Stage 4

The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor decide which treatment you need.

Staging looks at the size of the cancer (tumour) and whether it has spread to other parts of 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 4 liver cancer is divided into 2 further stages - stage 4A and 4B.

Knowing the stage of your cancer helps you and your doctors plan the best treatment for you.

Stage 4A

The cancer is any size and there may be more than one tumour. It may have grown into blood vessels or the organs around the liver. It has spread to lymph nodes but not to other parts of the body.

Diagram showing stage 4A liver cancer

Stage 4B

The cancer is any size and there may be more than one tumour. It may have grown into blood vessels or the organs around the liver. It may or may not have spread into lymph nodes, but has spread to another part of the body such as the lungs or bones.

Diagram showing stage 4B liver cancer

TNM stages

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 

Your doctor gives each letter a number depending on how far the cancer has grown.

Stage 4A  is the same as Any T, N1, M0 in the TNM staging system.

Stage 4B is the same as Any T, Any N, M1.

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 your liver is working and your general health (your performance status). Then they can decide what treatment would be best. For this, doctors use a system such as the Barcelona Clinic Liver Cancer (BCLC) staging system.


Unfortunately when liver cancer is advanced, treatment won't be able to cure it. It aims to control the cancer, relieve symptoms and give you a good quality of life.

Targeted and immunotherapy cancer drugs

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. They are called immunotherapies.

You might have a combination of these drugs, or treatment with a single drug. Examples include:

  • atezolizumab and bevacizumab
  • lenvatinib
  • sorafenib

Treating symptoms

You can also have other treatments to control specific symptoms such as sickness and pain. 

Research and clinical trials

Researchers are always trying to improve the treatment and quality of life for people with liver cancer. This includes the care of people with advanced cancer.

Other stages

Last reviewed: 
13 Oct 2021
Next review due: 
13 Oct 2024
  • 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: Principles and Practice of Oncology (11th edition)
    VT DeVita, TS Lawrence, SA Rosenberg
    Wolters Kluwer, 2019

  • Hepatocellular carcinoma
    JM Llovet and others
    National Reviews Disease Primers, 2021. Volume 21;7(1), Pages 1 – 28

  • Systemic treatment of hepatocellular carcinoma: An EASL position paper
    J Bruix and others
    Journal of Hepatology, July 2021. Pages 1-15

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