David Mitchell, a 64-year-old retired structural engineer from Vancouver, had been monitored for hepatitis B-related cirrhosis for over a decade. In mid-2025, routine surveillance found a 3.8 cm lesion in segment VI of his liver.

Diagnosis: hepatocellular carcinoma, stage II (T2N0M0, BCLC stage A).

The problem wasn't the tumor — it was the liver. Child-Pugh class B (7 points): albumin 3.1 g/dL, bilirubin 2.1 mg/dL, INR 1.4, mild ascites. The tumor was operable, but Vancouver General's tumor board estimated a 30% risk of post-hepatectomy liver failure.

The alternative — proton therapy — wasn't available in Canada.…