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HCC Within Milan Criteria — RACP Adult Medicine MCQ

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ModerateGastroenterologyHCC Within Milan CriteriaRACP Adult Medicine

A 60-year-old man with hepatitis C cirrhosis (Child-Pugh B, MELD 14) has a single HCC measuring 4 cm. He is within Milan criteria (single tumour ≤5 cm, or ≤3 tumours each ≤3 cm, no vascular invasion, no extrahepatic metastases). What is the most appropriate management?

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Correct answer: C — Liver transplant referral

Explanation lettering: C = shown as A · A = shown as C

HCC within Milan criteria in a patient with decompensated cirrhosis (Child-Pugh B/C) is best managed with liver transplantation, which treats both the tumour and the underlying cirrhosis. Bridging therapies (TACE or RFA) may be used while awaiting transplant to prevent tumour progression and dropout from the waiting list.

Reference: Cancer Council Australia – 2024 – HCC; AASLD 2023; Milan Criteria