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Stage 4

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 4 liver cancer is divided into 2 further stages - stage 4A and 4B.

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 (M - for metastasis)

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

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


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 cancer drugs

Targeted cancer drugs work in different ways to control a cancer. This includes stopping signals that tell cancer cells to divide and grow, and stopping cancer cells from growing new blood vessels (which they need to keep growing).

A targeted cancer drug doctors most often use for primary liver cancer is 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 wanting to improve treatment and quality of life for people with liver cancer. This includes for advanced cancer.

Other stages

Last reviewed: 
14 Jan 2019
  • 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 (10th edition)
    VT DeVita, TS Lawrence, SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

Information and help