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Q1: BCLC Staging (3 min)
"Describe the BCLC staging system for HCC."
- 0: Very early (single under 2 cm, PS 0) → resection or ablation
- A: Early (single or up to 3 under 3 cm) → resection, transplant (Milan), or RFA
- B: Intermediate (multinodular, preserved function) → TACE
- C: Advanced (vascular invasion, extrahepatic, PS 1-2) → systemic (atezo+bev or sorafenib)
- D: End-stage (PS over 2, Child-Pugh C) → best supportive care
Q2: Milan Criteria (2 min)
"What are the Milan criteria for liver transplant?"
- Single tumour under 5 cm OR up to 3 tumours each under 3 cm
- No macrovascular invasion, no extrahepatic spread
- 5-year survival: 70-80%
- Bridging therapy (TACE/RFA) while waiting
Q3: Resection vs Transplant (3 min)
"When do you resect vs transplant HCC?"
- Resect: single tumour, Child-Pugh A, no portal hypertension, adequate future liver remnant
- Transplant: meets Milan criteria + has cirrhosis/portal hypertension
- Transplant treats BOTH cancer and cirrhosis
- Resection recurrence rate: 50-70% at 5 years
Q4: Systemic Therapy (2 min)
"What systemic options exist for advanced HCC?"
- First-line: atezolizumab + bevacizumab (IMbrave150) — check varices first
- Alternatives: sorafenib (SHARP), lenvatinib (REFLECT)
- Second-line: regorafenib, cabozantinib, ramucirumab (AFP over 400)