When you are diagnosed with liver cancer, your doctor will mention your
cancer stage. Staging is a way of knowing the status of your condition.
Stages of liver cancer
The first step in diagnosing liver cancer is to find out how many tumors have developed, its size, whether it has blood vessels, and whether it involves advanced local extensions. This is a T score (tumor).
Lymph nodes are examined if the cancer has spread to every nearby lymph node and given a score of N (node). Finally, any metastasis, or spread to other points and body parts, is examined and scored M (metastasis).
For each score there will be a scale from 0 to 4:
- The numbers 0 to 4 indicate the severity.
- The letter X means "cannot be assessed" because this information is not available.
Combining the T, N, and M scores determines the stage for cancer ranging between I (1) and IV (4). Roman numerals are used to label cancer rates. A lower number of I and II means the cancer has not expand and is still localized in the liver. The higher the number, cancer becomes more serious and more difficult to treat.
Stage III has 3 sub-stages: A, B and C. The sub-stages describe the size and location of the tumor. Stage III means the cancer in your liver has spread to the surrounding blood vessels, lymph nodes, and other organs close to the liver. Stage IV means the cancer has spread beyond the liver.
The stage system for liver cancer depends only on the extent of cancer spread. However, patients with liver cancer experience other damage to their liver. This makes the liver not work properly as it should, which also affects treatment options and prospects for patients.
Grouping of liver cancer stages
After the groups T, N, and M are determined, they are then combined to know the whole stage, using Roman numerals I through IV (1 to 4):
The First Is Stage I
T1, N0, M0: There is a single tumor (any size) that has not grown in the blood vessels. In this condition cancer still has not expanded, either to another organ or nearest lymph nodes.
The Second Is Stage II
T2, N0, M0: Either there is a single tumor (any size) that has developed in a blood vessel, or there are several tumors, and all measuring 5 cm (2 inches) or less. In this condition cancer still has not expanded, either to another organ or nearest lymph nodes.
The Third Is Stage IIIA
T3a, N0, M0: There is more than one tumor, and at least one larger than 5 cm (2 inches). In this condition cancer still has not expanded, either to another organ or nearest lymph nodes.
The Fourth Is Stage IIIB
T3b, N0, M0: At least one tumor grows into a branch of the main vein of the liver (portal vein or hepatic vein). In this condition cancer still has not expanded, either to another organ or nearest lymph nodes.
T4, N0, M0: A tumor grows on nearby organs (other than the gallbladder), or the tumor has grown outward and covered the liver. In this condition cancer still has not expanded, either to another organ or nearest lymph nodes.
The End Stage Is IVA
T, N1, M0: Tumors in the liver can have different sizes or numbers and they may have grown into a blood vessel or nearby organ. Cancer has spread to nearby lymph nodes. In this condition cancer still has not expanded, either to another organ or nearest lymph nodes.
Every T, every N, M1: cancer has spread to other parts of the body (tumors can have different sizes or numbers, and nearby lymph nodes may or may not have been affected).
Because liver cancer patients usually have a malfunctioning liver due to cirrhosis, the doctor who treats your liver cancer needs to know how well the rest of your heart is working. They use a system called the Child-Pugh score, which measures several different substances in the blood, fluid in the abdomen, and brain functions to do this.
Other stage systems
Liver cancer is very complicated. The TNM system usually only defines the extent of the cancer and does not include liver function. There are several systems that take into account the functions of the heart, these include:
- The Barcelona Clinic Liver Cancer (BCLC) system
- The Cancer of the Liver Italian Program (CLIP) system
- Okuda System
Cirrhosis stage system
Cirrhosis is a severe form of injury that occurs in the liver due to other conditions such as hepatitis and prolonged use of alcohol. Most patients with liver cancer also have cirrhosis.
For the stage of cirrhosis, the doctor may use the Child-Pugh score. It is a widely used system that measures liver function and categorizes the extent of cirrhosis. It uses a combination of physical examination and lab tests. Child-Pugh's assessment system is seen in 5 factors, the first 3 from the results of blood tests:
- Bilirubin levels. High bilirubin causes the skin and eyes to turn yellow.
- Albumin content is the main protein that is usually made by the liver.
- Prothrombin time, which means how good the heart is in freezing blood.
- Is there fluid (ascites) in the stomach.
- Does liver disease affect brain function?
Liver cancer rates can help you and your doctor decide which treatment plan is best for you. When you get the diagnosis, you can ask your doctor to explain your cancer level.