Objectives
  • To be able to perform specialist assessment, treatment and counselling of patients with hepatobiliary cancers

Awareness
  • Awareness of the existence of different biological and pathological subtypes of hepatobiliary cancers for the selection of the appropriate treatment strategies; specifically distinguish between hepatocellular and biliary cancers

  • Awareness of the existence of specific lifestyle risk factors, viral infections and premalignant conditions for hepatobiliary cancer

  • Awareness of substantial regional differences in the incidence and pathogenesis of hepatobiliary cancers worldwide

  • Awareness of the existence of different prognostic factors

  • Appreciation of the importance of the multimodality approach to treat patients with hepatobiliary cancer

  • Appreciation of the importance of adequate imaging techniques to allow for exact pretreatment staging

  • Awareness of specific surgical techniques and their respective complications in the management of hepatobiliary cancer

  • Appreciation of the use of liver transplantation for selecting patients with early-stage hepatobiliary cancers

Knowledge
  • Familiarity with the implication of the different biological and pathological subtypes of hepatobiliary cancer in order to select the appropriate treatment strategies

  • Understanding of the pattern of metastases of hepatobiliary cancer

  • Familiarity with the indications and diagnostic tools available for hepatobiliary cancer (such as diagnostic serum tumour markers like α-foetoprotein (AFP) and cancer antigen (CA)19-9, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET)/CT imaging) and their implications for an appropriate therapeutic strategy

  • Understanding of the role of endoscopic techniques to address biliary tract stenosis

  • Understanding of the importance of cancer precursor lesions and premalignant conditions for the development of hepatobiliary cancer

  • Familiarity with predisposing medical conditions for the development of hepatocellular (eg, viral infections, cirrhosis, storage diseases) and biliary cancers (eg, inflammatory bowel disease with primary biliary sclerosis, cholecystolithiasis)

  • Familiarity with the risk assessment of prognostic factors, especially the TNM staging system for hepatobiliary cancer

  • Familiarity with integrating clinical scoring systems like Child-Pugh, Model for End-Stage Liver Disease (MELD) and Milan criteria into treatment decisions

  • Familiarity with indications and value of multimodality approach of surgery, loco-regional ablative techniques and medical therapy in non-metastatic hepatobiliary cancer

  • Understanding of the difference between bland embolisation, chemo-embolisation and radio-embolisation as loco-regional interventional techniques

  • Understanding of the role of chemotherapy and targeted therapy in the management of patients with advanced hepatobiliary cancer

  • Familiarity with hereditary syndromes and the management of families with these implications for individual patients

  • Understanding of the value of medical therapy in advanced hepatobiliary cancer

  • Understanding of the symptoms and complications that derive from disease progression and those that are treatment-associated in the context of being familiar with supportive and palliative care settings

Skills
  • Ability to contribute actively to a variety of hepatobiliary cancer scenarios and patient presentations

  • Ability to discuss critically the treatment options and recommendations for various phases of the disease (early and metastatic disease)

  • Ability to perform a history and physical examination in patients with hepatobiliary cancer, including different subtypes and different stages of diseases

  • Ability to follow individual patients with hepatobiliary cancer throughout their patient history from initial diagnosis to hospice care

  • Ability to contribute to discussions on general management strategies in order to understand all the considerations on which treatment to use and which sequence to select for the multidisciplinary strategy

  • Ability to consider loco-regional embolisation techniques, local ablative procedures like radiofrequency ablation and surgical management for different stages of hepatobiliary cancers

  • Ability to recognise conditions or clinical prognostic factors such as performance status, tumour load, number of metastases prior adjuvant chemotherapy, concomitant diseases and other previous therapies that are important for considering when to start and to stop a treatment or switch to another option

  • Ability to manage side effects of various chemotherapeutic agents and targeted therapy