More about the stages of primary liver cancer

Staging takes into account the size of the tumour, whether the lymph 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 or metastasised (M).

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 major blood vessels.

T2 means that either

• There is a single tumour that has grown into a major blood vessel in the liver OR
• There are several tumours, all less than 5cm across, but none have grown into major blood vessels

T3 means that

• There are several tumours, and at least one is more than 5cm across OR
• At least one tumour has grown into a major branch of a main blood vessel such as the portal vein or hepatic vein

T4 means that

• Other organs contain cancer cells (not counting the gall bladder) OR
• There are cancer cells that have grown through the lining of the abdomen (the peritoneum)

There are 2 N stages

• N0 means that there are no cancer cells in nearby lymph nodes
• N1 means that there are cancer cells in lymph nodes around the liver and its major blood vessels

If there are cancer cells in lymph nodes further away, this counts as cancer spread (M1) and so the cancer is automatically stage 4.

There are 2 M stages

• M0 means there is no sign that the cancer has spread outside the liver or nearby lymph nodes
• M1 means there are cancer cells in other body organs or in lymph nodes that are further away

The TNM stages mean 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 TNM staging system describes the size and position of liver cancer. But because people with liver cancer often have cirrhosis and cancer, 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) or the Child-Pugh staging system.

The BCLC system looks at the number and size of tumours and at how well the person is. There are 5 stages

• Stage 0 means the tumour is less than 2cm, the person feels well and the liver is working normally.
• Stage A means there is 1 tumour less than 5cm or up to 3 tumours all less than 3cm. The person feels well and the liver is working normally
• Stage B means there are many tumours in the liver but the person feels well and the liver is working well
• Stage C means there are 1 or more tumours in the liver but the person is not feeling well and their liver is not fully working. Or the cancer has spread to blood vessels or lymph nodes near the liver.
• Stage D means the cancer has spread to other parts of the body and the liver is not working very well

The Child-Pugh system looks at the following five 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 illness and people are usually offered treatment such as surgery or chemotherapy – 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 and they are not likely to be offered treatment