Liver cancer is staged according to the size of the tumors in the liver, whether the cancer has spread (metastasized) and, if so, how far. There are two staging systems that are typically used for liver cancer:

The TNM system

In the United States, liver cancer is often staged using the American Joint Committee on Cancer’s TNM system, which takes into consideration the:

Size of the tumor (T)
Lymph node involvement (N)
If and how far the cancer has metastasized (M)

The cancer is staged on a scale from 1 to 4, with 4 being the most advanced. The following is a brief overview of each stage:

Stage 1A

A single tumor smaller than 2 centimeters across. The cancer is confined to the liver and has not grown into nearby blood vessels.

Stage 1B

A single tumor larger than 2 centimeters across. The cancer is confined to the liver and has not grown into nearby blood vessels.

Stage 2

A single tumor larger than 2 centimeters has grown into blood vessels, or multiple tumors that are smaller than 5 centimeters across. The cancer is confined to the liver.

Stage 3A

Multiple tumors, with one or more larger than 5 centimeters across. The cancer is confined to the liver.

Stage 3B

One or more tumors of any size have grown into the portal vein, a large vein in the liver. The cancer is confined to the liver.

Stage 4A

One or more tumors of any size have spread to nearby lymph nodes.

Stage 4B

One or more tumors of any size have spread to distant parts of the body, such as the lungs or bones.

The BCLC system

The TNM system is widely used for liver cancer staging, but it does not take into consideration the impact of declining liver function. The Barcelona Clinic Liver Cancer (BCLC) system factors in key aspects of liver health and classifies the cancer into five main stages:

Stage 0 (Very Early Stage)

The tumor is smaller than 2 centimeters across and does not place pressure on the portal vein. Bilirubin levels are normal.

Stage A (Early Stage)

The tumor is smaller than 5 centimeters across and there may be increased portal vein pressure with normal or high bilirubin levels."

Stage B (Intermediate Stage)

There may be a single large tumor or multiple tumors, but the liver is working well overall.

Stage C (Advanced Stage)

The cancer has spread to blood vessels, lymph nodes or other organs, although the liver may still function relatively well.

Stage D

Severe liver damage has occurred and noticeable symptoms have developed.

Find answers at Moffitt

Moffitt Cancer Center’s Gastrointestinal Oncology Program offers comprehensive evaluation, staging and treatment for liver cancers. To request an appointment at Moffitt quickly and easily, submit a new patient registration form online or call 1-888-663-3488.

Diagnosis

Liver Cancer Stages