Liver Cancer: Stages

What does the stage of cancer mean?

The stage of a cancer is how much cancer there is and how far it has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. Scans can also show if the cancer has grown into nearby areas and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The TNM system for liver cancer

Several systems can be used to divide liver cancer into stages. Healthcare providers in different parts of the world might use different systems. In the U.S., the most commonly used system to stage liver cancer is the TNM system from the American Joint Committee on Cancer. Be sure to ask your healthcare provider to explain the stage of your cancer in a way you can understand.

The first step in staging is to find the value for each part of the TNM system. Here's what the letters stand for:

• T describes the size of the main (primary)  tumor and how far it has spread inside the liver and to nearby tissues.

• N tells if the lymph nodes near the primary tumor have cancer in them.

• M tells if the cancer has spread ( metastasized) to distant organs in the body, like the lungs or bones.

Numbers or letters after T, N, and M provide more details about each of these factors. There are also two other values that can be assigned:

• X means the provider does not have enough information to tell the extent of the main tumor (TX) or if the lymph nodes have cancer cells in them (NX).

• 0 means no sign of cancer, such as no sign of the primary tumor in the liver (T0).

Once your healthcare provider knows your T, N, and M values, they're used to put these cancers into stage groupings. The groupings give an overall description of your cancer.

A stage grouping is listed as a Roman numeral and can have a value of I (1), II (2), III (3), or IV (4). The higher the number, the more advanced the cancer is. Letters and numbers can be used after the Roman numeral to give more details.

What are the stages of liver cancer?

These are the stage groupings of liver cancer and what they mean:

• Stage I. The cancer has not spread to lymph nodes or to organs in other parts of the body. This stage is divided into two subgroups:

  • Stage IA. There's only one tumor in the liver. It's 2 cm or less across and has not grown into any blood vessels.

  • Stage IB. There's only one tumor in the liver. It's more than 2 cm across and has not grown into any blood vessels.

• Stage II. There's no spread to lymph nodes or to organs in other parts of the body. And one of these is true:

• • There's only one tumor in the liver. It's more than 2 cm across and has grown into blood vessels.

  • There's more than one tumor, but none of them are more than 5 cm across.

• Stage III. The cancer has not spread to lymph nodes or to organs in other parts of the body. This stage is divided into 2 subgroups.

  • Stage IIIA. There is more than one tumor in the liver and at least one is more than 5 cm across. 

  • Stage IIIB. At least one tumor growing into one of the main blood vessels in the liver (the portal vein or hepatic vein). 

• Stage IV. This stage is divided into two subgroups:

  • Stage IVA. Tumor or tumors can be any size, and the cancer has spread into lymph nodes near the liver. It has not spread to organs in other parts of the body.

  • Stage IVB. The tumor or tumors can be any size. The cancer has spread to distant organs, such as the lungs or bones. It may or may not have spread to nearby lymph nodes.

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for you. Your healthcare provider will look at other factors, too. For instance, before doing surgery to remove the tumor, your healthcare provider will want to know how the rest of your liver is working. They will want to be sure that there would be enough healthy liver left after surgery. Ask your healthcare provider to explain the stage of your cancer to you in a way you can understand. Ask any questions and talk about your concerns.