Figure 3.

Alberta Hepatocellular Carcinoma algorithm. The algorithm recognizes the importance of tumour properties (blue boxes [size, number, extrahepatic spread and alpha-fetoprotein levels [AFP]), patient characteristics (red boxes [performance status (PS) and candidacy for transplantation]), and liver function (yellow boxes [Child-Turcotte-Pugh (CTP) class along with elevated pressure within or thrombosis of the portal vein]) and links patients to the most appropriate therapy (white boxes). Dotted line represents potential role of radiofrequency ablation (RFA) in very early stage hepatocellular carcinoma. Dashed line recognizes potential role of ⁹⁰Yttrium (Y) transarterial radioembolization with ⁹⁰Y, especially for patients who are not candidates for transarterial chemoembolization (TACE) because of bland portal vein thrombosis (PVT). BCLC Barcelona Clinic Liver Cancer; LT Liver transplantation; M Metastases; Milan Milan criteria (19); N Lymph node; PVI Portal vein invasion; TTV Total tumour volume; Portal P Portal pressure; PEI Percutaneous ethanol injection