Liver Cancer Staging

If liver cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is an attempt to find out whether the cancer has spread, and if so, to what parts of the body.

When liver cancer spreads, the cancer cells may be found in the lungs. Cancer cells also may be found in the bones and in lymph nodes near the liver.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if liver cancer spreads to the bones, the cancer cells in the bones are actually liver cancer cells. The disease is metastatic liver cancer, not bone cancer. It's treated as liver cancer, not bone cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.

To learn whether the liver cancer has spread, your doctor may order one or more of the following tests:

• CT scan of the chest: A CT scan often can show whether liver cancer has spread to the lungs.
• Bone scan: The doctor injects a small amount of a radioactive substance into your blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.
• PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether liver cancer may have spread.

The American Joint Committee on Cancer (AJCC) uses the TNM classification to define the stages of liver cancer:

T is for Tumor. The number after the T indicates the size of the tumor and how far it has invaded. The larger the number, the bigger and/or more invasive the cancer.

• TX means the primary tumor cannot be assessed.
• T0 means there is no evidence of primary tumor.
• T1 means there is a solitary tumor without vascular invasion.
• T2 means there is a solitary tumor with vascular invasion or there are multiple tumors that are 5 cm or less.
• T3a means there are multiple tumors more than 5 cm.
• T3b means there is a single tumor or multiple tumors of any size involving a major branch of the portal vein or hepatic vein.
• T4 means there are tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of the visceral peritoneum.

N is for Nodes. The number after the N indicates whether the cancer has spread to the lymph nodes and to what extent.

• NX means the regional lymph nodes cannot be assessed.
• N0 means there is no cancer in the lymph nodes in the region of the cancer.
• N1 means there has been metastasis to  regional lymph nodes.

M is for Metastasis. The number after the M indicates whether the cancer has spread to distant areas of the body.

• M0 means there is no distant metastasis.
• M1 means the cancer has metastasized to at least one site distant from the kidney. 

Stage Grouping