A 55-year-old man with hepatitis B cirrhosis (Child-Pugh A) is found to have a 2.5 cm arterially enhancing liver lesion with portal venous washout on triphasic CT. No biopsy is performed. According to Barcelona Clinic Liver Cancer (BCLC) staging guidelines, this lesion is classified as BCLC stage A (early HCC). What is the preferred curative treatment option?

• A Liver transplantation (exceeds Milan criteria so not applicable)
• B Transarterial chemoembolisation (TACE) as first-line treatment
• C Sorafenib targeted therapy
• D Surgical resection if future liver remnant is adequate ✓

Explanation

For BCLC stage A HCC in Child-Pugh A cirrhosis, surgical resection is the preferred curative treatment when there is no clinically significant portal hypertension and adequate future liver remnant. Transplantation (within Milan criteria: single ≤5 cm or ≤3 lesions each ≤3 cm) is considered when resection is not feasible due to portal hypertension or insufficient liver reserve. TACE is palliative (BCLC B) and sorafenib is for advanced/metastatic disease (BCLC C). Radiological diagnosis without biopsy is standard when classical CT/MRI features are present.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.