Medical Oncologist
CION Cancer Clinics
What to write down from the liver cancer staging conversation | CION Cancer Clinics
Write down four things: the stage label exactly as spoken, how well the liver is working, how fit the team thinks you are, and what treatment is aiming for. Liver cancer staging mixes all three into one letter, so notes that capture only the tumour can mislead the family at home. This page gives you the headings, a simple way to take notes together, and the words you will hear. At CION Cancer Clinics, our team goes through your scan, blood test and biopsy reports with you and plans the next step.
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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 I write down when the doctor explains the stage?
- Which details from the staging talk should go on paper?
- How can a family take useful notes without missing the conversation?
- What do the staging words on my notes mean?
- What do families often get wrong after a staging talk?
- What can this page not tell you?
- Common questions about the staging conversation
The short answer
What should I write down when the doctor explains the stage?
Write down four things: the stage name exactly as the doctor says it, how well the liver is working, how fit the team thinks you are, and what the treatment is aiming to do. With those four on paper, almost every later conversation makes sense.
Why notes matter more in liver cancer
Liver cancer is usually staged with BCLC, a system that uses letters rather than the stage one to four most families expect. The letter is built from three things at once: the tumour, the health of the rest of the liver, and your day-to-day fitness. A doctor may say all three in a single sentence. If only the tumour part reaches home, the family can come away with the wrong picture. Our page on how liver cancer is staged explains the system itself.
First, check which cancer it is
This page is about cancer that started in the liver. If the report says the cancer spread to the liver from the bowel, breast or another organ, it is staged as that original cancer instead. Read what liver metastases means before using the list below.
You are allowed to write while the doctor talks. Most doctors welcome it.The four lines
Which details from the staging talk should go on paper?
Keep a single page with these four headings. Fill each one in the doctor's own words, then ask them to check it.
The stage, word for word
Write the exact label: BCLC 0, A, B, C or D, or a TNM stage if that is what was used. Do not convert it into stage one to four at home. The two systems do not line up neatly.
Also note
- How many tumours were seen
- Whether a blood vessel is involved
- Whether anything is seen outside the liver
How the liver is working
Ask for the Child-Pugh class, a grade of A, B or C for how well the rest of the liver copes. Some teams also mention a MELD score. This often decides which treatments are safe, as our page on Child-Pugh A, B and C explains.
How fit you are judged to be
Doctors record performance status, a short score for how much of your normal day you can manage. Write down the score and what it was based on. If it was judged on a bad week, say so.
What treatment is aiming for
Ask whether the plan has curative intent, aims to control the cancer for as long as possible, or focuses on comfort. Write the answer in one plain sentence. This line shapes every decision that follows.
Not sure whether this applies to you?
Ask an oncologistOn the day
How can a family take useful notes without missing the conversation?
Decide who writes
Choose one person to write and another to listen and ask. The patient should not have to do both. A son or daughter who reads English often takes the pen.
Bring a prepared page
Write the four headings before you arrive. Leave space under each. Add your own list of questions at the bottom, so nothing is forgotten when the room feels rushed.
Ask to record, politely
Some doctors are happy for you to record the talk on a phone. Ask first, every time. If they say no, accept it and write instead.
Read it back before you leave
Read your four lines aloud and ask, "Have I got this right?" This takes a minute and catches most mistakes, especially letters and numbers that sound alike.
Write it up the same evening
Copy the notes into one clean page while the talk is fresh. Keep it with the scan reports, as our page on keeping your own records describes.
Words you will hear
What do the staging words on my notes mean?
- BCLC
- Barcelona Clinic Liver Cancer staging. It uses labels from 0 to D, combining the tumour, liver function and fitness into one label.
- Child-Pugh
- A grade of A, B or C for how well the liver is working, based on blood tests, fluid in the abdomen and confusion.
- Performance status
- A short score for how active you are. A lower score means you can manage more of your normal day.
- Portal vein involvement
- The tumour has grown into the main vein carrying blood into the liver. It changes the stage and the options.
- Curative intent
- The treatment is planned with the aim of removing or destroying all the cancer. It is an aim, not a promise.
- AFP
- Alpha-fetoprotein, a blood marker that is raised in some liver cancers. It supports the picture but does not set the stage.
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Commonly believed
What do families often get wrong after a staging talk?
"Stage C means the same as stage three."
BCLC letters are not the same as numbered stages. A letter reflects liver function and fitness as well as the tumour. Ask what the letter means for you, rather than translating it.
"The stage tells us how long he has."
A stage describes the illness now. It does not predict one person's future. Figures in books come from large groups and often from older treatment. Our page on reading survival statistics explains why.
"We should not ask too many questions."
Asking is part of good care. A doctor would rather repeat an answer than have a family act on a misunderstanding.
"The stage never changes once it is given."
The tumour stage at diagnosis is kept on record, but liver function and fitness can change. Teams reassess after treatment, and the options can widen or narrow.
Did you know
At CION, liver cancer staging is reviewed by a multidisciplinary tumour board before a plan is confirmed. Bringing your written notes to the follow-up visit lets you check that what you heard matches what the board decided.
Being straight with you
What can this page not tell you?
It cannot tell you your stage or what it means for you. Staging needs your scans, blood tests and a doctor who has examined you. Two people with the same letter can be offered very different plans, because the liver and the person behind the letter differ.
It cannot read your notes for you
If something on your page does not make sense later, do not guess and do not search the term late at night. Write the question down and ask at the next visit, or call the team. Clinic nurses and coordinators answer these questions every day.
Who this does not apply to
This list is built for cancer that started in the liver. If the cancer spread to the liver from another organ, or the tumour is in the bile ducts, the staging words differ. Children with liver tumours are staged in a different way altogether. Ask the team which system they used before relying on the headings here.
If you want a second team to look at the same scans and notes, our page on getting a second opinion explains how.Questions we are asked
Common questions about the staging conversation
Can I record the staging conversation on my phone?
Often, yes, but always ask first. Many doctors are comfortable with a recording that stays within the family. If the doctor prefers not, take written notes and read them back before you leave. Never share a recording publicly or on group chats without the doctor's agreement.
Should the patient be in the room for the staging talk?
That is the patient's choice. Many people want to hear it directly, and doctors generally prefer that. If a patient asks a family member to hear it first, tell the team. Hiding the stage from the patient completely usually makes decisions harder later.
What if the doctor uses a stage we do not understand?
Say so straight away. Ask, "Which system is that, and what does it mean for treatment?" Write the label exactly as spoken. Then ask the doctor to point to the line on the report where it comes from, so you can find it again.
Do I need to write down the blood test numbers?
Not every number. The reports keep those. What matters is the summary the doctor gives: the Child-Pugh class, whether bilirubin or albumin is a concern, and whether the AFP is being followed. Keep the printed reports in date order with your notes.
Should I ask about survival in the staging talk?
You can, and a good doctor will answer honestly. Expect a range and an explanation, not one number. Ask what could make things go better or worse than average. Some patients prefer not to hear this, so let the patient decide first.
How do I explain the notes to relatives who were not there?
Share your clean one-page summary rather than retelling from memory. Keep it to the four headings. If relatives disagree about the plan, bring their questions to the next visit rather than arguing over what was said.
Can I bring my notes to a second opinion?
Yes. Bring the notes along with the scan images on disc, the radiology reports, blood tests and any biopsy report. Your notes help the second team understand what you were told, but they will make their own judgement from the original scans.
Who do I call if something in my notes is unclear?
Call the team that staged you first, since they know your scans. If you are a CION patient, the helpline can connect you to the clinic coordinator, who can arrange a call back or bring the question to your next appointment.
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 — Liver Cancer Stages
- Cancer Research UK — Stages of liver cancer
- National Cancer Institute — Liver Cancer Stages
- National Cancer Institute — Cancer Prognosis
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
Liver cancer staging explainedHow the stage letter is built, before you read your notesChild-Pugh A, B and C explainedThe liver function grade that sits inside the stageKeeping your own records and scan copiesWhere your notes go once you are homeQuestions to ask before agreeing to a treatmentThe next conversation after staging
Talk to us
Not sure what the stage on your notes means?
Bring your notes and reports, and a CION oncologist can go through them with you line by line. One helpline serves every CION centre.