Liver Cancer

Staging

Staging is how physicians determine the extent of your cancer, where it is located and whether it has spread to nearby organs or tissues or to other parts of your body. Your physical exam, diagnostic tests and pathology report help your doctor decide the stage of your cancer and develop a treatment plan. Staging can also assist with determining your prognosis (outlook).

To describe the stage of most cancers, doctors use what’s called the TNM system developed by the American Joint Committee on Cancer. It’s based on the size and location of the tumor (T), whether cancer cells are found in nearby lymph nodes (N) and whether the cancer has metastasized, or spread, to other parts of the body (M). The results of the TNM analysis are then combined to determine the overall stage of the cancer for each individual.

In general, your doctor may classify your liver cancer into one of four stages:

  • Stage I: A tumor has formed but is confined to the liver and has not yet invaded any blood vessels, nearby lymph nodes or distant sites. Stage I cancer is typically very treatable.
  • Stage II: There may be more than one tumor, and cancerous cells may have grown into nearby blood vessels.
  • Stage III: There is more than one tumor but the cancer has not yet spread beyond the liver, the tumor has spread to a major vein around the liver, or the tumor has spread to nearby organs (except the gallbladder) or broken through the visceral peritoneum (the outer layer of the liver). In all cases, the tumor has not yet spread to nearby lymph nodes or distant sites.
  • Stage IV: Cancer has spread to nearby lymph nodes or to distant lymph nodes and/or areas of the body.

Other liver cancer staging systems include the Barcelona Clinic Liver Cancer (BCLC) system, the Cancer of the Liver Italian Program (CLIP) system and the Okuda system. If your doctor uses one of these systems rather than the TNM system and you have questions about the stage of your cancer, be sure to ask.

In addition, your doctor may classify your liver cancer based on whether it can be entirely cut out (resected) through surgery. Your cancer may be called localized resectable (confined to the liver and able to be surgically removed), localized unresectable (confined to the liver but cannot be surgically removed), or advanced (has spread beyond the liver and likely can’t be treated with surgery).

Below is the TNM classification for liver cancer. It is followed by a table that shows how TNM classifications fall into the stages of liver cancer.

TUMOR (T)

TX: The tumor cannot be assessed.
T0: There is no evidence of a primary tumor.
T1: The tumor is 2 centimeters or smaller and has not yet spread to nearby blood vessels.
T2: The tumor has spread to nearby blood vessels or there is more than one tumor (all smaller than 5 centimeters).
T3: The tumor has grown, multiplied or spread into a nearby vein.
T3a: There is more than one tumor (at least one larger than 5 centimeters).
T3b: At least one tumor of any size has grown into the portal or hepatic vein.
T4: The tumor has invaded a nearby organ (except the gallbladder), or it has spread beyond the liver into the visceral peritoneum (the outer layer of the liver).

NODES (N)

NX: Nearby lymph nodes cannot be assessed.
N0: Tumor cells have not spread to nearby lymph nodes.
N1: Tumor cells have spread to lymph nodes near the liver.

METASTASIS (M)

M0: No tumor cells have spread to distant organs or tissues.
M1: Tumor cells have spread to distant organs or tissues.

Stages of liver cancer

Stage T N M
I T1 N0 M0
II T2 N0 M0
IIIA T3a N0 M0
IIIB T3b N0 M0
IIIC T4 N0 M0
IVA Any T N1 M0
IVB Any T Any N M1

 

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