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Liver cancers

About

What is covered

This NICE Pathway covers liver and bile duct cancers.

Updates

Updates to this NICE Pathway

26 November 2019 Irreversible electroporation for primary liver cancer (NICE interventional procedures guidance 664) added to cholangiocarcinoma and hepatocellular carcinoma.
29 October 2019 Ramucirumab for treating unresectable hepatocellular carcinoma after sorafenib (terminated appraisal) (NICE technology appraisal 609) added to hepatocellular carcinoma.
23 May 2019 Cabozantinib for previously treated advanced hepatocellular carcinoma (terminated appraisal) (NICE technology appraisal 582) added to hepatocellular carcinoma.
15 January 2019 Ex-situ machine perfusion for extracorporeal preservation of livers for transplantation (NICE interventional procedures guidance 636) added to liver transplantation.
8 January 2019 Regorafenib for previously treated advanced hepatocellular carcinoma (NICE technology appraisal guidance 555) added to hepatocellular carcinoma.
18 December 2018 Lenvatinib for untreated advanced hepatocellular carcinoma (NICE technology appraisal guidance 551) added to hepatocellular carcinoma.
30 October 2018 Selective internal radiation therapy for unresectable primary intrahepatic cholangiocarcinoma (NICE interventional procedures guidance 630) added to cholangiocarcinoma.
22 May 2018 Endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer (NICE interventional procedures guidance 614) added to cholangiocarcinoma.
5 September 2017 Sorafenib for treating advanced hepatocellular carcinoma (NICE technology appraisal guidance 474) added to hepatocellular carcinoma.
26 April 2016 Microwave ablation for treating liver metastases (NICE interventional procedures guidance 553) added to liver metastases.
24 November 2015 Living-donor liver transplantation (NICE interventional procedures guidance 535) added to liver transplantation.
21 July 2015 Everolimus for preventing organ rejection in liver transplantation (NICE technology appraisal guidance 348) added to liver transplantation.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on liver and bile duct cancers in an interactive flowchart

What is covered

This NICE Pathway covers liver and bile duct cancers.

Updates

Updates to this NICE Pathway

26 November 2019 Irreversible electroporation for primary liver cancer (NICE interventional procedures guidance 664) added to cholangiocarcinoma and hepatocellular carcinoma.
29 October 2019 Ramucirumab for treating unresectable hepatocellular carcinoma after sorafenib (terminated appraisal) (NICE technology appraisal 609) added to hepatocellular carcinoma.
23 May 2019 Cabozantinib for previously treated advanced hepatocellular carcinoma (terminated appraisal) (NICE technology appraisal 582) added to hepatocellular carcinoma.
15 January 2019 Ex-situ machine perfusion for extracorporeal preservation of livers for transplantation (NICE interventional procedures guidance 636) added to liver transplantation.
8 January 2019 Regorafenib for previously treated advanced hepatocellular carcinoma (NICE technology appraisal guidance 555) added to hepatocellular carcinoma.
18 December 2018 Lenvatinib for untreated advanced hepatocellular carcinoma (NICE technology appraisal guidance 551) added to hepatocellular carcinoma.
30 October 2018 Selective internal radiation therapy for unresectable primary intrahepatic cholangiocarcinoma (NICE interventional procedures guidance 630) added to cholangiocarcinoma.
22 May 2018 Endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer (NICE interventional procedures guidance 614) added to cholangiocarcinoma.
5 September 2017 Sorafenib for treating advanced hepatocellular carcinoma (NICE technology appraisal guidance 474) added to hepatocellular carcinoma.
26 April 2016 Microwave ablation for treating liver metastases (NICE interventional procedures guidance 553) added to liver metastases.
24 November 2015 Living-donor liver transplantation (NICE interventional procedures guidance 535) added to liver transplantation.
21 July 2015 Everolimus for preventing organ rejection in liver transplantation (NICE technology appraisal guidance 348) added to liver transplantation.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Regorafenib for previously treated advanced hepatocellular carcinoma (2019) NICE technology appraisal guidance 555
Lenvatinib for untreated advanced hepatocellular carcinoma (2018) NICE technology appraisal guidance 551
Sorafenib for treating advanced hepatocellular carcinoma (2017) NICE technology appraisal guidance 474
Everolimus for preventing organ rejection in liver transplantation (2015) NICE technology appraisal guidance 348
Irreversible electroporation for primary liver cancer (2019) NICE interventional procedures guidance 664
Microwave ablation for treating liver metastases (2016) NICE interventional procedures guidance 553
Living-donor liver transplantation (2015) NICE interventional procedures guidance 535
Selective internal radiation therapy for primary hepatocellular carcinoma (2013) NICE interventional procedures guidance 460
Irreversible electroporation for treating liver metastases (2013) NICE interventional procedures guidance 445
Selective internal radiation therapy for non-resectable colorectal metastases in the liver (2011 updated 2013) NICE interventional procedures guidance 401
Cryotherapy for the treatment of liver metastases (2010) NICE interventional procedures guidance 369
Radiofrequency ablation for colorectal liver metastases (2009) NICE interventional procedures guidance 327
Ex-vivo hepatic resection and reimplantation for liver cancer (2009) NICE interventional procedures guidance 298
Microwave ablation of hepatocellular carcinoma (2007) NICE interventional procedures guidance 214
Radiofrequency-assisted liver resection (2007) NICE interventional procedures guidance 211
Laparoscopic liver resection (2005) NICE interventional procedures guidance 135
Photodynamic therapy for bile duct cancer (2005) NICE interventional procedures guidance 134
Radiofrequency ablation of hepatocellular carcinoma (2003) NICE interventional procedures guidance 2
LiMAx system for assessing the functional capacity of the liver (2019) NICE medtech innovation briefing 168
SIR-Spheres for treating inoperable hepatocellular carcinoma (2016) NICE medtech innovation briefing 63

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

NICE has published a medtech innovation briefing on LiMAx system for assessing the functional capacity of the liver.

Glossary

Eastern Cooperative Oncology Group

Paths in this pathway

Pathway created: November 2013 Last updated: November 2019

© NICE 2019. All rights reserved. Subject to Notice of rights.

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