hepatocellular carcinoma

Question 1

Child pugh interpretation based on points

Answer 1

A = 5-6
B = 7-9
C = >9

Question 1

Child pugh components (*Need to know this for boards since it guides treatment options)

Answer 1

A,B,C,D,E
A = albumin
B = bili
C = coagulation (INR)
D = dullness or ascites
E = encephalopathy

Question 2

Role for adjuvant systemic therapy following hepatectomy for localized disease

Answer 2

• no proven role, observation alone

Question 3

Milan criteria for transplant eligibility
*Common board question

Answer 3

• single lesion <5 cm
• up to 3 lesions, each <3 cm

Question 4

RFA criteria for HCC

Answer 4

1) up to 4 cm
2) not near major vessel
3) preserved liver function

Question 5

Treatment options for patients with child pugh B7

Answer 5

1) sorafenib
*atezo/bev and durva/trem only approved for Child Pugh A
*others?

Question 6

Ramucirumab approval indication

Answer 6

AFP >400

Question 7

Later line options for HCC

Answer 7

• regorafenib
• Lenvatinib
• ipi/nivo
• nivo alone, pembro alone
• ramucirumab
• cabo

Question 8

When biopsy can be deferred in HCC

Answer 8

• cirrhotic liver
• lesion >1 cm with arterial enhancement and venous phase washout

Question 9

Preferred firstline if ineligible for immunotherapy

Answer 9

lenvatinib

Question 10

Initial management of small solitary HCC

Answer 10

• IF preserved liver function and no vascular invasion, surgical resection is actually preferred to transplant