NCCN Guidelines Version 1.2026: Hepatocellular Carcinoma

This set of vocabulary flashcards covers key terminology, staging systems, and therapeutic modalities outlined in the NCCN Guidelines for Hepatocellular Carcinoma.

Hepatocellular Carcinoma (HCC)

A primary cancer of the liver, often associated with underlying cirrhosis or chronic liver disease.

Alpha-fetoprotein (AFP)

A serum biomarker used in screening and surveillance for HCC; levels >$400\,ng/dm^{3}$ are often suspicious for malignancy, though it can be normal in early disease.

Child-Turcotte-Pugh (CTP) Score

A classification system (Classes A, B, and C) used to assess the hepatic functional reserve and operative risk in patients with cirrhosis.

Model for End-Stage Liver Disease (MELD)

A numerical scale ranging from $6$ to $40$ based on bilirubin, creatinine, and INR, used to prioritize patients for liver transplantation.

Milan Criteria

Selection criteria for liver transplantation in HCC patients: a single tumor $\le 5\,cm$ or up to 3 nodules each $\le 3\,cm$, with no macrovascular invasion.

Barcelona Clinic Liver Cancer (BCLC)

A staging system that incorporates tumor characteristics, liver function, and performance status to guide treatment selection for HCC.

Radiofrequency Ablation (RFA)

A thermal locoregional therapy that uses heat to induce tumor necrosis; generally considered definitive treatment for tumors $\le 3\,cm$.

Transarterial Chemoembolization (TACE)

A locoregional therapy that delivers a concentrated dose of chemotherapy directly to the tumor via the hepatic artery followed by vessel occlusion.

Stereotactic Body Radiation Therapy (SBRT)

An advanced technique of hypofractionated radiotherapy that delivers large, ablative doses of radiation with rapid dose fall-off in surrounding tissues.

Radioembolization (RE)

Also known as selective internal radiation therapy (SIRT); involves the administration of Yttrium-90 ($Y\text{-}90$) microspheres to deliver targeted internal radiation.

Future Liver Remnant (FLR)

The portion of the liver that will remain after surgical resection; must be at least $20\%$ in non-cirrhotic patients and $30\%\text{--}40\%$ in patients with CTP Class A cirrhosis.

Bridge Therapy

Locoregional treatments used to decrease tumor progression and the dropout rate for patients on the liver transplantation waiting list.

Downstaging Therapy

The use of locoregional or systemic treatments to reduce tumor burden to within accepted transplant criteria (e.g., Milan criteria).

Sorafenib

An oral multikinase inhibitor used as first-line systemic therapy that suppresses tumor cell proliferation and angiogenesis.

Lenvatinib

A first-line systemic multikinase inhibitor of VEGFR, FGFR, and PDGFR shown to be non-inferior to sorafenib in the REFLECT trial.

Atezolizumab + Bevacizumab

A preferred Category 1 first-line systemic therapy combination involving a PD-L1 inhibitor and a VEGF inhibitor.

Cabozantinib

A systemic multikinase inhibitor approved as subsequent-line therapy for patients who have progressed on or after sorafenib.

Albumin-Bilirubin (ALBI) Grade

A model for assessing liver function based solely on serum albumin and bilirubin levels, used as an alternative to the CTP score.

Portal Vein Embolization (PVE)

A preoperative procedure used to induce hypertrophy in the future liver remnant by redirecting blood flow away from the segments to be resected.

Biologically Effective Dose (BED10)

A measure used in SBRT to quantify biological effect; the guidelines prefer a BED_{10} > 100\,Gy for optimal tumor control.