A 55-year-old man has chronic hepatitis C (genotype 1b), cirrhosis (Child-Pugh A), and an AFP 320 ng/mL. Ultrasound shows a 3.2 cm single hepatic lesion with arterial enhancement and portal venous washout on dynamic CT. No vascular invasion or extra-hepatic spread. BCLC staging and PREFERRED treatment are:
- A BCLC B; trans-arterial chemoembolisation (TACE)
- B BCLC C; sorafenib
- C BCLC 0; surveillance only
- D BCLC A; ablation (RFA) or resection ✓
Explanation
BCLC staging: BCLC 0 = single ≤2 cm, very early; BCLC A = single or up to 3 nodules ≤3 cm, preserved liver function (Child-Pugh A/B), PS 0. This patient has a single 3.2 cm HCC with Child-Pugh A = BCLC A (early stage). BCLC A HCC is treated with curative intent: surgical resection (if adequate hepatic reserve, no portal hypertension) or thermal ablation (RFA/MWA for lesions ≤3 cm). TACE is BCLC B (intermediate). Sorafenib is for BCLC C (advanced: vascular invasion/metastasis). Diagnosis of HCC is by non-invasive imaging criteria (LIRADS 5/LI-RADS algorithm) in cirrhotic liver.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.