Liver Cancer: Stages

What does the stage of cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see 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 TMN system for liver cancer

Several systems can be used to divide liver cancer into stages. Doctors 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 TMN system. Here's what the letters stand for:

Here is what the letters mean in the TNM system:

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

• N says whether the cancer has reached the nearby lymph nodes.

• M says whether the cancer has spread (metastasized) to other organs in the body, such as the lungs or bones.

Numbers or letters after T, N, and M provider more details about each of these factors. There are also 2 other values that can be assigned:

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

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

Once your doctor knows your T, N, and M status, he or she uses this information to assign the cancer an overall stage grouping. Stage groupings are determined by combining the T, N, and M values from the TNM system. These groupings give an overall description of your cancer.

A stage grouping can have a value of 1 to 4 and are written as Roman numerals, I, II, III, and IV. The higher the number, the more advanced the cancer. 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 2 sub-groups:

  • Stage IA. There is only 1 tumor in the liver. It's 2 cm or less across and has not grown into any blood vessels.

  • Stage IB. There is only 1 tumor in the liver that's more than 2 cm across and has not grown into any blood vessels. It has not spread to lymph nodes or other parts of the body.

• Stage II. Either there is only 1 tumor in the liver that's more than 2 cm across and has not grown into any blood vessels. Or, there's more than 1 tumor, but 1 of them is more than 5 cm across. There is no spread to lymph nodes or to organs in other parts of the body.

• 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 sub-groups.

  • Stage IIIA. There are many tumors in the liver and at least 1 is more than 5 cm across. 

  • Stage IIIB. The cancer is growing into a branch of one of the main blood vessels in the liver (the portal or hepatic veins). 

• Stage IV. This stage is divided into 2 sub-groups.

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

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

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Your doctor will look at other factors, too. For example, before doing surgery to remove the tumor, your doctor will want to know how the rest of your liver is working. He or she will want to be sure that there would be enough healthy liver remaining after surgery. Make sure to ask any questions or talk about your concerns.