Staging

• TNM staging system: The TNM staging system stands for tumour, node and metastases. T describes the size of the tumour (cancer) and if there is more than one tumour in the liver.
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

Your doctor gives each letter (T, N and M) a number, depending on how far the cancer has grown. T is scored from 1 to 4. N and M are scored from 0 to 1.

• Number staging system
  • The Number staging system divides liver cancer into four main stages, from 1 to 4. Stage 1 is an early cancer. Stage 4 is advanced, which means the cancer has spread to the lymph nodes or another part of the body.
• The Child-Pugh system
  • The Child-Pugh system looks at the following five things that tell how well the liver is working:
    • bilirubin levels in the blood
    • albumin levels in the blood (albumin is a protein made by the liver)
    • how quickly the blood clots (prothrombin time)
    • if there is fluid in the abdomen (ascites)
    • if the liver disease is affecting brain function (encephalopathy)
  • Each one is given a number score, and based on that score, people fall into one of three classes:
    • Class A means the liver is working normally
    • Class B means mild to moderate damage
    • Class C means there is severe liver damage
• The Barcelona Clinic Liver Cancer (BCLC) staging system
  • The BCLC staging classification links the stage of the disease to a specific treatment strategy. There are five stages as follows:
    • Stage 0 (very early stage): optimal candidates for surgery
    • Stage A (early stage): potential candidates for surgery or liver transplantation
    • Stage B (intermediate Stage): may benefit from chemoembolization
    • Stage C (advanced stage): may benefit from targeted therapies
    • Stage D (severe liver damage): will receive symptomatic treatment/palliative care

For a summary of what these treatments are, please see the Treatments section.