Liver Cancer

BCLC Staging System

Below are liver cancer staging illustrations along with the components considered by the Barcelona Clinic Liver Cancer (BCLC) staging system. They include the Child-Pugh scoring system, the most commonly used staging system for hepatocellular carcinoma, which is used to evaluate liver function, and the Eastern Cooperative Oncology Group (ECOG) Performance Status, which measures how the disease is affecting your ability to conduct daily activities.

Child-Pugh Scoring

Clinical Measures 1 point 2 points 3 points
Albumin (g/dL) > (more than) 3.5 2.8-3.5 < (less than) 2.8
Bilirubin (mg/dL) < (less than) 2.0 2.0-3.0 > (more than) 3.0
Prothrombim time (in seconds) < (less than) 4 4-6 > (more than) 6
International Normalized Ratio (INR) < (less than) 1.7 1.7-2.3 > (more than) 2.3
Presence of ascites None Moderate Severe
Presence of hepatic encephalopathy None Grades I-II (or suppressed with medication) Grades III-IV (or refractory)
Classification Class A Class B Class C
Total points 5-6 points 7-9 points 10-15 points
Indication Indicates a well-functioning liver Indicates liver function is significantly compromised Indicates severe liver damage

The Barcelona Clinic Liver Cancer (BCLC) System

BCLC Stage Details
0 (very early stage)
  • Tumor less than 2 cm
  • ECOG Performance Status 0
  • Child-Pugh A
A (early stage)
  • Solitary lesion more than 2 cm or early multifocal disease characterized by up to 3 lesions measuring less than 3 cm
  • ECOG Performance Status 0
  • Child- Pugh A to C
B (intermediate stage)
  • Multifocal disease: More than one lesion with at least one over 3 cm, or more than 3 lesions regardless of their size
  • ECOG Performance Status 0
  • Child- Pugh A to C
C (advanced stage)
  • Vascular incasion and/or nodal disease and/or metastatic disease
  • ECOG Performance Status 1-2
  • Child- Pugh A to C
D (end-stage disease)
  • Tumor may have grown into large blood vessels or spread to other parts of the body. Severe liver damage.
  • ECOG Performance Status 3 or 4
  • Child- Pugh C

Eastern Cooperative Oncology Group (ECOG) Performance Status

Grade ECOG
0 Fully active, able to carry on all pre-disease performance without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work
2 Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours
3 Capable of only limited self-care; confined to bed or chair more than 50% of waking hours
4 Completely disabled; cannot carry on any self-care; totally confined to bed or chair

Staging Illustrations


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