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Hepatocellular Carcinoma — RACP Adult Medicine MCQ

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ModerateGastroenterologyHepatocellular CarcinomaRACP Adult Medicine

A 50-year-old man with hepatitis B cirrhosis (Child-Pugh A) is found to have a 3 cm lesion in the right lobe of the liver on surveillance ultrasound. Contrast-enhanced CT shows arterial phase hyperenhancement with washout in the portal venous phase. AFP is 250 μg/L. What is the most appropriate management?

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Correct answer: B — Surgical resection (hepatectomy)

A single HCC ≤5 cm in compensated cirrhosis (Child-Pugh A) with preserved liver function is best managed with surgical resection (hepatectomy) if technically feasible. The arterial enhancement + portal venous washout pattern is diagnostic of HCC on LI-RADS criteria (LR-5). Transplant is considered if within Milan criteria and the patient meets eligibility. RFA is an alternative for lesions ≤3 cm if surgery is not possible.

Reference: Cancer Council Australia – 2024 – HCC Guidelines; AASLD 2023