Haemochromatosis HCC Surveillance — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyHaemochromatosis HCC SurveillanceRACP Adult Medicine

A 45-year-old man with known haemochromatosis (C282Y homozygous) and established cirrhosis has completed iron depletion with phlebotomy (ferritin now 45 µg/L). What ongoing surveillance is essential?

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Correct answer: E — 6-monthly liver ultrasound and AFP for HCC surveillance

Haemochromatosis with established cirrhosis carries a significantly increased risk of hepatocellular carcinoma (HCC) – approximately 20-fold compared to non-cirrhotic haemochromatosis. Even after iron depletion, the HCC risk persists in cirrhotic patients. Six-monthly ultrasound with or without AFP is recommended for HCC surveillance, consistent with general cirrhosis HCC screening guidelines. Non-cirrhotic haemochromatosis patients do not require HCC surveillance.

Reference: eTG – 2025 – Gastrointestinal; EASL – 2010 – Haemochromatosis Guidelines