Medical Oncologist
CION Cancer Clinics
The liver cancer pathway from first scan to treatment | CION Cancer Clinics
Most people go from a first scan, to a detailed liver CT or MRI, to blood tests that measure liver function, to a tumour board that agrees the plan, and then to treatment. Many different doctors are involved, and each handover is where delays creep in. This page sets out the usual order, who does what, and how to stop a step from stalling. 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
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- What happens between the first scan and the first treatment?
- Which doctors will I meet along the way?
- What is the usual order of tests and decisions?
- Words you will hear at each step
- Four things families expect about the pathway
- What this page cannot tell you
- Common questions about the liver cancer pathway
The short answer
What happens between the first scan and the first treatment?
The pathway usually runs from a first scan, to a detailed liver scan, to blood tests that measure how well the liver works, to a team meeting that agrees the plan, and then to treatment. Each step answers one question, and the plan is only as good as the answers it is built on.
Which liver cancer this page is about
This page follows cancer that starts in the liver, mostly hepatocellular carcinoma (HCC). If you were told the cancer spread to the liver from the bowel, breast or elsewhere, the pathway is planned around where it started. Our page on primary and secondary liver cancer explains the difference.
Why it feels so fragmented
Few cancers pass through as many hands. A physician, a gastroenterologist, a hepatologist, a radiologist, an interventional radiologist, an oncologist and sometimes a transplant surgeon may all be involved. Each handover is where reports get lost and weeks slip by. Knowing the order of steps helps you notice when one has stalled.
The pathway is a map, not a timetable. Your team may skip or repeat a step for good reason.The people involved
Which doctors will I meet along the way?
Not everyone sees all of them. These are the roles most people meet.
The doctor who found it
Often a general physician or gastroenterologist who ordered an ultrasound for pain, a check-up or a hepatitis follow-up. They make the first referral, so their letter matters.
Hepatologist
A liver specialist. They judge how well the liver works, look for cirrhosis and varices, and treat hepatitis B or C. Their view decides which treatments the liver can tolerate.
Radiologist and interventional radiologist
The radiologist reads the scans. The interventional radiologist treats through needles and fine tubes, with procedures such as TACE and ablation.
Oncologist and surgeon
The medical oncologist plans drug treatment and often coordinates the whole plan. The surgical oncologist assesses whether part of the liver can be removed.
Sometimes also
- A transplant surgeon at a licensed transplant centre
- A radiation oncologist
- A palliative care doctor for symptoms
Not sure whether this applies to you?
Ask an oncologistStep by step
What is the usual order of tests and decisions?
A first scan raises the question
Usually an ultrasound shows a spot or lesion. It cannot say what the spot is. It only says it needs a closer look.
A detailed liver scan
A triple-phase CT or liver MRI shows how the spot takes up contrast. In a liver with cirrhosis, the pattern can be enough to diagnose HCC without a biopsy.
Blood tests and hepatitis checks
Liver function, AFP, platelets, INR and hepatitis B and C tests. These show how well the liver works and what may have caused the cancer.
A biopsy, only if needed
If the scan pattern is not clear, or the liver is not cirrhotic, a needle biopsy may be arranged.
Staging and the tumour board
The team combines the tumour, liver function and your fitness into a BCLC stage, then discusses the case together.
Treatment begins
Surgery, ablation, TACE, transplant assessment, radiation or drug treatment, depending on the stage and the liver.
On the way
Words you will hear at each step
- Lesion or SOL
- A spot or space-occupying lesion on a scan. The word describes something seen, not what it is.
- Arterial enhancement and washout
- How a spot lights up with contrast and then fades. Together they are the pattern that suggests HCC.
- LI-RADS
- A scale radiologists use to say how likely a spot is to be HCC.
- Child-Pugh
- A score, A to C, for how well the liver is working.
- BCLC stage
- The staging system that links the tumour, the liver and your fitness to the treatment options.
- Tumour board
- A meeting where specialists review the scans and reports together and agree a plan.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Did you know
At CION, liver cases are discussed at a multidisciplinary tumour board before a plan is confirmed. Scans, biopsies, TACE, ablation and transplant assessment are coordinated through accredited partner hospitals and diagnostic centres, so the board can see every result in one place.
Commonly believed
Four things families expect about the pathway
"Nothing can happen until there is a biopsy."
In a liver with cirrhosis, HCC can often be diagnosed from a good-quality scan alone. Waiting for a biopsy that is not needed can add delay. Our page on diagnosis without a biopsy explains when this applies.
"The first scan we had is enough for the specialist."
A plain ultrasound or a single-phase CT rarely answers the question. Most teams need a liver-protocol CT or MRI before they can stage the cancer.
"Treatment depends only on the size of the tumour."
The liver around the tumour matters just as much. Two people with the same tumour can be offered different treatment because one liver is working well and the other is not.
"Seeing more doctors means more delay."
Each specialist answers a different question. Delay usually comes from reports not reaching the next doctor, not from the number of doctors. A single file and a tumour board review shorten the gaps.
Being straight with you
What this page cannot tell you
It cannot tell you which step you are on, or whether a spot on your scan is cancer. Only the team that has your scans, blood tests and history can do that. It also cannot say how long each step should take where you are being seen. Our page on where delays happen covers the common hold-ups and what helps.
Who this does not apply to
Cancer that has spread to the liver from another organ follows the pathway of that cancer. Children with liver tumours are cared for on a separate path, described on our hepatoblastoma page. Someone who is very unwell, with jaundice, confusion or bleeding, may need hospital care before any of these steps.
What helps at every step
Carry every report and the scan images in one place, as described in keeping a single liver cancer file. Ask at each visit what the next step is and who will arrange it. If nobody can answer, ask for your case to be reviewed by a tumour board.
Questions we are asked
Common questions about the liver cancer pathway
Who should coordinate the whole pathway?
Ideally one named doctor, often the medical oncologist or hepatologist, who keeps track of every result and makes sure the next step is booked. If you are passing between several doctors and nobody holds the full picture, ask which of them will act as your lead.
Do I always need a biopsy before treatment?
No. In a liver with cirrhosis, a clear pattern on a liver-protocol CT or MRI can be enough to diagnose HCC. A biopsy is arranged when the scan is not typical, when the liver is not cirrhotic, or when another type of cancer is suspected.
Why do they test for hepatitis when the problem is cancer?
Hepatitis B and C are common causes of liver cancer in India. Treating the virus protects the rest of the liver, and hepatitis B can flare during some cancer treatments if it is not controlled. The result also matters for screening family members.
Why do I need an endoscopy?
People with cirrhosis can have swollen veins in the food pipe, called varices, which can bleed. Checking for them before some treatments allows them to be treated first. It is arranged through a gastroenterologist or hepatologist.
What is a tumour board and do I attend it?
It is a meeting where several specialists review your scans and reports together and agree a plan. Patients do not usually attend. Your doctor explains the recommendation afterwards and talks it through with you and your family.
Can I get a second opinion partway through?
Yes, at any step. A second opinion is most useful once the detailed scan and blood tests are done, because the reviewing team can then see the whole picture. Bring the scan images, not just the written reports.
Where does treatment actually take place?
It depends on the treatment. Drug treatments are given at CION centres. Procedures such as TACE, ablation, surgery, radiation and transplant are coordinated through accredited partner hospitals, and your team will tell you exactly where each one takes place.
We live outside Hyderabad. Can some steps happen nearer home?
Often, yes. Blood tests and some scans can be done near home if the quality is suitable, and results shared with the team. Call the helpline to check what can be done locally before you travel. One helpline serves every CION centre.
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
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Sources
- National Cancer Institute — Liver Cancer Diagnosis
- American Cancer Society — Diagnosing Liver Cancer
- American Cancer Society — Treatment of Liver Cancer, by Stage
- Cancer Research UK — Diagnosing 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
Talk to us
Not sure what the next step should be?
Share the reports you have and we will tell you which step you are on and what is still needed before a plan can be made. One helpline serves every CION centre.