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About staging of liver cancer

The stage of a cancer tells you its size and whether it has spread. This is important because your doctor uses this information to help decide which treatment you need. The tests you have after being diagnosed with liver cancer help stage your cancer.

There are different staging systems your doctor can use. The staging systems used to describe the size and position of liver cancer are the:

  • TNM staging system
  • Number staging system

BCLC staging system and Child-Pugh system

When deciding on treatment your doctor also has to think about how well your liver is working, especially if you also have liver damage (cirrhosis). Doctors can use the Child-Pugh system for this. This gives a score depending on how well the liver is working. Unfortunately people with severe liver damage may be too unwell to have treatment for the cancer.

Doctors often use the Barcelona Clinic Liver Cancer (BCLC) staging system to help make treatment decisions for hepatocellular carcinoma. This system looks at the number and size of liver tumours, as well as how well your liver is working and how well you are overall. 

TNM stages

The TNM staging system stands for tumour, node and metastases.

  • T describes the size of the tumour (cancer) and if there is more than one tumour in the liver
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

Your doctor gives each letter (T, N and M) a number, depending on how far the cancer has grown.

For example, a very small cancer which hasn't spread to the lymph nodes or elsewhere in the body may be T1 N0 M0. A larger cancer that has spread to the lymph nodes and to another part of the body, such as the lungs, may be T4 N1 M1.

Some of the information doctors need for the TNM staging system may only be found out after surgery to remove the cancer. Unfortunately many people with liver cancer aren't able to have surgery because they aren't well enough or the cancer is too advanced.

Number staging system

The Number staging system divides liver cancer into 4 main stages, from 1 to 4. Stage 1 is an early cancer. Stage 4 is advanced, which means the cancer has spread to the lymph nodes or another part of the body.

Whether your cancer can be removed with surgery

Your doctor might also classify liver cancer depending on whether they can remove it (resectable liver cancer) or not (unresectable liver cancer).

Surgery to remove cancer that is only in the liver includes removing part of the liver (resection) or a liver transplant. If you can’t have surgery, you have other treatments to help control the cancer.

Last reviewed: 
27 Dec 2018
  • AJCC Cancer Staging Manual, 8th edition
    American Joint Committee on Cancer
    Springer, 2017

  • EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma
    European Association for the Study of the Liver
    Journal of Hepatology, 2018. Volume 69, Pages 182-236

  • Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up
    A Vogel and others
    Annals of Oncology, 2018. Volume 29, Supplement 4, Pages 238-255

  • Cancer and its Management (7th edition)
    J Tobias and D Hochhauser
    Wiley Blackwell, 2015

  • Cancer: Principles and Practice of Oncology (10th edition)
    VT DeVita, TS Lawrence, SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

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