wrong, missing or unclear, politely ask for it to be corrected before you leave. Doctors are used to this. A short added line saying what question the next doctor should answer is often the most useful change you can ask for.
Is a prescription slip with a note enough?
It is better than nothing, but it rarely carries enough detail. If that is all you have, make sure you also carry every scan report, the images and recent blood tests. The receiving doctor can then piece the story together.
Should the letter be in English or Telugu?
Referral letters between doctors in Telangana and Andhra Pradesh are usually written in English, and that suits most hospitals. If a family member cannot read it, ask the doctor or nurse to explain the key lines in Telugu before you leave.
How recent should the reports be?
There is no fixed rule. Blood tests for liver function change quickly, so the newest ones matter most. Scans may still be useful even if older, especially for comparison. Bring all of them and let the new team decide which need repeating.
What if the referral is for cancer that spread from elsewhere?
The letter should name the original cancer, when it was found, and what treatment has been given. Bring those reports too. The plan usually follows the original cancer, so the team treating it needs the full story, not only the liver scan.
Do I need a referral letter for a second opinion?
Not always. A second opinion depends more on the reports and images than on a letter. A summary from your current doctor helps. See our page on getting a second opinion for what to bring.
Does a scheme like Aarogyasri need a special referral?
Government schemes have their own paperwork, and the rules change from time to time. Ask the scheme desk at the hospital what they need before your visit. This is general information, not advice on any scheme, so check the details at the time.
Can CION help if my letter is unclear?
Yes. You can call the CION helpline and describe what the letter and reports say. The team can explain which specialist is likely to help first and what else to bring. One helpline serves every CION centre, so you do not need to know which one to call.
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
- NHS — Tests and next steps for liver cancer
- American Cancer Society — Diagnosing Liver Cancer
- MedlinePlus — Liver Function Tests
- Cancer Research UK — Secondary liver cancer
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
Carrying your scans between hospitalsThe images matter as much as the letterWho does what in the liver teamKnow which specialist your letter is going toWhere delays happen and how to avoid themThe handovers where referrals usually stallWhat to do while you wait for an appointmentUse the gap before the next visit well
Talk to us
Holding a letter and not sure where it goes next?
Read us the letter and the reports you have. We will help you work out which specialist to see first and what else to bring. One helpline serves every CION centre.