BCLC

Question 1

Stages of HCC according to bclc
زي السلم

Answer 1

Stage 0 (very early)
* Single Tumour <2cm with good liver
Stage 1 (early)
* Single Tumour ≤5cm or multiple tumours ≤3 in number and the largest one is ≤3 cm
*Stage 2(intermediate)
Single Tumour >5cm or multiple tumours >3 in number but without vascular invasive or metastasis
*Stage 3 (advanced)
Vascular invasion or metastasis
*Stage 4 (terminal)
End stage liver disease
(Child c يعني)

Question 2

العلاج بقي هيبقي ازاي؟

Answer 2

علي حسب stage
R,(R or T),TACE, systemic ,supportive
0- ressection
A-RFA or Transplantation
B-TACE
C- systemic therapy,soferanib
D-Supportive, palliative care

Question 3

Milan criteria for choosing patient for liver transplant

Answer 3

One tumor ≤ 5 cm
OR Up to 3 tumors, each ≤ 3 cm
+
No vascular invasion
+
No distant metastasis

Question 4

Absolute contraindications of tace

Answer 4

“BLOOD PIC”

Bilirubin high (>3)

Liver failure (Child C)

Outside liver spread (metastasis)

Organ failure (renal, cardiac)

Diffuse portal vein thrombosis

Performance status poor

Infection/sepsis

Coagulopathy

Question 5

Relative contraindications of tace

Answer 5

1. Portal vein thrombosis (segmental or partial — may consider selective TACE or use of DEB-TACE)
2. Large tumor burden (increased risk of post-embolization syndrome)
3. Moderate ascites or mild hepatic decompensation (Child B)
4. Elevated bilirubin (2–3 mg/dL) — borderline liver reserve
5. Cardiopulmonary disease (risk from post-embolization stress)
6. Uncontrolled hypertension or diabetes
7. Previous TACE with poor response