A 55-year-old man with compensated cirrhosis (Child-Pugh A) and hepatocellular carcinoma is found to have two nodules: a 3.5 cm nodule with arterial enhancement and portal venous washout, and a 2.0 cm nodule with similar characteristics. By Barcelona Clinic Liver Cancer (BCLC) staging, this represents which stage, and what is the preferred treatment?
- A BCLC stage 0 (very early); ablation preferred
- B BCLC stage B (intermediate); transarterial chemoembolisation (TACE)
- C BCLC stage C (advanced); sorafenib systemic therapy
- D BCLC stage A (early); liver transplantation within Milan criteria ✓
Explanation
Milan criteria for liver transplantation in HCC (as per Mazzaferro, 1996) allow transplantation for: single nodule ≤5 cm, OR up to 3 nodules each ≤3 cm, without macrovascular invasion or extrahepatic metastasis. This patient has two nodules (3.5 cm + 2.0 cm) fitting within the Milan criteria. By BCLC 2022 staging, this is stage A (early HCC with 2–3 nodules ≤3 cm each). Liver transplantation offers the best long-term outcome with 5-year survival ~70% and the lowest recurrence risk. Resection is an alternative if liver function is adequate. TACE is for BCLC-B (intermediate stage). BCLC-0 is a single nodule <2 cm.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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