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Malignant Neoplasm of the Liver B032

Last amended 
7 May 2020
Current RMA Instruments

Reasonable Hypothesis SOP

31 of 2020

Balance of Probabilities SOP

32 of 2020

Changes from previous Instruments

SOP bulletin 214

ICD Coding
  • ICD-9-CM Code: 155.0
  • ICD-10-AM Code: C22.0
Brief description

This SOP covers primary malignant tumours of the liver.  These usually arise in the setting of chronic liver disease.  The liver is a common site for secondary/metastatic cancer, which is not covered by this SOP.

Confirming the diagnosis

The diagnosis can be difficult.  In patients with cirrhosis or other chronic liver disease it may be possible to make the diagnosis on the basis of specialised imaging, if specific characteristics are demonstrated on MRI, or contrast enhanced CT scanning or ultrasound.  In other patients biopsy and histology, or histological confirmation following surgery will be required.

The relevant medical specialist is a general surgeon or gastroenterologist/hepatologist.

Additional diagnoses covered by SOP
  • hepatocellular carcinoma
  • hepatoblastoma
  • hepatocarcinoma
  • liver cell carcinoma
  • malignant hepatoma
  • malignant teratoma of the liver
Conditions excluded from SOP
  • Carcinoid tumour of the liver#
  • carcinoma of an intrahepatic bile duct* - malignant neoplasm of the bile duct SOP
  • cholangiocarcinoma of the liver* - malignant neoplasm of the bile duct SOP
  • Hodgkin’s lymphoma of the liver*
  • Malignant neoplasm of the gallbladder*
  • non-Hodgkin lymphoma of the liver*
  • soft tissue sarcoma of the liver*
  • Secondary/metastatic cancer/carcinoma involving the liver (code to primary cancer site)

* another SOP applies

# non-SOP condition

Clinical onset

Many patients have no symptoms specific to the tumour and the condition is detected by regular surveillance of chronic liver disease.  Some patients will present with new symptoms such as jaundice or abdominal pain, or may be found to have an upper abdominal mass on examination.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management. This is typically an aggressive disease, often diagnosed late in its course and having a poor prognosis.  Surgical removal is the main treatment, but will not be possible in a significant proportion or patients.