A 58-year-old man with hepatitis C cirrhosis (Child-Pugh B, MELD 16) undergoes surveillance ultrasound showing a 2.8 cm arterially enhancing hepatic nodule with portal venous washout on dynamic CT. AFP is 520 ng/mL. According to BCLC staging, this is:
- A BCLC Stage A (Early — resection, transplant, or ablation) ✓
- B BCLC Stage 0 (Very early — curative resection/ablation)
- C BCLC Stage B (Intermediate — TACE)
- D BCLC Stage C (Advanced — sorafenib/systemic)
Correct answer: A. BCLC Stage A (Early — resection, transplant, or ablation)
Explanation
BCLC Stage A (early HCC) encompasses a single tumor or up to 3 nodules ≤3 cm, with preserved liver function (Child-Pugh A or B) and no portal hypertension symptoms — curative treatment is possible with resection, transplant, or ablation. This patient has Child-Pugh B cirrhosis and a single 2.8 cm HCC, fitting BCLC Stage A criteria. BCLC Stage 0 requires a single tumor <2 cm with preserved Child-Pugh A and no portal hypertension. BCLC B requires multinodular disease beyond Milan criteria.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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