The stages of liver cancer are used to describe how advanced the cancer is in your body. The higher the stage number, the more advanced the cancer is. These stages are important when choosing the best treatments for you.
Treatment for liver cancer, unlike many other kinds of cancer, is often determined not only by the cancer’s stage, but also by how well or poorly the liver functions.
For example, some early-stage cancers cannot be removed by surgery because the liver is badly damaged (often by cirrhosis). If the surgeon takes out the cancer, the patient will not have enough healthy liver left. Doctors often use the categories below to describe a person’s liver cancer.
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Localized resectable - The cancer is found only in the liver and the entire tumor can be removed by surgery.
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Localized and locally advanced unresectable - The cancer is found only in the liver and it has not spread. However, it cannot be removed (resected) by surgery. This might be because you have cirrhosis and you would not have enough healthy liver tissue left after surgery. Your cancer might also be localized unresectable if it has spread throughout the liver or it is too close to where the liver meets the main arteries, veins, and bile ducts.
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Advanced - The cancer has spread throughout most of the liver or it is has spread to the lymph nodes or other organs. The tumor cannot be removed by surgery.
The TNM staging system described below is more precise and doctors often use it to figure out whether surgery is possible.
TNM System
The TNM system uses three different codes to describe the size and location of the tumor, whether it has spread to the lymph nodes around the tumor, and whether it can be found in other parts of the body.
In the TNM system, “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. The tumor stages for liver cancer are:
TX - The primary, or original, tumor cannot be evaluated because of incomplete information.
T0 - There is no evidence of a primary tumor.
T1 - One tumor of any size is in the liver and has not invaded the blood vessels.
T2 - One tumor of any size has spread into the blood vessels, or the liver has several tumors that are smaller than 5 cm (about 2 inches).
T3 - Several tumors larger than 5 cm (about 2 inches) are in the liver, or one tumor involves a major branch of the major liver blood vessels (portal or hepatic veins).
T4 - The cancer has spread to organs near the liver (except for the gallbladder), or the cancer has spread into the lining of the abdomen.
The "N" in the TNM system stands for node. Lymph nodes are tiny organs shaped like beans that can be found throughout the body. Lymph nodes help the body fight infections. Regional lymph nodes are near the liver, while distant lymph nodes are in other parts of the body. Lymph node stages are:
NX - The regional lymph nodes cannot be evaluated because of incomplete information.
N0 - The cancer has not spread into the regional lymph nodes.
N1 - The cancer has spread to regional lymph nodes near the tumor.
The "M" in the TNM system is used for cancer that has spread, or metastasized, to other parts of the body. The stages for liver cancer metastasis are:
MX - Distant metastasis cannot be evaluated because of incomplete information.
M0 - The cancer has not metastasized to distant lymph nodes or other parts of the body.
M1 - The cancer has metastasized to distant lymph nodes or other parts of the body.
Cancer Stages I to IV
After the T, N, and M categories of your cancer have been identified, your doctor will combine this information to assign a stage (I to IV) to your cancer. The higher the number, the more serious (advanced) the cancer is.
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Stage I - The liver has one tumor that has not spread to nearby blood vessels or lymph nodes (T1, N0, M0).
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Stage II - A single tumor of any size has spread to nearby blood vessels, or the liver has several tumors that are not bigger than 5 cm (T2, N0, M0).
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Stage IIIA - The liver has several tumors and at least one is bigger than 5 cm, or the liver has one tumor that has spread into a branch of the portal or hepatic vein (T3, N0, M0).
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Stage IIIB - The tumor has spread to organs near the liver (except for the gallbladder) or it has spread into lining of the abdomen (T4, N0, M0).
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Stage IIIC - One or more tumors of any size have spread into regional lymph nodes (any T, any N, M0).
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Stage IV - One or more tumors of any size have spread to other parts of the body, such as the lungs or bones. The tumor might also have spread to nearby blood vessels and lymph nodes (any T, any N, M1).
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Recurrent - The cancer has come back (recurred) after it has been treated.
This content has been reviewed and approved by Myo Thant, MD.