Home 🡪 Blogs 🡪 What Are the Stages of Liver Cancer?

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Dr. Praveen Kammar

MS, MRCS, MCH

Surgical Oncologist

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Liver Cancer | 02 May 2022, Monday

What Are the Stages of Liver Cancer?

Stages of Liver Cancer

If a person is diagnosed with liver cancer or any other, doctors will determine if it has spread and how far; this process is known as “staging”. Cancer staging is essential to decide treatment and to understand survival statistics.

The cancer stage shows how big the cancer is and whether it has spread to other body parts.

Several tests are required to assess the stage of liver cancer. These include

  • CT and MRI scan of the liver
  • CT and PET scan of the body
  • Overall condition of the liver which is determined by a combination of blood tests determining liver condition, imaging findings and clinical findings.

Patients’ overall health is also taken into consideration when staging is carried out.

When it comes to liver cancer, there are several staging systems. They are

  • TNM staging system
  • Okuda staging system
  • BCLC staging system
  • CLIP staging system

Each staging system uses a different set of parameters to stage the liver cancer. Different institutes use different staging system based on their experience and reproducibility.

TNM staging

This TNM staging system stands for Tumor, Node, and Metastases.

  • “T” describes tumor size and presence of more than one tumor in the liver. A number ( 1 to 4) is added in front of “T” to depict the T stage. Higher the size or the number of nodules, higher is the T stage. E.g.: T3 is a higher stage than T2.
  • “N” depicts the spread of cancer in the lymph nodes.
  • “M” describes whether cancer has spread to other distant body parts of the body.

Combinations of T,N and M stage gives us the overall stage of the liver cancer.
These combinations are determined by anaylsing the survival of patients from different stage combinations. Patients grouped in the same stage are likely to have similar survival outcomes.

There are 4 main stages of liver cancer in TNM staging system i.e. from stage 1 to stage 4. Stage 1 is early cancer, whereas stage 4 is advanced, which signifies that cancer has spread to the lymph nodes or other body parts.

Stage 1

Stage 1 liver cancer is the initial stage of cancer that is further divided into stage 1A and stage 1B.

  • Stage 1A signifies a single tumor in the liver not more than 2 cm, which has not spread into other body parts.
  • Stage 1B shows a single tumor of more than 2 cm and is localized.

Stage 2

In stage 2 liver cancer, a single tumor over 2 cm has grown into the liver’s blood vessels. It can also indicate several tumors in the liver, all less than 5 cm.

Stage 3

Stage 3 liver cancer is further divided into 2 stages – stage 3A and 3B.

  • Stage 3A

In this stage, multiple tumors (at least one more than 5 cm) are present in the liver.

  • Stage 3B

Here the tumor has spread to one of the major blood vessels of the liver (the hepatic or portal vein) or has spread into organs close to the liver (except the gallbladder) or in the lining of internal organs of the abdomen but has still not involved the lymph nodes.

Stage 4

Stage 4 liver cancer is the most advanced and critical stage and is further divided into 2 stages: 4A and 4B.

  • Stage 4A

Here the tumour has spread to the surrounding nodes but not to the distant parts of the body. The T stage ( i.e. size and number of tumour nodules ) is not of significance in this stage.

  • Stage 4B

This stage consists of tumor that has spread to the distant organs. Here the T and N stage are of no significance.

The TNM staging does not consider the overall health and the status of the liver in staging. However these 2 factors play a vital role in treatment decisions and affect the outcomes as well.

The other classification systems – CLIP , OKUDA and BCLC – incorporate other parameters apart from tumour dimensions and have been validated.

BCLC staging system incorporates

  1. Patients general condition ( represented by performance status score)
  2. Liver condition ( represented by Child Pugh score)
  3. Tumor characteristics ( size, number, spread etc)

RESULTS AND SURVIVAL BASED ON STAGE:

Stage  5 year survival 
Tumour confined to liver  35%
Tumour spread to nodes  12%
Tumour spread to distant organs  3%

Conclusion

Knowing your cancer status assists your doctors in planning the best treatment for you. Staging liver cancer can help us determine the extent of spread and its prognosis.

For more information on liver cancer staging, connect with our specialists today!

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