Why tumor records and liver-function records are two separate questions
Liver cancer sits in an organ that is often already damaged. That single fact changes how records are read. A tumor record answers questions about the cancer: where the lesions are, how many, how large, whether there is vascular invasion, whether nodes or distant sites are involved, and what the tissue or imaging suggests about the type of tumor. A liver-function record answers a different question: how much working liver the patient has, whether there is cirrhosis or portal hypertension, and whether the synthetic and excretory functions are stable or deteriorating.
These two sets of information are not interchangeable, and one cannot compensate for a missing other. A small tumor in a badly decompensated liver and a similar tumor in a well-preserved liver are not the same clinical problem, even if the imaging report looks almost identical. That is why a treating team reviewing an overseas case will usually want both threads visible in the same summary, rather than a folder of scans with no laboratory context, or a set of blood results with no imaging.
For the patient, the practical consequence is that the enquiry summary should be organised in two labelled parts. Part one: tumor. Part two: liver background and function. Anything that does not fit either part can wait until the treating team asks for it.
What belongs in the tumor record
The tumor record should let a reader reconstruct the disease without opening every file. Start with the most recent cross-sectional imaging report: the date, the modality, the number and size of lesions, their segmental location, and any statement about vascular invasion, bile duct involvement, lymph nodes or extrahepatic disease. If earlier imaging exists, a short dated sequence showing how the lesions have changed is more useful than a pile of undated discs.
Pathology matters when a biopsy or resection has been performed. The report should be included in full, including the immunohistochemical panel and any statement about differentiation or vascular invasion. If no tissue diagnosis exists, say so explicitly rather than leaving the reader to guess. A treating team can work with imaging-based diagnosis in some situations, but they need to know that is what they are doing.
Tumor markers are part of the tumor record, not the liver-function record. Include the values with dates and units, and note whether they were measured before or after any previous treatment. A single number without a date is difficult to interpret; a short trend is easier to place in context.
Finally, include a one-paragraph treatment history. What was done, when, at which hospital, and what the response was. If the patient had local treatment such as ablation, embolisation, resection or radiotherapy, the treating team will want to know the target, the technique and the follow-up imaging result. This part of the file is frequently thin in overseas enquiries, and it can change how the review reads.
What belongs in the liver-function record
The liver-function record is not only a set of enzyme values. It should include the standard biochemical panel with dates: bilirubin, albumin, transaminases, alkaline phosphatase, gamma-glutamyl transferase, and coagulation studies such as prothrombin time or INR. These give a picture of synthetic and excretory function, and they are read together rather than one at a time.
Beyond the blood tests, the record should state what is known about the underlying liver disease. Is there cirrhosis, and if so, what is the evidence? Has portal hypertension been documented, for example by imaging, endoscopy or clinical findings? Is there ascites, encephalopathy or a history of variceal bleeding? These are not laboratory values, but they belong in the same part of the file because they describe the liver the tumor is sitting in.
Viral status is also relevant background. If hepatitis B or C has been documented, include the serology and any current antiviral treatment. If the status is unknown, say so. A treating team will want to know whether viral suppression is part of the picture, and they will confirm current status themselves if it is not clear.
One practical point: liver-function results can change quickly, especially around procedures or infections. The most recent set is the most useful, but a short dated trend over recent weeks is more informative than a single value with no comparison.
Previous local treatment: the part that is frequently incomplete
Many liver cancer patients arrive at an overseas enquiry having already had some form of local treatment. That history is not a footnote. It changes what options remain, what imaging means, and how the treating team interprets the current lesion pattern.
For each previous local treatment, the useful details are: the date, the hospital, the technique used, the target lesion or segment, and the imaging assessment after treatment. If the treatment was transarterial, note whether it was a single session or a series. If it was ablation, note the approach and the follow-up imaging result. If it was radiotherapy, note the target and the completion date. If it was surgery, include the operative note and the pathology report.
The reason this matters is that post-treatment imaging is read differently from treatment-naive imaging. A lesion that looks active after embolisation may represent residual disease, post-treatment change, or both, and the treating team needs the prior images and reports to judge. Without them, the review may be limited to a general discussion rather than a case-specific one.
If the patient is unsure what was done, the honest answer is to say so and to request the discharge summary and procedure report from the treating hospital. A short gap in the history is easier to work with than a guessed one.
How to present the file so a multidisciplinary review can use it
Liver cancer decisions are often made by more than one specialty. Surgery, interventional radiology, medical oncology, radiotherapy and hepatology may all have a view, and the value of a multidisciplinary review depends on whether each specialty can see the information it needs. A file that is organised by specialty question is easier to use than one organised by date alone.
A practical structure is a short cover summary followed by labelled attachments. The cover summary should be one or two pages: diagnosis or working diagnosis, date of diagnosis, current tumor description, liver background, previous treatments, current symptoms, current medications, and the specific question the patient wants answered. The attachments then follow in labelled groups: imaging reports, pathology, laboratory results, treatment records, and a medication list.
Two administrative points are worth confirming with the receiving provider rather than assuming. First, how they prefer to receive imaging: some teams want the original discs or a secure upload link, not photographs of films. Second, whether they want the records translated in advance or will arrange interpretation themselves. These are provider-specific questions, and the answer affects how quickly a review can start.
It is also worth being explicit about what the patient wants from the review. A general request to 'look at the case' produces a general reply. A specific question, such as whether a particular local treatment is still an option or what the treating team would need to assess suitability for a named approach, produces a more useful response. The patient does not need to decide the treatment; they need to state the decision they are trying to make.
What a records review can and cannot settle
A records-based review can clarify whether the file is complete enough for a meaningful discussion, identify what is missing, and give a view on whether the case is worth bringing to a specific team. It cannot replace an in-person assessment, and it does not establish hospital acceptance, treatment availability or a final plan. Those decisions belong to the treating hospital and its clinicians after they have seen the patient and any additional tests they require.
This distinction matters for planning. If the review suggests the case is suitable for further assessment, the next step is usually a direct clinical appointment, not a commitment to treatment. If the review identifies gaps, the next step is to obtain the missing records. If the review suggests the question is better answered locally, that is also a useful outcome, because it avoids unnecessary travel.
Radiotherapy is one example where the treating team's own planning process is central. Radiotherapy uses radiation to treat cancer, and the technique and schedule depend on the individual treatment plan. A records review can discuss whether radiotherapy is a plausible option to assess, but the planning itself is done by the treating team with their own imaging and dosimetry.
For patients considering care in China, the practical next step is a short initial enquiry with the cover summary described above. An initial enquiry is free and does not require buying a proxy consultation. The team can then say what is missing and whether a specialist appointment or a records-based opinion is the more useful route.
Sources & scope of this guide
References and official service information relevant to this guide.
This is general planning information and has not been individually reviewed by a doctor. Medical decisions and personal treatment advice come from your treating clinicians.