Stages of Liver Cancer

A cancer stage is a way to describe the extent of the cancer at the time you are first diagnosed. The American Joint Committee on Cancer (AJCC) created this to determine how much cancer is in your body, where it is located, and what subtype you have. AJCC is just one type of staging system. Staging is needed to make treatment decisions. Once treatment starts, staging does not change.

TNM scores
The tumor, node, metastasis (TNM) system is sometimes used to stage liver cancer. In this system, the letters T, N, and M describe different areas of cancer growth. Based on surgery and lab results, your doctor will assign a score or number to each letter. The higher the number, the larger the tumor or the more the cancer has spread. These scores will be combined to assign the cancer a stage. A TNM example might look like this: T1N0M0 or T1, N0, M0.

> T (tumor) – Size of the main (primary) tumor
> N (node) – If cancer has spread to nearby (regional) lymph nodes
> M (metastasis) – If cancer has spread to distant parts of the body or metastasized

Keep in mind, TNM scores are not always used to describe liver cancer. Doctors may explain your cancer stage in different ways to make it less confusing.

T= Tumor

The primary tumor size is measured in centimeters (cm). A large pea is 1 cm. A golf ball is 4 cm.
> T1 One tumor 2 cm or smaller, or one tumor larger than 2 cm without vascular invasion
• T1a One tumor 2 cm or smaller
• T1b One tumor larger than 2 cm, but blood vessels do not have cancer
> T2 One tumor larger than 2 cm with vascular invasion, or multiple tumors, no tumors are larger than 5 cm
> T3 Multiple tumors with at least one that is larger 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) that involve nearby organs (other than the gallbladder) or have invaded the peritoneum (lining of the abdomen)

N = Node

There are hundreds of lymph nodes throughout your body. They work as filters to help fight infection and remove harmful things from your body. Regional lymph nodes are those located near the liver. These include the hilar, hepatoduodenal ligament, inferior phrenic, inferior vena cava lymph nodes, and the hepatic artery and portal vein lymph nodes. Cancer in the lymph nodes is called nodal disease.
> N0 means no cancer is in regional lymph nodes
> N1 means cancer in the regional lymph nodes is found

M = Metastatic

Cancer that has spread to distant parts of the body is shown as M1. Common sites for metastasis include the lung and bone.
> M0 means no distant metastasis
> M1 means distant metastasis is found

Grade

Another factor used in staging is the cancer grade. Grade describes how abnormal the tumor cells look under a microscope (called histology). Higher-grade cancers tend to grow and spread faster than lower-grade cancers. GX means the grade can’t be determined, followed by G1, G2, G3, and G4. G4 is the highest grade for liver cancer. Well differentiated means the cancer cells look similar to normal cells. Poorly differentiated means the cancer cells look very different compared to normal cells. Undifferentiated means the cells are abnormal and don’t look like the cells in the organ where cancer started.
> GX Grade cannot be determined
> G1 Well differentiated
> G2 Moderately differentiated
> G3 Poorly differentiated
> G4 Undifferentiated

Numbered stages

Number stages range from stage 1 to stage 4, with 4 being the most advanced. Doctors write these stages as stage I, stage II, stage III, and stage IV.

Liver cancer stages
Stage 1
Stage 1A :  T1a, N0, M0
Stage 1B : T1b, N0, M0

Stage 2 :  T2, N0, M0

Stage 3
Stage 3A : T3, N0, M0
Stage 3B : T4, N0, M0

Stage 4
Stage 4A : Any T, N1, M0
Stage 4B : Any T, Any N, M1

Stage 1
In stage 1 liver cancer, there is only one tumor up to 2 cm in size or a tumor larger than 2 cm that does not involve blood vessels found in the liver. It may have grown into veins, arteries, or bile ducts. Cancer has not spread to lymph nodes (N0) or other parts of the body (M0).

Stage 2
In stage 2 liver cancer, there is one tumor larger than 2 cm that has grown into veins, arteries, or bile ducts. There might be multiple tumors that are smaller than 5 cm. Cancer has not spread to lymph nodes (N0) or other parts of the body (M0).

Stage 3
In stage 3a liver cancer, there are multiple tumors. One of these tumor is larger than 5 cm. Cancer has not spread to lymph nodes (N0) or other parts of the body (M0).
In stage 3b liver cancer, there is a single tumor or multiple tumors of any size involving a major branch of the portal vein or hepatic vein, or tumor(s) that involve nearby organs (other than the gallbladder), or the peritoneum (lining of the abdomen). Cancer has not spread to lymph nodes (N0) or other parts of the body (M0).

Stage 4
In stage 4A liver cancer, the cancer is any size and there may be more than one tumor in the liver. It may have grown into blood vessels or the organs around the liver. Cancer has spread to lymph nodes (N1), but not to other parts of the body (M0).
Stage 4B liver cancer is cancer that has spread to distant parts of the body (M1). The tumor can be any size and there may be more than one tumor in the liver. Cancer might be in the lymph nodes. This is metastatic liver cancer.

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