More about the stages of primary liver cancer
This page tells you about the TNM and Barcelona Clinic Liver Cancer (BCLC) staging systems, and the Child-Pugh system for primary liver cancer. You can find the following information
More about the stages of primary liver cancer
The TNM system is used for cancer staging all over the world. TNM stands for Tumour, Node, Metastasis. The TNM system describes the size of a primary tumour (T), whether the cancer has spread to the lymph nodes (N), and whether the cancer has spread to a different part of the body (M - for metastases).
- Tumour (T) has 4 main T stages – T1 to T4. The main factors that doctors take into account are the size of the liver tumours and whether the cancer has grown into any blood vessels in the liver
- Nodes (N) has 2 N stages – N0 and N1. N0 means there are no cancer cells in nearby lymph nodes. N1 means that there are cancer cells in lymph nodes near the liver
- Metastases (M) has 2 M stages – M0 and M1. M0 means there is no sign that the cancer has spread outside the liver. M1 means there are cancer cells in other body organs such as the lungs or bones
Using the TNM staging system means that a doctor can describe very accurately and clearly what the stage of a cancer is. But day to day, your doctor is most likely to describe your cancer as being stage 1, 2, 3, or 4 (the number staging system).
Systems such as the Barcelona Clinic Liver Cancer staging system and the Child-Pugh system describe how well you feel or how well the liver is working, and helps doctors decide what type of treatment is best.
You can view and print the quick guides for all the pages in the treating liver cancer section.
Staging takes into account the size of the tumour, whether the lymph nodes (glands) are affected and whether cancer cells have spread anywhere else.
TNM stands for Tumour, Node, Metastasis. The TNM system describes the size of a primary tumour (T), whether the cancer has spread to the lymph nodes (N), and whether the cancer has spread to a different part of the body (M - for metastases).
The TNM system is used for cancer staging all over the world. It is important for doctors to use the same staging system because then they can be sure they are all talking about the same situation when they are comparing notes or carrying out research.
There are 4 main T stages – T1 to T4. The main factors that doctors take into account are the size of the liver tumours and whether the cancer has grown into any blood vessels in the liver. This may mean that the cancer is obviously growing into or around a vein or artery. Or it may mean that there is microscopic growth of cancer cells into the vein or artery wall.
T1 means that there is a single small tumour that has not grown into any blood vessels.
T2 means that either
- There is a single tumour that has grown into a blood vessel in the liver OR
- There are several tumours, all less than 5cm across, but none have grown into blood vessels
T3 is divided into T3a and T3b
- T3a means there are several tumours, and at least one is more than 5cm across
- T3b means at least one tumour has grown into a major branch of one of the main blood vessels (the portal vein or hepatic vein)
T4 means that the cancer has grown
- Into organs close to the liver (not including the gallbladder) OR
- Through the lining that wraps around the internal organs of the abdomen (visceral peritoneum)
There are 2 M stages
- M0 means there is no sign that the cancer has spread outside the liver
- M1 means there are cancer cells in other body organs such as the lungs or bones
The TNM staging system describes the size and position of liver cancer. But because people with liver cancer often have cirrhosis, doctors also need a system that describes how well the liver is working. Then they can decide what sort of treatment would be best. To help them decide this, they use a system such as the Barcelona Clinic Liver Cancer (BCLC) staging system or the Child-Pugh system.
The BCLC staging system looks at the number and size of tumours and at how well the person is (the performance status - PS). It also takes into account how well the liver is working, using the Child-Pugh score. There are 5 stages
- Stage 0 means the tumour is less than 2cm, the person feels well (PS 0) and the liver is working normally (Child-Pugh A)
- Stage A means there is a single tumour less than 5cm, or up to 3 tumours all less than 3cm. The person feels well and is active (PS 0) and the liver is working well (Child-Pugh A or B)
- Stage B means there are many tumours in the liver, but the person feels well (PS 0) and the liver is working well (Child-Pugh A or B)
- Stage C means the cancer has spread into the blood vessels, lymph nodes or other body organs. Or the person does not feel well (PS 1 or 2). The liver is still working (Child-Pugh A or B)
- Stage D means there is severe liver damage (Child-Pugh C) or the person is not well and needs help in being looked after (PS 3 or 4)
The Child-Pugh system looks at the following 5 things that tell how well the liver is working
- Bilirubin levels in the blood
- Albumin levels in the blood
- How quickly the blood clots (prothrombin time)
- If fluid has collected in the abdomen (ascites)
- Brain function (encephalopathy)
Each one is given a number score, and based on that score, people fall into 1 of 3 classes.
- Class A means the liver is working normally
- Class B means mild to moderate illness and people may be offered treatment such as surgery or chemoembolisation – you can read more about these treatments on the which treatment for liver cancer page
- Class C means there is severe liver damage – unfortunately, the outlook is then quite poor. They are often too sick to have treatment for the cancer.
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