1. If pre-operative assessment reveals (1) tumour diameter greater than 16 mm, (2) symptoms suggestive of systemic spread, (3) clinical examination or biochemical liver function tests indicate hepatomegaly or ascites, consultant informs patient of increased risk of metastatic disease and organises liver ultrasonography and biochemical liver function tests.
2. If enucleation or local resection is performed, specimens are taken by surgeon for (1) routine histology and (2) cytogenetic studies.
3. If cytogenetic studies indicate monosomy 3, consultant (1) writes letter to referring ophthalmologist and GP, (2) informs patient as agreed before surgery, (3) informs oncology nurse.
4. Oncology nurse (1) computerises information, (2) organises screening according to protocol: six monthly abdominal scan and biochemical liver function tests at referring hospital or RLUH at time of Ophthalmic follow-up visits (Wed. pm).
5. If abnormal screening result, consultant (1) telephones GP and acts according to instructions, (i.e. telephoning or writing to patient after specified delay), (2) writes to referring ophthalmologist and GP, and (3) writes to medical oncologist at Clatterbridge, who would institute appropriate management. This would consist of (1) inclusion in clinical study of chemotherapy, (2) referral to medical oncologist at referring hospital, or (3) referral to gastrointestinal surgeon for consideration of partial hepatectomy and/or intra-hepatic chemotherapy.
6. Oncology nurse (1) counsels patient.
7. Data manager computerises information on progress and outcomes.

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