Experiences with HCC in cirrhosis (56M) – Y90 vs TACE vs immunotherapy? Biopsy and second opinion?

Hi everyone, I’m hoping to hear from anyone who has had a similar experience and would be willing to share. It’s about my father (born in 1969, 56 years old). He has known liver cirrhosis with portal hypertension and an enlarged spleen. Recently, he also had esophageal varices that were treated with endoscopic band ligation. In his latest MRI, multiple new and/or growing liver lesions were found. According to the radiology report, they are typical for hepatocellular carcinoma (HCC) (hypervascular with wash-out). The largest lesions are around 2 cm. AFP is normal, but PIVKA-II is elevated. No suspicious lymph nodes were described. There will be a tumor board discussion next week. We are wondering: – Does anyone have experience with Y90 (radioembolization) or TACE? – When is immunotherapy usually considered? – If imaging is typical for HCC, is a biopsy still necessary, or is it often skipped? – What is the quality of life like with these treatments? – Should we try to get a second opinion in parallel, or would that not delay things? We understand every case is different. We’re just looking for experiences from people who have been in a similar situation. Thank you.