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HCC in HBV Curative Options — SCE Infectious Diseases MCQ

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ModerateHepatitisHCC in HBV Curative OptionsSCE Infectious Diseases

A 50-year-old man with known Hepatitis B (HBsAg positive, on Tenofovir DF, HBV DNA undetectable) is diagnosed with hepatocellular carcinoma on surveillance ultrasound. AFP is 450 µg/L. CT shows a 4 cm arterially enhancing lesion with portal venous washout (LIRADS-5). He has compensated cirrhosis. What is the optimal management approach?

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Correct answer: B — Multidisciplinary team assessment for curative treatment (resection, ablation, or transplant) — HCC detected on surveillance is often at an earlier stage amenable to curative therapy

HCC detected through surveillance (as in this case — the value of 6-monthly USS screening is demonstrated) is typically at an earlier stage than symptomatic HCC, allowing curative treatment options. Management follows Barcelona Clinic Liver Cancer (BCLC) staging: a single 4 cm lesion with compensated cirrhosis (BCLC 0/A) is potentially curable with surgical resection, radiofrequency ablation, or liver transplant (which also cures the underlying cirrhosis and HBV). MDT assessment involving hepatology, surgery, radiology, and oncology is mandatory. Tenofovir should continue.

Reference: NICE NG50 2016 – Cirrhosis; EASL 2024 – HCC; BCLC 2022