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Dr. Praveen Kammar


Surgical Oncologist

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Liver Blogs | 22 Feb 2022, Tuesday

What Happens in Stage 1 of Liver Cancer?

To make an informed and educated treatment decision, determining the disease’s stage or progression is important. The staging of liver cancer is done to decide the right kind of treatment out of various treatment options available.


Staging signifies cancer’s spread, how large it is and how much it affects the body.

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Staging of liver cancer

There are different staging systems for liver cancer. For e.g., BCLC staging, CLIPstaging , OKUDA staging, CUPI score, TNM staging etc. TNM staging is one of the most commonly used and most recognised staging systems for cancers of various organs.

This system uses numbers to indicate the stage and divides liver cancer into 4 main stages, from 1 to 4. So when we say Stage 1, it implies that we are referring to the TNM staging system. Stage 1 liver cancer is further divided into two categories.

Stage 1 liver cancer is further divided into stages 1A and 1B.

  • Stage 1A signifies a single tumor in the liver, not over 2 cm, and does not grow into blood vessels.
  • Stage 1B shows a single tumor more than 2cm and does not grow into the blood vessels.
  • There is no spread to lymph nodes or other organs in Stage 1.



The exact cause of liver cancer is still not known, but you are more likely to have it if you have:

  • Infections: Both chronic hepatitis B virus (HCB) and chronic hepatitis C virus (HCV) infection can lead to cirrhosis (scarring of liver tissue)and liver cancer.
  • Alcoholism: Years of heavy drinking can cause liver cancer.
  • Nonalcoholic fatty liver disease is commonly seen in overweight and obese people, even in non-drinkers.This is a risk foactor for liver cancer.
  • Other hereditary conditions: Livers disease like hemochromatosis (your body absorbs more iron) ,Wilson’s disease (when the body absorbs more copper), Primary biliary cirrhosis.
  • Type 2 diabetes: Type 2 diabetes is also a risk factor for liver cancer.


Stage 1 is the early stage of cancer, and hence it may not show any symptoms most of the time. It is usually identified incidentally when you are undergoing tests for other reasons.

However in advanced stages of liver cancer one may develop one or more of the following symptoms.

  1. A lump on the right side of the abdomen
  2. Yellowish discoloration of skin and eyes
  3. Unexplained weight loss
  4. Nausea and vomiting
  5. Loss of appetite
  6. Fatigue
  7. Dark-coloured urine
  8. Bloating

Diagnosis and Tests

Your doctor will start with a physical exam to check for unusual swelling or lumps in the right side of your abdomen.

Your doctor will advise you to get some tests done such as:

  • Blood tests for certain substances released by tumors: Tumour markers – AFR, Ca 19-9
  • Ultrasound: It’s the most commonly performed first imaging test. However, it does not provide complete information about the tumour extent or spread. Hence additional imaging tests are needed.
  • CT, MRI, PET scans are routinely needed to understand the spread of the tumour and anatomical relationship of the tumour with surrounding structures.
  • Need for biopsy?
    The features seen on contrast enhanced CT scan and MRI are sensitive enough to diagnose the presence of liver cancer with a high degree of accuracy. Hence biopsy is not needed for stage 1 liver cancer that is amenable for surgery.


Treatment of stage 1 cancer will depend on your general health, liver functioning, and personal preferences.

Liver cancer at the early stages may be treated using either surgery, loco-regional therapy,and, if needed, liver transplantation.

Surgical treatments

  1. Partial hepatectomy: Liver is divided into 8 smaller segments based on the blood supply. Liver surgery for cancer follows these anatomical boundaries. For liver cancer, the entire segment where the cancer is located is removed. Segment oriented liver surgery has been shown to give better results compared to non anatomical resections.
  2. Total hepatectomy and liver transplant: Removing the entire liver and replacing it with a donor liver. Liver transplant is considered in early stage liver cancer when there is damage to the rest of the liver as well which leads to cirrhosis. The reasons for liver damage and cirrhosis are the same as those causing liver cancer.

Locoregional therapies:

  1. Ablation therapy: Destruction of tumor cells in the liver without taking them out. There are several ways to do this, like microwave ablation, radiofrequency, cryoablation, and ethanol. Radiofrequency ablation and microwave ablations are more favoured and the experience with these methods is steadily growing. These therapies are performed by an interventional radiologist.
  2. Newer methods : Stereotactic Body Radiation Therapy ( SBRT) and Proton beam therapy are the newer radiation methods that use high energy beams to specifically target the tumour while avoiding collateral damage to the rest of the liver.
  3. Non surgical treatment modalities are considered in patients who have early stage liver cancer but are not fit for surgery ( due to poor health or bad liver condition).


Detection of stage 1 liver cancer is difficult as it shows no symptoms. Hence, if you have any other risk mentioned above or family history, regular monitoring can help you with timely diagnosis. Treatment at Stage 1, liver cancer, shows a better prognosis and good quality of life. Detection of cancer at this stage ensures a complete cure and reduces the risk of recurrence.

To know more about stage 1 liver cancer, get in touch with our experts now!




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