{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 24, Ep 2 of 4: Hepatocellular Carcinoma End to End","html":"","width":"100%","height":180,"duration":750,"description":"Episode two works hepatocellular carcinoma as one continuous algorithm built on a single override: a new lesion in a cirrhotic or chronic hepatitis B liver is HCC until proven otherwise. Surveillance goes to every Child-Pugh A or B cirrhotic and to high-risk hepatitis B, by ultrasound and AFP every six months timed to the tumor doubling time and the curative-size cutoffs. LI-RADS turns that finding into a diagnosis, with the definite category diagnostic by imaging alone and the two special categories forcing biopsy or excluding transplant. The BCLC system then turns the diagnosis into the treatment the physiology will actually permit, from resection and ablation, through transplant within Milan, to locoregional therapy and first-line atezolizumab plus bevacizumab for advanced disease.\n \nTopics covered\n\nSurveillance eligibility and Child-Pugh cutoffs\nNon-cirrhotic hepatitis B risk triggers\nUltrasound plus AFP every six months\nThe role and limits of AFP\nLI-RADS categories and the diagnostic five\nMajor features and their mechanisms\nBCLC staging and curative options\nMilan and UCSF criteria and down-staging\nLocoregional and systemic therapy\n \n \nKey decisions\n\nSurveil every patient with Child-Pugh A or B cirrhosis of any cause including cured hepatitis C, and surveil Child-Pugh C only when the patient is a transplant candidate.\nThe modality is right-upper-quadrant ultrasound with AFP every six months, substituting MRI or CT when severe obesity or steatosis makes the ultrasound useless; AFP is never stand-alone, but a value over two hundred nanograms per milliliter with arterial enhancement strongly supports HCC.\nLI-RADS five requires a lesion at least one centimeter with arterial-phase hyperenhancement plus a major feature, namely washout, an enhancing capsule, or threshold growth of fifty percent or more in six months, and in a cirrhotic liver that is a diagnosis without biopsy.\nA rim-enhancing, peripheral-washout, targetoid lesion is the malignant-but-not-HCC...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}