Staging liver cancer is a procedure which aims to describe where your cancer is located, where it has spread to, and if it has affected other body parts or organs. Staging liver cancer is very important since it helps in determining the prognosis of your cancer and the most suitable treatment option available for you. However, only the earliest stages of liver cancer can be cured successfully.
Healthcare professionals use different tests to diagnose the stage of your liver cancer. This means that staging cannot be comprehensive if all tests are not fully completed. Being aware of what stage your cancer is at will help your doctor predict your chances of recovery and the best kind of treatment. There are different stage descriptions for all different types of cancer. For example, there are two types of liver cancer: primary and metastatic. Primary liver cancer is the type of cancer that begins in the liver, while metastatic - or secondary - cancer is the cancer that has spread from another body organ to the liver.
In this article am going to describe the different stages of primary liver cancer. Take a look!
BCLC Cancer Staging System
For liver or hepatocellular cancer, doctors mostly use the Barcelona Clinic Liver Cancer system to describe the stage of your cancer and the recommended treatment. This staging system groups your liver cancer based on tumor characteristics, cancer related symptoms, liver performance status and liver function.
The BCLC liver cancer groupings are:
1. Very early stage: At this stage your liver tumor has a diameter of less than 2cm. This means there is no increased pressure on your portal vein and your bilirubin levels are very normal. Surgery is usually recommended at this stage.
2. Early stage: In this stage, your liver tumor is smaller than 5cm. Here, the liver function varies. There can be no pressure on the portal vein with normal bilirubin levels, increased pressure on the portal vein with normal bilirubin levels or an increased pressure of the portal vein with elevated bilirubin levels. The best treatments recommended for this stage are radiofrequency ablation, liver transplant or surgery, depending on how well your liver is functioning.
3. Intermediate stage: In this stage, there are multiple tumors or one large tumor on your liver. For this stage your doctors may recommend transarterial chemoembolization for treatment
4. Advanced stage: At this stage, your tumor has invaded the portal vein and spread to other body organs, such as the lungs. For this stage, your doctors may recommend targeted therapy for treatment.
TNM Staging System
This is another staging system which is mostly used to stage other types of body cancers. However, this staging system has many limitations when it comes to liver cancer staging, especially for patients with liver cirrhosis. This is because cirrhosis manifests its characteristics equally or over liver tumors during diagnosis.
When using the TNM staging system, your doctors will use your diagnostic scans and tests to answer the following questions:
- Tumor (T): How big is your primary liver tumor? What is its location?
- Node (N): Has your liver tumor invaded the lymph nodes? If yes, which nodes and how many?
- Metastasis (M): Has your cancer spread to other body parts? If so, which organs?
The answers from the above questions are combined together to help stage the liver cancer for each person. There are four stages, ranging from stage I through stage IV.
Below is a detailed explanation of each stage of the TNM system of your liver cancer.
When using the TNM staging system, the letter (T) plus another letter (or a number from 0 to 4) are used to describe the location and size of your tumor. Some liver cancer stages are further divided into sub-groups to help describe your tumor in a more detailed manner. In case of more than one tumor on your liver, a letter "M" - meaning multiple - is added to the letter "T" category. Below is tumor specific information for liver cancer:
TX: This means that your primary tumor has no way of being evaluated.
T0: Means that no evidence is available to evaluate your tumor stage.
T1: Your tumor is smaller than 2cm. It has not yet invaded its neighboring blood vessels.
T2: Characterized by either:
- More than one tumor, but smaller than 5cm.
- Any one tumor that has invaded the nearby blood vessels.
T3a: There is more than one tumor, with at least one of them larger than 5cm.
T3b: There is at least one tumor of any size invading the liver's major veins.
T4: Can be either of these:
- Your tumor has moved through the visceral peritoneum, a layer of tissue lining your abdomen.
- The tumor has invaded the neighboring organs, except for the gallbladder.
In the TNM staging system, the letter "N" stands for lymph nodes. Lymph nodes are small, bean-shaped organs which help your body fight infections. The lymph nodes near the liver are referred to as regional lymph nodes. Other lymph nodes on different body parts are referred to as distant lymph nodes. Below is lymph node tumor-specific information.
NX: This means that the regional lymph nodes cannot be assessed or evaluated.
N0: This means that your liver cancer has not yet spread to the lymph nodes.
N1: This means that your liver cancer has spread to or invaded the regional lymph nodes.
The letter "M" in this staging system describes whether your cancer has spread to other body organs or not.
MX: This means that your liver cancer cannot be evaluated.
M0: Your liver cancer has not yet invaded other body parts or organs.
M1: The cancer has spread from the liver and invaded other body organs.
Staging Liver Cancer Groups
Once your doctors have grouped your liver cancer using the TNM system, they then combine the groups to give an overall stage using roman numerals I to IV (1 to 4).
Stage I: It is the earliest stage of your liver cancer. It means that your tumor has not spread to either lymph nodes, blood vessels or other body organs. It is a combination of T1, N0 and M0 groups.
Stage II: Means the tumor has invaded the neighboring blood vessels but has not yet spread to the regional lymph nodes or other body organs. It combines groups T2, N0 and M0.
Stage IIIA: Means that the liver cancer has not spread beyond the liver but is larger compared to stage I and II. It combines group T3a, N0 and M0.
Stage IIIB: The cancer has invaded the major veins found around the liver, but has not yet spread to the neighboring lymph nodes or other organs. Combines groups T3b, N0 and M0.
Stage IIIC: Means that any of your liver tumors have spread to the neighboring organs, except for the gallbladder. The tumor has not spread to the lymph nodes. It is a combination of group T4, N0 and M0.
Stage IVA: Means that any of your tumors has invaded the regional lymph nodes, but no other body parts. Can be either group T, N1, or M0.
Stage IVB: Means than any of your tumors has spread or invaded other body organs. Can be either group T, N, or M1.
The Bottom Line
Staging liver cancer is always done after diagnosis. Your doctors uses the information from your scans or tests results to stage your liver cancer accordingly. This staging is very important since it helps your doctor with your liver cancer prognosis and in determination of a treatment method.