skip to main content

Hepatocellular carcinoma — MCCQE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardWeight LossHepatocellular carcinomaMCCQE Part 1

A 60-year-old man with chronic hepatitis B and compensated cirrhosis has a solitary 6 cm hepatic mass. Multiphase CT shows nonrim arterial enhancement with portal-venous washout and no vascular invasion or extrahepatic disease. He has ECOG 0, normal bilirubin, platelets 170 × 10^9/L, no varices or ascites, and an adequate future liver remnant. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Refer for multidisciplinary hepatobiliary assessment for curative surgical resection

In an at-risk patient, a lesion at least 2 cm with nonrim arterial phase hyperenhancement and washout can meet definitive imaging criteria for HCC without routine biopsy. This patient has a solitary, liver-confined tumour, preserved function, no evidence of clinically significant portal hypertension and an adequate future liver remnant, making multidisciplinary assessment for curative resection the best option listed. A 6 cm single lesion is outside standard Milan size criteria, so the original claim that it was 'within Milan' was incorrect; transplant eligibility and any downstaging pathway are separate centre-specific decisions. Systemic therapy and TACE are not default first choices for explicitly resectable disease.

Reference: Alberta Health Services, Hepatocellular Carcinoma Clinical Practice Guideline (last revision January 2024): https://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-gi007-hepatocellular-carcinoma.pdf