Staging looks at the size of the cancer (tumour) and whether it has spread anywhere else in the body. There are different staging systems doctors can use for liver cancer. The Number staging system is one of these. It divides liver cancer into 4 main stages, from 1 to 4.
Stage 1 liver cancer is divided into stage 1A and stage 1B.
Stage 1A means there is a single tumour in the liver that is 2cm or less, and it may or may not have grown into a blood vessel (microvascular invasion).
Stage 1B means there is a single tumour that is more than 2cm, and has not grown into the blood vessels.
Stage 1 liver cancer has not spread to the lymph nodes or anywhere else in the body.
Doctors may use another staging system called the TNM staging system.
- T describes the size of the tumour
- N describes whether there are cancer cells in the lymph nodes
- M describes whether the cancer has spread to a different part of the body (M - for metastasis)
Your doctor gives each letter a number depending on how far the cancer has grown.
Stage 1A liver cancer is the same as T1a, N0, M0 in the TNM staging system. Stage 1B is the same as T1b, N0, M0.
Other staging systems
The Number and TNM staging systems describe the size and position of liver cancer. However, because people with liver cancer often have scarring of the liver (cirrhosis), doctors also need a system that describes how well the liver is working and how well the person is overall (their performance status). Then they can decide what treatment would be best. For this, they use a system such as the Barcelona Clinic Liver Cancer (BCLC) staging system.
The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:
- where the cancer is
- how well your liver is working
- other health conditions
You might have:
Surgery to remove part of your liver
Depending on the size of the cancer and where in the liver it is, you might have an operation to remove part of your liver (liver resection). To have this type of surgery the rest of your liver must be healthy.
A liver transplant
Your doctor may recommend a liver transplant if you have scarring of the liver (cirrhosis) and you are well enough. You may have to wait a long time to receive a transplant. You might have other treatments to help control the cancer while you are on the transplant list.
Chemotherapy directly into the liver
This is called chemoembolisation or trans arterial chemoembolisation (TACE). It means having chemotherapy directly to the area of your liver that contains the cancer and then blocking off the blood supply to the tumour.
You usually have this treatment if you can't have surgery, or to help control the cancer while you are waiting for a liver transplant. In some cases, you may have this treatment to shrink a tumour so that it then becomes small enough to remove with surgery.
Radiofrequency ablation (RFA) or microwave ablation (MWA)
These treatments use heat to destroy cancer cells. You might have treatment with ablation if you can't have surgery, or to control the cancer while you are waiting for a transplant.
Percutaneous ethanol injection (PEI)
This treatment uses alcohol to destroy cancer cells. You might have treatment with ablation if you can't have surgery, or to control the cancer while you are waiting for a transplant.