There are two types of liver cancer: primary and metastatic. Primary liver cancer begins in the liver; metastatic (secondary) liver cancer has spread to the liver from a cancer that started in another part of the body. For information about staging of secondary liver cancer, read the Cancer.Net Guide to Cancer for the primary cancer, because there are different stage descriptions for different types of cancer. For example, lymphoma that has spread to the liver is still staged as lymphoma.
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery).
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
- How large is the primary tumor and where is it located? (Tumor, T)
- Has the tumor spread to the lymph nodes? (Node, N)
- Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the site and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. If there is more than one tumor, the lowercase letter “m” (multiple) is added to the “T” category. Specific tumor stage information for HCC is listed below.
TX: The primary tumor cannot be evaluated.
T0: There is no evidence of a primary tumor.
T1: The tumor is 2 centimeters (cm) or smaller. It does not involve adjacent blood vessels.
T2: Either of these:
- Any tumor that involves adjacent blood vessels is present.
- Multiple tumors, none larger than 5 cm, are present.
T3: Either of these conditions:
- More than one tumor larger than 5 cm is present.
- The tumor involves the veins around the liver.
T4: Either of these conditions:
- The tumor has spread to the organs near the liver (except the gallbladder).
- The tumor is present with perforation (an abnormal opening) of the visceral peritoneum (layer of tissue that lines the abdomen).
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the liver are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The regional lymph nodes cannot be evaluated.
N0: Cancer has not spread to the regional lymph nodes.
N1: The cancer has spread to the regional lymph nodes.
Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body.
MX: The tumor cannot be evaluated.
M0: The cancer has not metastasized.
M1: There is metastasis to another part of the body.
Cancer stage grouping
Doctors assign the stage of the HCC by combining the T, N, and M classifications.
Stage I: This is the earliest stage of HCC. The tumor has not spread to the blood vessels, lymph nodes, or other parts of the body (T1, N0, M0).
Stage II: The tumor involves nearby blood vessels, but it has not spread to the regional lymph nodes or other parts of the body (T2, N0, M0).
Stage IIIA: The cancer has not spread beyond the liver, but the area of the cancer is larger than stage I or II, and it often has invaded nearby blood vessels (T3, N0, M0).
Stage IIIB: The cancer has spread to organs near the liver, but the cancer has not spread to nearby lymph nodes or other parts of the body (T4, N0, M0).
Stage IIIC: Any tumor that has spread to the regional lymph nodes but not to other parts of the body (any T, N1, M0).
Stage IV: Any tumor that has spread to other parts of the body (any T, any N, M1).
HCC is different from other types of cancers, in that its treatment is determined not only by the staging (using the TNM system) but also by the degree of liver dysfunction. For example, early stage disease may not always be removable by surgery because the liver is seriously damaged (usually with cirrhosis) and there would not be sufficient liver reserve to support life after an operation. Therefore, sometimes a patient’s condition is described using one of the four descriptions below as well as the stage.
Localized resectable: Cancer is in one place in the liver, and the other part of the liver is healthy. The cancer is resectable, meaning it can be removed through surgery.
Localized unresectable: Cancer is found in one part of the liver, but it cannot be removed by surgery (unresectable).
Advanced: Cancer has spread throughout the liver and/or to other parts of the body, such as the lungs and bones.
Recurrent: Recurrent cancer is cancer that comes back after treatment.
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
Last Updated: December 02, 2008
