HCC — SCE Medical Oncology MCQ

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A 72-year-old man has a solitary 2 cm hepatocellular carcinoma in a cirrhotic liver with Child-Pugh A function and clinically significant portal hypertension. He is not suitable for transplant or resection, and the lesion is safely accessible percutaneously. Which curative locoregional treatment is most appropriate?

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Correct answer: E — Percutaneous radiofrequency or microwave thermal ablation

The BSG guideline supports thermal ablation as an alternative first-line curative treatment for a solitary 2 to 3 cm HCC when resection or transplantation is unsuitable, with radiofrequency and microwave ablation considered similarly effective. NICE HTG138 supports microwave ablation as a treatment option. Selective internal radiotherapy using yttrium-ninety microspheres: radioembolisation is not the preferred curative treatment for this small, safely accessible lesion. Transarterial chemoembolisation using drug-eluting embolic particles: TACE is generally used for multinodular intermediate-stage disease rather than a solitary ablatable lesion. Stereotactic radiotherapy using an ablative hypofractionated schedule: SABR may be considered when thermal ablation is unsuitable but is not the first choice under the anatomy specified. External-beam radiotherapy using conventional daily fractionation: conventional fractionation is not a curative ablative approach for this presentation.

Reference: British Society of Gastroenterology guideline for hepatocellular carcinoma in adults (Published July 2024; current UK specialist guideline): https://pmc.ncbi.nlm.nih.gov/articles/PMC11287576/; NICE HTG138 microwave ablation for hepatocellular carcinoma (Current NICE interventional guidance, accessed July 2026): https://www.nice.org.uk/guidance/HTG138/chapter/1-recommendations