Here, the Hampshire Hospitals NHS Foundation Trust’s Basingstoke and North Hampshire Hospital liver team describe a patient’s journey from the time of diagnosis.
*Please note that this applies to Basingstoke practice. If you have questions or concerns about your specific diagnosis and treatment, you should chat to your specialist nurse.
Timing of diagnosis of liver cancer
Liver cancer can either have developed within the liver (a primary cancer) or have spread to the liver from elsewhere, most commonly from the bowel (metastatic cancer). It may be diagnosed when a patient presents with new symptoms, or discovered during a patient’s follow up after surgery for bowel cancer. The diagnosis is usually made on an ultrasound or CT scan. The patient’s GP or specialist will then refer them to a liver surgeon for further assessment.
As liver surgeons, we need to answer the following questions:
- Is this a primary or secondary liver cancer?
- Is surgery the best treatment?
- Is surgery possible?
- Is the patient fit for major surgery?
- Do we need to consider additional or alternative treatments such as chemotherapy or ablation?
We can answer many of these questions by performing a specialised MRI scan. One of our Consultant Radiologists, Dr Delia Peppercorn has a specific interest in liver MRI. She can usually tell us what the lesion in the liver is and its relationship to the blood vessels going into and coming out of the liver.
We may also want to do other tests such as a CT scan of the chest or a PET-CT scan and would discuss this with the patient. Our Nurse Specialist Ms Debbie Butler helps coordinate any additional investigations and liaises directly with the patient.
Discussions with the patient
When all the necessary tests are complete we would sit down with the patient and any relatives (who are most welcome) and discuss their results. We would normally do this on the same day as the MRI scan if the patient has travelled far.
If it is appropriate and possible to remove the section of the liver with the cancer in it, we would discuss this with the patient and assess their fitness for surgery. We would also discuss with them and their family whether additional or alternative treatments might be appropriate.
If a patient is to undergo surgery, they would then come in for a formal pre-operative assessment. This takes about half a day and involves being seen by the junior doctors, the anaesthetists, the nursing staff and the physiotherapists.
All aspects of the operation and recovery period are discussed and the patient’s consent for surgery obtained. The patient would also have routine blood tests performed and be screened for MRSA, so that we can treat this pre-operatively if present.
The patient would usually be admitted to hospital the day before surgery. The operation takes about four hours and patients wake up in the Theatre Recovery Area, the High Dependency Unit or the Intensive Care Unit, where they can be closely monitored and receive one to one nursing care. We usually like to telephone a close relative immediately after the operation (with the patient’s permission) to tell them how the operation has gone and reassure them.
The post-operative period
The following day patients usually go back to the ward where they are closely monitored by the medical and nursing staff. They can start drinking fluids as they feel able. They will have a number of tubes, drips and drains which will all be removed over the next few days as they recover from surgery.
The physiotherapists help the patients get out of bed on the first post-operative day and encourage deep-breathing exercises. Most patients will go home at about 5-8 days after the operation. We ask their GP Practice Nurse to take out the skin stitch on the fourteenth post-operative day.
We usually like to see patients back in the clinic at two to three weeks post-operatively as a check-up. If the patient lives far away, we would ask their referring centre to do this. At this visit, we discuss the report from the histopathologist regarding the section of liver we have removed and plan any further treatment or follow up, either in Basingstoke, or at the patient’s referring centre.
Where we are
The team are based at Hampshire Hospitals NHS Foundation Trust’s Basingstoke and North Hampshire Hospital but also perform outpatient clinics in Alton and Bordon.
What’s special about us?
We are constantly striving for perfection for each and every one of our patients and our results compare to the best in the world.
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