Staging of Liver Tumors

Liver cancers are classified into the following general stages:

  • Stage I – One tumor is found in the liver and the cancer has not spread to nearby blood vessels.
  • Stage II – Refers to one liver tumor that’s spread to nearby blood vessels, or there is more than one tumor in the liver, but none of them are larger than 5 centimeters (cm).
  • Stage III – Refers to more advanced cancers such as:
    • Stage IIIA – More than one liver tumor larger than 5 cm, or one tumor that has spread to a major branch of nearby blood vessels.
    • Stage IIIB – One or more tumors of any size that have spread to nearby organs (other than the gallbladder), or the cancer has broken through the lining of the peritoneal cavity.
    • Stage IIIC – Liver cancer has been found in nearby lymph nodes.
  • Stage IV – Refers to liver cancer that has spread to other sites such as the bones or lungs, and may also be found in nearby lymph nodes and/or blood vessels.

Specifically, 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

Stage Groups

Tumor

Nodes

Metastases

Stage I

T1

N0

M0

Stage II

T2

N0

M0

Stage IIIA

T3a

N0

M0

 Stage IIIB

T3b

N0

M0

 Stage IIIC

T4

N0

M0

Stage IVA

Any T

N1

M0

 Stage IVB

Any T

Any N

M1

 

In addition, our liver team uses other scoring and staging systems to assess each patient’s liver function, overall performance with the cancer, and overall health.