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.

Our cancer doctors use a variety of diagnostic tests to evaluate liver cancer and develop an individualized treatment plan. If you have been recently diagnosed, we will review your pathology to confirm you have received the correct diagnosis and staging information and develop a personalized treatment plan. If you have a recurrence, we will perform comprehensive testing and identify a treatment approach that is suited to your needs.

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

T (tumor): This describes the number and size of the original tumor.

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

M (metastasis): This 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.

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 important functions for the body, aiding in digesting and detoxification. Reduced liver function may result in severe, 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 five 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 are class B; and those with severe abnormalities are class C. Liver cancer patients with class C cirrhosis are generally not fit to receive treatment.

Stage I (stage 1 liver cancer): 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.

Stage II (stage 2 liver cancer): A single primary tumor (any size) has grown into the blood vessels, or several small tumors are present, all less than five centimeters (two inches) in diameter. The cancer has not spread to nearby lymph nodes or distant sites.

Stage III (stage 3 liver cancer): This stage has three subcategories:

• Stage IIIA: Several tumors have been found, and at least one is larger than five centimeters. The cancer has not spread to nearby lymph nodes or distant sites.
• Stage IIIB: 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 has not spread to nearby lymph nodes or distant sites.
• 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.

Stage IV (stage 4 liver cancer): The cancer has spread to nearby lymph nodes and may have grown into nearby blood vessels or organs. Advanced liver cancer does not often metastasize (or travel to distant organs), but when it does, it is most likely to spread to the lungs and bones. Stage IV liver cancer may be:

• Any T, N1 and M0, meaning the cancer consists of any number or size of tumors in the liver, and it has spread to nearby lymph nodes, but no evidence has been found that the cancer has spread to distant organs or tissue.
• Any T, any N and M1, meaning the cancer consists of any number or size of tumors in the liver, the cancer may or may not have grown into the lymph nodes, and it has spread to another part of the body.

Learn more about treatment options for liver cancer

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