Liver cancer stages

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on July 20, 2022.

Making an educated treatment decision begins with determining the stage, or progression, of the disease. The stage of liver cancer is one of the most important factors in evaluating treatment options.

This article will cover:

What does staging tell you?

Staging helps:

Your care team speak the same language: The stage is a quick way for your care team to communicate how advanced the cancer is—where it’s spread, how large it is, and how much it’s affecting the body.

Inform treatment: Most importantly, your stage informs a treatment plan—more advanced cases may need a different approach than smaller tumors caught early on. Liver cancers in the same stage are typically treated in similar ways.

Determine clinical trial eligibility: Clinical trials are programs researching new drugs or treatments intended to improve a person’s chances of survival. You and your care team may work together to decide on a treatment plan that best manages a particular cancer and its symptoms and provides the best quality of life.

TNM staging system

The TNM system is used to describe many cancers, and it’s the most common system used to stage liver cancer in the United States. However, TNM—created by the American Joint Committee on Cancer—doesn’t look at liver function. This is why other staging systems, such as the Barcelona Clinic Liver Cancer system, are sometimes used for primary liver cancer.

The TNM system bases the staging criteria on the evaluation of three primary factors:

T (tumor) describes the size of the original tumor.

N (node) indicates whether the cancer is present in the regional (nearby) lymph nodes.

M (metastasis) 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 example, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information couldn’t be assessed. Once the T, N and M scores have been assigned, an overall liver cancer stage is assigned.

The four stages of liver cancer

Stage 1 liver cancer

The single primary tumor (any size) hasn’t grown into any blood vessels. The cancer hasn’t spread to nearby lymph nodes nor distant sites. This stage has two subcategories.

  • Stage 1A: The primary tumor measures 2 cm or smaller.
  • Stage 1B: The primary tumor is larger than 2 cm.

Stage 2 liver cancer

A single primary tumor (any size) has grown into blood vessels, or several tumors are present (all smaller than 5 cm). The cancer hasn’t spread to nearby lymph nodes nor distant sites.

Stage 3 liver cancer

This stage has two subcategories.

  • Stage 3A: Several tumors have been found, and at least one is larger than 5 cm. The cancer hasn’t spread to nearby lymph nodes nor distant sites.
  • Stage 3B: Several tumors have been found, and at least one tumor is growing into a branch of the portal vein or the hepatic vein. The liver cancer hasn’t spread to nearby lymph nodes nor distant sites.

Stage 4 liver cancer

In stage 4 liver cancer the cancer may have spread to nearby lymph nodes and/or to distant sites within the body. Advanced liver cancer doesn’t often metastasize, but when it does, it’s most likely to spread to the lungs and bones. This stage has two subcategories:

  • Stage 4A: One or several tumors of any size have been found and the cancer has spread to nearby lymph nodes, but it has not reached distant sites. 
  • Stage 4B: One or several tumors of any size have been found. The cancer may or may not have reached nearby lymph nodes, but it has spread to faraway organs such as the lungs or bones.
Unlike other cancers, liver cancer is complicated by the fact that most patients have damage that limits the organ’s function. The liver provides a crucial service for the body, aiding in digestion and detoxification. Reduced liver function may result in severe, even life-threatening, conditions. Reduced liver function may also have implications when choosing treatment options.

Learn more about metastatic stage 4 liver cancer

Other liver cancer staging systems

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

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

Though the TNM system is the most common, there’s no single staging system consistently used by the medical community, so if you have questions about your liver cancer stage, make sure to discuss them with your oncology team.

Child-Pugh score

The Child-Pugh score is part of the BCLC staging system and describes liver function using blood tests and imaging. Liver cancer patients often have cirrhosis as well, which is scarring of liver tissue due to disease or toxins. Cirrhosis may be described with this scale.

Child-Pugh measures liver function by looking at five factors:

  • Blood levels of bilirubin, which is made by the liver and results in yellowing of the skin and eyes when there is too much (jaundice)
  • Blood levels of albumin, a protein normally made by the liver
  • The time it takes for clotting factors to work
  • Fluid levels in the abdomen
  • Whether the liver disease is affecting brain function

The Child-Pugh score is used to determine the class of liver function:

  • Class A means the liver function is normal.
  • Class B means there are some abnormalities in the way the liver is working.
  • Class C indicates severe abnormalities in liver function. Individuals with class C liver function may not be good candidates for aggressive treatment or surgery because of the intensity of their disease.

Liver cancer survival rates

In cancer care, doctors typically refer to five-year relative survival rates when discussing outcomes with their patients. These rates approximate the probability that someone with a certain type of cancer will live five years or longer after they are diagnosed, compared with people without that cancer. Survival rates can provide context, but they are rough measurements, and they don’t account for all of the individual factors that may influence patient outcomes. The calculations are also somewhat dated because they rely on patient data from five or more years ago. Due to recent treatment advances and other factors, current patients may have better outcomes than the rates suggest.

According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, the overall five-year relative survival rate for liver cancer is 20.3 percent, based on data from patients diagnosed between 2011 and 2017. The rate suggests that people with any stage of liver cancer are, on average, about 20.3 percent as likely as people without liver cancer to survive five years or longer after their diagnosis.

SEER also collects survival rates according to the cancer’s stage, but it uses three general stages for all cancer types, instead of grouping them according to the staging system of a particular cancer. The SEER stages are:

  • Localized (cancer is confined to where it started)
  • Regional (cancer has spread to nearby lymph nodes)
  • Distant (cancer has spread to distant body parts)

The five-year relative survival rates for liver cancer according to SEER stages are:

  • Localized: 35.3 percent
  • Regional: 12.3 percent
  • Distant: 2.7 percent

Some of the factors that play a role in determining a patient’s chance of recovery include the cancer’s stage, the extent of liver function and the patient’s overall health.

Early-stage liver cancer tumors in patients with otherwise healthy livers can sometimes be treated with surgery. However, it’s difficult to detect liver tumors early, and most patients already have cirrhosis or are not healthy enough to undergo surgery by the time they’re diagnosed.

Stage 4 liver cancer survival rates

Liver cancer tumors that cannot be completely removed by surgery often have low survival rates, but the length of time a patient may live with the cancer can vary.

While stage 4 liver cancer has low survival rates, some patients may live for years after their diagnosis. There are treatments available to help boost quality of life and prolong survival. New therapies are always being developed. Some of these newer treatments, such as virus therapy, have shown promise for patients with advanced liver cancer, leading to hope that outcomes may improve for stage 4 patients in the future.

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