From the Guidelines
A 3 cm node in the liver is considered a significant finding that warrants prompt medical evaluation, as it could represent various conditions including benign lesions or primary liver cancer, and patients with such findings should consult with a gastroenterologist or hepatologist promptly. According to the Barcelona Clinic Liver Cancer (BCLC) staging classification for hepatocellular carcinoma, a 3 cm node in the liver falls under the BCLC A stage, which includes patients with a single nodule ≤5 cm or up to three nodules ≤3 cm 1. The management of a 3 cm liver node depends on several factors, including the patient's medical history, risk factors for liver disease, and the radiological characteristics of the lesion.
Key Considerations
- The patient's performance status, tumour volume, number, and invasiveness, as well as Child-Pugh score, are crucial in determining the best course of treatment 1.
- Percutaneous local radiofrequency ablation (RFA) is preferable to ethanol injections (PEI) in 2 and 3 cm tumours because of improved prevention of tumour recurrence on the periphery of the nodule 1.
- The Milan criteria, which include patients with a single tumour ≤5 cm or up to three nodules ≤3 cm, are universally recognized as the guideline to list patients for orthotopic liver transplantation (LT) with an overall predicted survival of 75% at 5 years 1.
Treatment Options
- For patients with a 3 cm liver node, treatment options may include percutaneous ablation, resection, or liver transplantation, depending on the patient's characteristics and the presence of comorbidities 1.
- Antiviral therapy may be recommended to reduce the risk of postoperative decompensation and late onset recurrence from second primary tumours in patients with hepatitis B or C related tumours undergoing resection or local ablation of HCC 1.
Prognosis
- The prognosis for patients with a 3 cm liver node depends on several factors, including the patient's medical history, risk factors for liver disease, and the radiological characteristics of the lesion, as well as the treatment approach used 1.
- Median survival of patients with early HCC, which includes those with a 3 cm liver node, reaches 50% to 70% at five years after resection, liver transplantation, or local ablation in selected candidates 1.
From the Research
Definition of a 3 cm Node in the Liver
- A 3 cm node in the liver refers to a nodule or lesion that is 3 centimeters in diameter, which can be a significant size for various liver conditions, including hepatocellular carcinoma (HCC) and liver metastases 2, 3, 4, 5, 6.
Clinical Significance
- The size of a liver nodule is an important factor in determining the appropriate treatment and prognosis, with larger nodules often requiring more aggressive treatment 2, 6.
- A 3 cm node in the liver may be considered for treatment with radiofrequency ablation (RFA) or microwave ablation (MWA), depending on the location and characteristics of the nodule 2.
- For HCC, a 3 cm node may be considered for anatomical resection or non-anatomical liver resection, with the goal of achieving complete removal of the tumor 6.
Diagnostic Considerations
- Imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are commonly used to diagnose and characterize liver nodules, including those that are 3 cm in diameter 3, 4, 5.
- MRI is particularly useful for detecting and characterizing liver metastases, with features such as peripheral ring enhancement, diffusion restriction, and hypointensity on hepatobiliary phase images being hallmarks of metastatic disease 4, 5.
Treatment Options
- Treatment options for a 3 cm node in the liver depend on the underlying diagnosis, with HCC and liver metastases requiring different approaches 2, 6.
- For HCC, treatment options may include surgical resection, RFA, MWA, or systemic therapy, depending on the stage and characteristics of the disease 2, 6.
- For liver metastases, treatment options may include surgical resection, RFA, MWA, or systemic therapy, depending on the primary tumor type and extent of disease 2, 4, 5.