Staging

The stage of a cancer tells you its size and whether it has spread. This helps you and your doctor decide the best treatment approach.

There are several different methods your doctors may use to determine the state of your liver cancer. These include:

• 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.