Liver Cancer Staging

If liver cancer is diagnosed, your oncologist needs to determine the extent (stage) of the disease. This will help them determine if surgery is possible and which liver cancer treatments will most likely work best. Tests are needed to determine if the cancer has spread beyond the liver to lymph nodes or possibly other organs.

Tests Used to Determine the Extent of Liver Cancer

In addition to blood tests and images used to diagnose liver cancer, your oncologist may also request:

CT scan of the chest

A CT scan often can show whether liver cancer has spread to the lungs.

Bone scan

The doctor injects a small amount of a radioactive substance into your blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.

Pet scan

You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether liver cancer may have spread.

Staging Systems for Liver Cancer

There are multiple staging systems for liver cancer. In the United States, the most commonly used system is the AJCC (American Joint Committee on Cancer) TNM system, which evaluates three primary factors:

  • T (tumor) describes the size of the tumor
  • N (node) indicates whether the cancer spread to nearby lymph nodes
  • M (metastasis) refers to whether cancer has spread to distant parts of the body

A number or letter is assigned to T, N, and M to provide more details about each factor. A higher number indicates a more advanced cancer. Once the T, N, and M scores have been assigned, an overall liver cancer stage is determined.

While the TNM system describes the extent of liver cancer, it doesn’t consider liver function. Therefore, other staging systems, such as the Barcelona Clinic Liver Cancer (BCLC) system, are sometimes used for primary liver cancer. The BCLC system is used to predict the patient’s chance of recovery and to plan treatment based on:

  • How well the liver is working
  • Whether the cancer has spread within the liver or to other parts of the body
  • The symptoms caused by the cancer
  • The overall health of the patient

The BCLC staging system has five stages:

  • Stage 0: very early
  • Stage A: early
  • Stage B: intermediate
  • Stage C: advanced
  • Stage D: end-stage

Talk with your liver cancer specialist if you have questions about the stage of your cancer or which system they used.

Stages of Liver Cancer

Stage I Liver Cancer

There is one tumor that has not spread to nearby blood vessels.

Stage II Liver Cancer

During this stage, either:

  • One tumor that has spread to nearby blood vessels or
  • More than one tumor, none of which is larger than 5 centimeters.

Stage II Liver Cancer

During this stage, either:

  • One tumor that has spread to nearby blood vessels or
  • More than one tumor, none of which is larger than 5 centimeters.

Stage III Liver Cancer

Divided into stages IIIA, IIIB, and IIIC:

  • Stage IIIA - one of the following is found: more than one tumor larger than 5 centimeters or one tumor that has spread to a major branch of blood vessels near the liver.
  • Stage IIIB - there are one or more tumors of any size that have either spread to nearby organs other than the gallbladder or broken through the lining of the peritoneal cavity.
  • Stage IIIC - the cancer has spread to nearby lymph nodes.

Stage IV Liver Cancer

Cancer has spread beyond the liver to other places in the body, such as the bones or lungs. The tumors may be of any size and may also have spread to nearby blood vessels and/or lymph nodes.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if liver cancer spreads to the bones, the cancer cells in the bones are actually liver cancer cells. The disease is metastatic liver cancer, not bone cancer. It's treated as liver cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.

Can the Cancer Be Surgically Removed?

Liver cancer staging systems provide doctors with insight into a patient's prognosis. However, for treatment purposes, liver cancers are often broadly classified as resectable or unresectable.

  • Resectable liver cancers include Stage I and some Stage II cancers, which can be treated with a surgical procedure such as hepatectomy or liver transplant. 
  • Unresectable liver cancers require a different treatment approach using medical oncology therapies and in some cases radiation therapy.

If your treatment plan includes surgery, your care team will include Compass Oncology's hepato-pancreato-biliary (HPB) surgical oncologist.