HCC Variceal Screening — SCE Medical Oncology MCQ

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ModerateGI CancersHCC Variceal ScreeningSCE Medical Oncology

A 65-year-old man with advanced HCC on atezolizumab + bevacizumab develops haematemesis. Emergency endoscopy reveals bleeding oesophageal varices. What should have been done before starting bevacizumab?

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Correct answer: B — Variceal screening with upper GI endoscopy

Before starting bevacizumab-containing regimens for HCC, upper GI endoscopy is mandatory to screen for oesophageal/gastric varices. Patients with high-risk varices (F2/F3 or red wale marks) must be treated (band ligation or non-selective beta-blocker) before commencing anti-VEGF therapy. This is specified in the IMbrave150 protocol and NICE TA816. Bevacizumab increases bleeding risk in patients with portal hypertension and untreated varices.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer