American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment of choice for patients with cirrhosis who meet the Milan criteria for hepatocellular carcinoma?

1. Liver transplantation

2. Partial hepatectomy

3. Radiofrequency ablation

4. Transarterial chemoembolization

The correct answer is: Liver transplantation

Liver transplantation is the treatment of choice for patients with cirrhosis who meet the Milan criteria for hepatocellular carcinoma (HCC) due to several important factors. The Milan criteria include: 1. A single tumor ≤5 cm in diameter. 2. A maximum of three tumors, none larger than 3 cm in diameter. 3. No extrahepatic spread or vascular invasion. For patients within these criteria, liver transplantation serves two critical purposes: it removes the cancerous tissue and addresses the underlying liver disease (cirrhosis). This dual approach can significantly improve survival rates and offers a potential cure. While partial hepatectomy, radiofrequency ablation, and transarterial chemoembolization are viable treatment options for HCC, they are not typically preferred for patients with cirrhosis. Partial hepatectomy can lead to postoperative liver failure in individuals with compromised liver function due to cirrhosis. Radiofrequency ablation is mainly used for smaller tumors and may not be as effective in larger lesions or when there are multiple tumors. Transarterial chemoembolization is generally reserved for patients who are not candidates for either surgery or transplantation and have larger or multifocal tumors. Thus, given the context of the Milan criteria and