Liver Tumor Board Note

Date/Time: [Date and time of tumor board meeting]

Patient: [Full name], [MRN], [DOB], [Age], [Sex]

Referring Clinician: [Name, specialty, service]

Primary Diagnosis: [Working diagnosis: HCC / iCCA / pCCA / dCCA / other]; [Reason for presentation: initial staging / post-treatment response / recurrence evaluation / treatment selection]

Disciplines Present: [List specialties present: Hepatology, Diagnostic Radiology, Interventional Radiology, HPB Surgery, Transplant Surgery, Medical Oncology, Radiation Oncology, Pathology, other]

Sources Reviewed:

• Imaging: [Modality, date, facility, source: outside / in-house] (List all studies referenced in discussion.)
• Pathology: [Specimen type/site, date, source: outside / in-house, status: final / preliminary]
• Key Labs: [Date, source: outside / in-house]
• Prior Treatments: [Therapy type, date(s), best response] (Include if applicable.)

Decision Snapshot

• [One-line case identity: Patient with (cirrhosis etiology if present / no cirrhosis) and (tumor type), presenting for (explicit question)]
• [Staging at-a-glance: For HCC include BCLC stage with tumor burden summary, Child-Pugh, ECOG. For CCA include anatomic subtype, TNM if available, resectability status, metastatic status.]
• [Key constraints affecting treatment options: hepatic reserve, portal hypertension, biliary obstruction status, major comorbidities, transplant eligibility] (List only those materially affecting options.)
• [Consensus recommendation: single primary next step]
• [Primary responsible service] to execute plan; [responsible clinician/service] to communicate with patient by [target date]

Clinical Context

[Explicit tumor board question: what decision is needed today]

[Problem-oriented summary in one short paragraph] (Add bullets below only if necessary for clarity.)

• Oncologic timeline: [Initial diagnosis date/basis], [Prior treatments with dates and best response], [Current status prompting review]
• Liver disease background: [Etiology], [Cirrhosis: present / absent / unknown], [Decompensation history], [Portal hypertension features] (Include if applicable.)
• Performance status: ECOG [0 / 1 / 2 / 3 / 4] ([date, source]); [Major functional limitations]

Liver Function and Labs

(Include value and collection date for each. Use "Not available" or "Pending" rather than omitting decision-critical fields.)

• Total bilirubin: [value] ([date])
• AST / ALT: [value] / [value] ([date])
• Alkaline phosphatase: [value] ([date])
• Albumin: [value] ([date])
• INR: [value] ([date])
• Platelets: [value] ([date])
• Creatinine: [value] ([date])
• Sodium: [value] ([date])
• AFP: [value] ([date]) (For HCC.)
• CA19-9: [value] ([date]) (For CCA. Note if cholestasis may confound.)
• Derived scores: Child-Pugh [A / B / C] ([date]), MELD-Na [score] ([date]) (Only compute if all components documented; otherwise state "Unable to compute—missing: [items].")

Imaging Summary

Imaging Adequacy: [Adequate for staging / Inadequate—needs: multiphasic liver protocol / chest imaging / other]

Lesion Summary: (Summarize up to 3–5 key lesions; then summarize remainder.)

• Lesion 1: [Segment], [size] ([modality, date]); [Key diagnostic features]; [For HCC: LI-RADS category, macrovascular invasion status] [For CCA: mass-forming / periductal, biliary level/extent, vascular involvement] (Indicate "Outside report states..." vs "TB radiology review..." if reinterpretation.)
• Lesion 2: [Details as above]
• Lesion 3: [Details as above]
• Additional lesions: [Number, size range, distribution] (If applicable.)

Post-Treatment Findings: [Response assessment], [Viable tumor portion], [New untreated lesions] (Include if applicable.)

Extrahepatic Disease: [Regional nodes: suspicious / indeterminate / absent; site/size]; [Distant metastases: organ, size, confirmation modality]

Tumor Board Imaging Impression:

• [Meets imaging criteria for diagnosis: yes / no / needs biopsy]
• [Transplant criteria status: within Milan / outside Milan / downstaging candidate] (If applicable.)
• [Resectability-limiting findings]
• [TB reinterpretation if different from outside read]

Pathology and Molecular

(Include only if pathology exists or is pending.)

• Status: [None performed / Pending / Final]; [Specimen type and site], [Date], [Source: outside / in-house]
• Histology: [Diagnosis], [Grade], [Microvascular invasion: present / absent / not assessed], [Margin status], [Lymph node status]
• Molecular profiling: [Test type: tissue NGS / ctDNA], [Actionable alterations], [MSI/dMMR status] (If tissue insufficient, note who is responsible for repeat biopsy or liquid biopsy.)

Staging Summary

(State explicit staging with inputs. Use the pathway that applies.)

• HCC: BCLC [0 / A / B / C / D]; Tumor burden: [number, largest size, macrovascular invasion, extrahepatic disease]; Liver function: Child-Pugh [class], MELD-Na [score]; ECOG [score]. Transplant criteria: [Within Milan / Downstaging candidate / Not eligible—rationale]
• Cholangiocarcinoma: Subtype: [iCCA / pCCA / dCCA]; TNM: [stage]; Resectability: [resectable / borderline / unresectable—rationale]; Biliary drainage: [status] (If relevant.)
• If staging cannot be assigned: Unable to assign [staging system] due to missing: [items] (Also list in Outstanding Items.)

Multidisciplinary Discussion

(Brief and decision-linked; not meeting minutes.)

• Options considered: [Option 1—rationale for/against], [Option 2—rationale], [Option 3—rationale] (2–4 realistic options.)
• Key discipline-specific considerations: [Considerations that materially influenced the recommendation]

Consensus Recommendations

1. [Primary plan step]—Owner: [service/clinician]; Timeline: [date/timeframe]
2. [Subsequent step if applicable]—Owner: [service]; Timeline: [date]
3. [Prerequisites before therapy: labs, anticoagulation, biliary drainage, variceal evaluation, etc.]—Owner: [service]; Timeline: [date]
4. [Clinical trial screening]—Owner: [service]; Timeline: [date] (If recommended.)
5. [Contingency: If (pending result) → then (alternate plan)]—Owner: [service]

Outstanding Items

(Omit this section if nothing is outstanding.)

• [Item needed]—Owner: [service/clinician]; Due: [date]
• [Item needed]—Owner: [service/clinician]; Due: [date]

Follow-up and Communication

• Next appointment: [Date] with [service/clinician]
• Return to tumor board: [Date or trigger for re-presentation]
• Patient communication: [Informed of recommendations: yes / no / pending]; [Who will contact patient] by [date]
• Note: Recommendations may be modified after patient discussion or acquisition of new data.

Attestation

This note reflects multidisciplinary tumor board discussion on [date]. (This is not a billable clinical encounter; tumor board participants did not directly examine the patient unless otherwise documented.)