A 58-year-old man with chronic HCV cirrhosis (Child-Pugh A, MELD 9) is found to have a 2.5 cm arterially enhancing hepatic lesion with washout on portal-venous phase and capsule appearance on MRI. Per LI-RADS v2018, this lesion is classified as LR-5 (hepatocellular carcinoma). The Barcelona Clinic Liver Cancer (BCLC) stage is 0 (very early) for lesions <2 cm and A for solitary 2–5 cm. First-line curative treatment for this BCLC Stage A patient with preserved liver function is:
- A Surgical resection or radiofrequency ablation (if ≤3 cm) ✓
- B Sorafenib targeted therapy
- C Transarterial chemoembolization (TACE)
- D Liver transplantation (Milan criteria)
Correct answer: A. Surgical resection or radiofrequency ablation (if ≤3 cm)
Explanation
For BCLC Stage A HCC (single tumor 2–5 cm or 3 nodules ≤3 cm) in a Child-Pugh A patient with no portal hypertension, surgical resection is the preferred curative option. Radiofrequency ablation (RFA) is an alternative for tumors ≤3 cm. Liver transplantation is preferred when portal hypertension is present or for patients with multiple tumors meeting Milan criteria. TACE is the standard of care for BCLC Stage B (intermediate) unresectable HCC. Sorafenib is used for BCLC Stage C.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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