A 55-year-old man with compensated cirrhosis from HCV infection is being monitored for hepatocellular carcinoma (HCC). Ultrasound shows a new 2.2 cm arterially enhancing lesion with washout appearance on contrast-enhanced CT (LI-RADS 5). AFP is 68 ng/mL. He has no extrahepatic disease and his liver function is Child-Pugh A. What is the preferred curative treatment?
- A Transarterial chemoembolisation (TACE)
- B Surgical resection or radiofrequency ablation depending on location ✓
- C Sorafenib as first-line systemic therapy
- D Liver transplantation immediately without further staging
Explanation
Per BCLC (Barcelona Clinic Liver Cancer) staging, a single HCC nodule ≤5 cm in a Child-Pugh A patient without portal hypertension is BCLC Stage A and is eligible for potentially curative therapies: surgical resection (first choice if anatomically feasible and adequate liver reserve) or thermal ablation (RFA/MWA for lesions ≤3 cm). TACE is palliative (BCLC B — intermediate stage). Sorafenib/atezolizumab-bevacizumab is first-line systemic therapy for BCLC C. Transplant criteria (Milan: single ≤5 cm or three nodules ≤3 cm) apply but require bridge therapy and waitlist considerations.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.