Liver Cancer Stages / Staging

Some cancers are more aggressive than others, and determining the stage of liver cancer is one of the most important factors in evaluating treatment options. Our cancer doctors use a variety of diagnostic tests to evaluate liver cancer and develop the appropriate treatment plan for you.

TNM System for Liver Cancer Staging

The American Joint Committee on Cancer (AJCC) TNM system is the most widely accepted method for liver cancer staging. This system bases the staging criteria on the evaluation of three primary factors:

• Tumor (T) describes the number and size of the original tumor.
• Lymph Node (N) indicates whether the cancer is present in the regional (nearby) lymph nodes.
• Metastasis (M) refers to whether cancer has spread to distant parts of the body. (The most common sites of liver cancer spread are the lungs and bones).

A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. For instance, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information could not be assessed.

Once the T, N, and M scores have been assigned, an overall liver cancer stage is assigned.

Other liver cancer staging systems have been developed that also take into account other factors, such as the function of the liver. However, the staging guidelines described here are based on the current AJCC TNM system.

Stages of Liver Cancer

• Stage I: The single primary tumor (any size) has not grown into any blood vessels. The cancer has not spread to nearby lymph nodes or distant sites. (Example: T1, N0, M0)
• Stage II: A single primary tumor (any size) that has grown into the blood vessels, or there are several small tumors, all less than 2 inches (5 cm) in diameter. The cancer has not spread to nearby lymph nodes or distant sites. (Example: T2, N0, M0)
• Stage IIIA: There are several tumors and at least one is larger than 2 inches (5 cm). The cancer has not spread to nearby lymph nodes or distant sites. (Example: T3a, N0, M0)
• Stage IIIB: There are several tumors and, at least, one tumor is growing into a branch of the portal vein or the hepatic vein. The liver cancer has not spread to nearby lymph nodes or distant sites. (Example: T3b, N0, M0)
• Stage IIIC: The tumor has grown into a nearby organ (other than the gallbladder), Or the tumor has grown into the outer covering of the liver. The cancer has not spread to nearby lymph nodes or distant sites. (Example: T4, N0, M0)
• Stage IVA: The tumors may be any size or number and have spread beyond the liver to blood vessels or nearby organs. The cancer has invaded nearby lymph nodes. The cancer has not spread to distant sites. (Example: Any T, Any N1, M0)
• Stage IVB: The liver cancer has spread to other parts of the body. (Example: Any T, Any N1, M1)

Understanding Liver Cancer Staging

Unlike other cancers, liver cancer is complicated by the fact that most patients have liver damage that limits the function of the liver. The liver provides a very important function for the body, aiding in digesting and detoxification. Reduced liver function could result in severe and, even, life-threatening conditions. Reduced liver function may also have implications when choosing treatment options.

Several other liver cancer staging systems have been developed that take into account how the function of the liver may affect the prognosis:

• The Barcelona-Clinic Liver Cancer (BCLC) system
• The Cancer of the Liver Italian Program (CLIP) system
• The Okuda system

The Child-Pugh score is part of the BCLC and CLIP staging systems, and gives the measure of liver function in people with cirrhosis. The system looks at 5 factors including: levels of bilirubin and albumin in the blood, prothrombin time, accumulation of fluid (ascites) in the abdomen, and impact of liver disease on brain function.

Patients with normal liver function are classified as class A, those with mild abnormalities as class B, and those with severe abnormalities as class C. Liver cancer patients with class C cirrhosis are generally not fit to receive treatment.

Next Topic: Liver Cancer Treatments