What are the stages of liver cancer?

Staging means finding out how big the cancer is and if it has spread to other parts of your body. 

Many liver cancer specialists use a combination staging system. This describes:

• The cancer
• The condition and function of the liver
• How well the person is 

This will help your medical team to decide what treatment might be of most benefit.

Barcelona Clinic Liver Cancer (BCLC) staging system

The BCLC staging system is used to stage HCC. it looks at liver function as well as the size and number of tumours. It has 5 stages:

Stage 0: Small tumour less than 2cm. The person is well and has normal liver function.

Stage A: One tumour less than 5cms, or 2-3 smaller tumours. The person is well and has normal liver function.

Stage B: There are many tumours in the liver. The person is well and has normal liver function.

Stage C: The size and number of tumours may vary but the cancer may have spread to nearby blood vessels and/or lymph nodes. It may also have travelled to other parts of the body. 

Stage D − There is severe damage to the liver. The person is not well at all and the cancer has spread beyond the liver.

Sometimes your doctor might describe your cancer as a stage number from 1-4. A higher number, such as stage 4, means a more advanced cancer. Some stages are further divided into stage A and B. 

The Child-Pugh system

The Child-Pugh system has 3 classes that describe how well your liver is working (liver function), in people who have liver cirrhosis. The system considers your blood test results, if there is fluid in your abdomen (ascites) and your brain function.

Class A: The liver is working normally

Class B: Mild to moderate liver damage

Class C: Severe liver damage

To decide the class, you will have tests such as blood tests, brain function tests and a check for fluid in your abdomen (tummy area). Based on the results, you will get a score that tells the doctor how well your liver is working (class A, B or C).

TNM staging system

This refers to the size of the tumour (T), if the cancer has spread to your lymph nodes (N), and if the cancer has spread to other parts of your body (M for metastasis). Your doctor often uses the TNM information to give your cancer a number stage – from 0 to 4.  A higher number, such as stage 4, means a more advanced cancer.

In general, the lower the number, the less the cancer has spread. Some stages are further divided into stage A and B.

Performance status (PS)

(Based on the Eastern Co-operative Oncology Group (ECOG)/WHO system)

Performance status (PS) is a scale to rate how well and physically fit you are:

PS 0: you are fully active and can do much the same as you did before your diagnosis. PS 1: you cannot do heavy physical work, but can do everything else.

PS 2: you are up and about more than half the day. You can look after yourself, but you can’t work.

PS 3: you are in bed or a chair for more than half the day. You can look after yourself to some extent but need help.

PS 4: you are in bed or a chair all the time and need complete care