Post-Treatment Follow-Up for Liver Cancer

Even after treatment ends, your doctor and care team will want to see you regularly for follow-up visits. Feeling anxious about these check-ups is natural, but follow-up care after cancer treatment is important. It gives your care team a chance to assess your health, address any physical or emotional concerns you may have, and adjust your care as needed. Regular check-ups can also help you stay on track with any ongoing medications or lifestyle changes that can help you and your long-term health.

At follow-up appointments, your doctors and care team may first ask you several questions, such as:

• How are you feeling or coping?
• Have you had any symptoms or side effects?
• Are you worried about anything related to your cancer?

They may do a physical examination, which involves:

• Feeling your abdomen to check if your liver or spleen is enlarged
• Feeling your abdomen for any buildup of fluid (known as ascites)
• Looking for any yellowing of your skin and eyes (known as jaundice)
• Checking your legs for swelling (known as edema)
• Checking for skin problems, e.g., rash, peeling or itching

This can be followed by tests and examinations, which can include:

• Blood tests, e.g., liver function test
• Tumor marker tests, e.g., alpha-fetoprotein (AFP) tumor marker test
• Computed tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Ultrasound scans
• X-rays

While you won’t undergo all these tests at every visit, your doctor may arrange for some of them depending on whether you’ve had any symptoms or if there’s something specific that needs to be checked out. This is to look for any possible side effects of treatment and any signs of cancer recurrence or second cancers. So remember, you must communicate any issues, no matter how small they may seem. These visits are a good time to ask questions or talk about any changes or concerns you have.

The frequency of follow-up appointments might not be the same for everyone who has had liver cancer. It depends on your overall health and the treatments you’ve undergone.

In general, the first follow-up visit after any type of liver cancer treatment is scheduled 4 to 6 weeks after treatment completion. Thereafter, appointments can be scheduled differently according to the different treatment types.

• Surgery, liver transplant or ablation/embolization: If you have no signs of cancer remaining, follow-up after these treatments will typically be every 3 to 6 months over the first 2 years, then every 6 to 12 months thereafter.
• Systemic therapy (i.e., chemotherapy, targeted therapy, immunotherapy): If you underwent systemic therapy, follow-up visits are usually every 2 to 3 months for the first year. Afterwards, if treatment is effective and you enter remission, the frequency may be reduced to once every 6 months.

Do take note that this is a general guide. The frequency of your follow-up appointments may differ depending on your overall health and whether you have any risk factors for cancer recurrence or second cancers. It’s best to check with your doctors and care team for a follow-up schedule that works for you. Also, if you have any concerns between appointments, please don’t hesitate to reach out to a healthcare professional for help.

What you will need for follow-up is documented in a survivorship care plan. Apart from summarizing what you went through during treatment, it details a multitude of things, including but not limited to:

• Schedule for follow-up tests and examinations
• Types of tests and examinations you need
• Possible long-term or late side effects of treatment
• Screening guidelines for post-treatment symptoms, recurrence and second cancers
• Recommendations for healthy living and lifestyle changes post-treatmen

If you haven’t already done so, talk to your healthcare providers about developing a comprehensive survivorship care plan for you. Knowing what to expect following treatment can help you make preparations and adapt to changes in your day-to-day life.