A 55-year-old woman without cirrhosis is found to have a 5 cm hepatic lesion showing arterial hyperenhancement with venous washout on CT. Serum AFP is 1200 ng/mL. She is Child-Pugh A and ECOG 0. What is the preferred curative treatment?

• A Surgical resection ✓
• B Transarterial chemoembolization (TACE) as definitive treatment
• C Liver transplantation based on BCLC stage
• D Sorafenib systemic therapy

Explanation

In a non-cirrhotic patient with HCC who is surgical candidate (Child-Pugh A, ECOG 0, adequate hepatic reserve), hepatic resection provides the best long-term survival with 5-year rates of 50–70%. The Barcelona Clinic Liver Cancer (BCLC) staging algorithm directs transplantation for cirrhotic patients within Milan criteria (single ≤5 cm or ≤3 nodules each ≤3 cm) where resection is not feasible. Non-cirrhotic patients can tolerate major hepatectomy. TACE is palliative for intermediate-stage (BCLC-B) unresectable HCC. Sorafenib is first-line for advanced (BCLC-C) or second-line disease.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.