Small HCC Treatment Child-Pugh B — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineSmall HCC Treatment Child-Pugh BRACP Adult Medicine

A 55-year-old man with known alcoholic cirrhosis is found to have a 2 cm HCC within Milan criteria. His Child-Pugh score is B7 and MELD-Na is 14. He is abstinent from alcohol for 8 months. Multidisciplinary team discusses treatment options. What is the most appropriate curative-intent treatment?

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Correct answer: D — Radiofrequency ablation

For a single HCC ≤3 cm within Milan criteria in a Child-Pugh B patient, radiofrequency ablation (RFA) or microwave ablation provides excellent local control with complete response rates >90% for tumours ≤3 cm. Surgical resection is generally preferred for Child-Pugh A patients with preserved liver function. In Child-Pugh B patients, the impaired hepatic reserve increases surgical risk, making ablation the preferred curative-intent treatment (if transplant listing is not feasible or as a bridge to transplant). Liver transplantation offers the best long-term outcome (treats both HCC and underlying cirrhosis) but is limited by organ availability and requires assessment of candidacy.

Reference: Cancer Council Australia – 2020 – HCC Guidelines; AASLD – 2023 – HCC Guidelines