Doctors assign stages to liver cancer to describe its severity and how far it has spread. Staging liver cancer can also help guide treatment decisions.
This article looks at how staging works according to the AJCC TNM system and what each of the four stages involves. It also looks at the treatment options and outlook for those with liver cancer at each stage.
The stages of liver cancer are 1, 2, 3, and 4. In general, a lower number means the cancer has spread less, while a higher number means the cancer has spread further.
The AJCC TNM system uses
- Tumor (T): This refers to the size of the tumor, how many tumors there are, and how far they have spread.
- Nodes (N): This refers to whether the cancer has spread to lymph nodes close to the liver.
- Metastasis (M): This refers to whether the cancer has spread to organs, bones, and lymph nodes that are far from the liver.
Doctors will assign letters and numbers to each T, N, and M category to provide more in-depth information about the cancer. For example:
- T1a means there is only one tumor that measures 2 centimeters (cm) across or smaller.
- N0 means the tumors have not spread to nearby lymph nodes, while N1 indicates that they have.
- M0 indicates that the tumors have not spread to distant areas of the body, while M1 indicates that they have.
According to the
| Stage | Grouping | Description |
|---|---|---|
| 1A | T1a N0 M0 | There is a single tumor that is 2 cm or smaller. It has not reached the blood vessels. The tumor has not spread to near or distant lymph nodes. It has also not spread to distant parts of the body. |
| 1B | T1b N0 M0 | There is a single tumor that is more than 2 cm in size. It has not reached the blood vessels. The tumor has not spread to nearby lymph nodes or distant parts of the body. |
In stage 2 liver cancer, there is either a single tumor that is larger than 2 cm and has reached into the blood vessels, or there is more than one tumor, all of which are smaller than about 5 cm.
The stage grouping would be T2, N0, and M0.
Doctors separate stage 3 liver cancer into 3A and 3B:
| Stage | Grouping | Description |
|---|---|---|
| 3A | T3 N0 M0 | A person with stage 3A liver cancer has multiple tumors, with at least 1 tumor that is larger than 5 cm across. It has not spread to nearby lymph nodes or distant parts of the body. |
| 3B | T4 N0 M0 | In stage 3B liver cancer, at least 1 tumor has grown and reached into a major branch of the hepatic or portal veins, which are large veins in the liver. It has not spread to nearby lymph nodes or distant parts of the body. |
Doctors separate stage 4 liver cancer into 4A and 4B:
| Stage | Grouping | Description |
|---|---|---|
| 4A | any T N1 M0 | In this stage, either 1 or multiple tumors of any size have spread to lymph nodes nearby. It has not spread to distant parts of the body. |
| 4B | any T any N M1 | In this stage, 1 or more tumors of any size may or may not have spread to nearby lymph nodes. The cancer has metastasized to distant organs, such as the lungs. |
Doctors categorize liver cancer into
Potentially resectable or transplantable liver cancer
Stage 1 and some stage 2 liver cancers fall into this category of treatment.
Doctors can treat people with potentially resectable liver cancer with surgery, such as a partial hepatectomy. This involves removing a part of the liver affected by the cancer and leaving the remainder of the liver to maintain its function.
Few people with liver cancer are good candidates for this type of treatment.
Potentially transplantable liver cancer means a doctor may suggest a liver transplant. This may be suitable for those in the early stages of liver cancer or people whose livers are not healthy enough to function after a partial hepatectomy.
Unresectable cancer
Unresectable liver cancer is a category that refers to inoperable tumors.
Surgeons may be unable to remove tumors on the liver for a variety of reasons, and stage 1, 2, 3, and 4 liver cancers can fall into this category.
Treatment for liver cancer that is inoperable may include:
- embolization
- ablation
- chemotherapy
- radiation therapy
- immunotherapy
- targeted therapy
Advanced cancer
Stage 4 liver cancer that has spread to distant nodes or has metastasized to distant areas of the body falls into this category.
Treatments for advanced liver cancer may include:
- targeted therapy medication, such as lenvatinib (Lenvima) and sorafenib (Nexavar)
- immunotherapy medication, such as atezolizumab (Tecentriq), combined with the targeted mediation bevacizumab (Avastin)
If the treatment is not effective, doctors may use other targeted and immunotherapy medications, such as:
The outlook is good for people with stage 1 or stage 2 liver cancer, on whom doctors can perform a partial hepatectomy or a liver transplant to fully remove the cancer.
However, only a small number of people with liver cancer are candidates for surgery. The overall outlook for the majority of people with liver cancer is poor.
Doctors are generally not able to cure inoperable liver cancer at any stage. Treatment may extend a person’s life by
People with liver cancer may benefit from palliative care to reduce the severity of their symptoms, improve their quality of life, and keep them comfortable.
Doctors define the extent of liver cancer by a process called staging. There are four stages of liver cancer. In general, the lower the stage, the less cancer there is, and the less it has spread.
In the higher stages of liver cancer, there may be larger or more tumors, and the cancer may have spread to distant nodes or organs in the body.