Liver Cancer

AJCC Staging System

The TNM staging system, developed by the American Joint Committee on Cancer (AJCC), may be used to classify and stage liver cancer. Although cancers with similar stages tend to have a similar outlook and are often treated in much the same way, your doctor will also consider the results of your physical exam, biopsy and imaging tests.

The AJCC system classifies the cancer by tumor (T), node (N) and metastasis (M), as well as histologic grade. The T category describes the size and location of the primary tumor. The N category indicates whether the lymph nodes show evidence of cancer cells. The number and location of these lymph nodes are important because they show how far the disease has spread. The M category describes metastasis (spread of cancer to another part of the body), if any.

The results of the TNM analysis are then combined to determine the overall stage of the cancer for each individual.

In general, using the TNM system, liver cancer may be classified into one of these 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 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 regional lymph nodes or distant sites.

Stage IV: The tumor(s) may be any size and may have spread to regional lymph nodes and/or distant parts of the body.

If your cancer recurs, your treatment team will use additional diagnostic tests, such as a biopsy or surgical procedure, to verify your cancer stage. Final staging may occur after treatment has begun. Once your stage is confirmed, your treatment team will be able to determine whether another form of treatment is necessary.

AJCC TNM System for Classifying Liver Cancer

Category Definition
Tumor (T)
TX Primary tumor cannot be assessed.
T0 No evidence of a primary tumor.
T1 Solitary tumor is not more than 2 cm, or more than 2 cm without vascular incasion
   T1a Solitary tumor not more than 2 cm.
   T1b Solitary tumor more than 2 cm without vascular invasion.
T2 Solitary tumor more than 2 cm with vascular invasion, or multiple tumors, none more than 5 cm.
T3 Multiple tumors, at least one of which is more than 5 cm.
T4 Single tumor or multiple tumors of any size involving a major branch of the portal vein or hepatic vein, or tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum (outer layer of the liver).
Nodes (N)
NX Regional lymph nodes cannot be assessed.
N0 No regional lymph node metastasis.
N1 Regional lymph node metastasis.
Metastasis (M)
M0 No distant metastasis.
M1 Distant metastasis.
Grade (G)
GX Grade cannot be assessed.
G1 Well differentiated.
G2 Moderately differentiated.
G3 Poorly differentiated.
G4 Undifferentiated.

Stages of Liver Cancer

Stage T N M
IA T1a N0 M0
IB T1b N0 M0
II T2 N0 M0
IVA Any T N1 M0
IVB Any T Any N M1

Staging Illustrations


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