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Stages of Liver Cancer

The stages of liver cancer are determined by the size and growth of the tumor, and the extent of the spread of the tumor. Determining the stage can help the doctors ascertain the treatment plan and the prognosis. This HealthHearty write-up provides information on the stages of liver cancer.
HealthHearty Staff
Last Updated: Feb 8, 2018
Cancer is a serious medical condition where abnormal cell division gives rise to the development of tumors. When the tumor develops in the liver, one is diagnosed with primary liver cancer. On the other hand, secondary liver cancer is said to occur when the cancer starts in another part of the body, and metastasizes (spreads) to the liver. Determining the stage is extremely essential for ascertaining the prognosis and suitable treatment options. With the exception of leukemia, staging method is applicable to all the types of cancer. Staging system is a way of determining the severity or the spread of cancer. The TNM staging system is one of the staging systems that is commonly used.
TNM System for the Staging of Liver Cancer

The TNM system describes the stages of cancer, and was designed by the American Joint committee on Cancer (AJCC). T, N, and M stand for tumor, nodes (lymph nodes), and metastasis, respectively. These help in determining the severity of liver cancer.
◆ What Does T Stand For?
T accounts for the number of primary tumors and the size of the tumor(s).
TX is used when the primary tumor cannot be evaluated.
TO is used when there is no evidence of a primary tumor.
T1 is used when the tumor is 2 cm or smaller, and does not involve nearby blood vessels.
T2 is used when the tumor involves nearby blood vessels or there are more than one tumor but none of them is larger than 5 cm.
T3a is used when there is more than one tumor, and at least one of them is larger than 5 cm.
T3b is used when the tumor (of any size) involves the major veins around the liver.
T4 is used when the tumor has spread to the organs near the liver (except the gallbladder), or the tumor has broken through the visceral peritoneum (layer of tissue that lines the abdomen).
◆ What Does N Stand For?
N accounts for the spread of cancer to the surrounding lymph nodes. While the lymph nodes that are located near the liver are called regional lymph nodes, the ones located in other parts of the body are called distant lymph nodes.
NX is used when the regional lymph nodes cannot be evaluated.
N0 is used when the cancer has not spread to the regional lymph nodes.
N1 is used when the cancer has spread to the regional lymph nodes.
◆ What Does M Stand For?
M accounts for distant metastasis (spread of the cancer to distant organs).
MX is used when the tumor cannot be evaluated.
M0 is used when the cancer has not spread to other parts of the body.
M1 is used when the tumor has spread to another part of the body.
Stages of Liver Cancer

Liver cancer is divided into the following stages:
Stage I (T1, N0, M0)
There is a single tumor (any size) that has not grown into any blood vessels. The tumor is localized and resectable at this stage. The term resectable is used for the tumors that can be surgically removed. The tumor is approximately 2 cm in size. The cancer has not spread to nearby lymph nodes or distant sites.
Stage II (T2, N0, M0)
In the second stage, there is either a single tumor (any size) that has grown into blood vessels, or there are several tumors, and all are 5 cm (2 inches) or less across. The cancer has not spread to nearby lymph nodes or distant sites. The tumor is resectable and localized.
Stage IIIA (T3a, N0, M0)
The third stage is referred to as an advanced stage. It is sub-divided into three stages: stage IIIA, stage IIIB, and stage IIIC. In stage IIIA, there is more than one tumor, and at least one is larger than 5 cm (2 inches) across. The cancer has not spread to nearby lymph nodes or distant sites.
Stage IIIB (T3b, N0, M0)
In stage IIIB, at least one tumor is growing into a branch of a major vein of the liver (portal vein or hepatic vein). The cancer has not spread to nearby lymph nodes or distant sites.
Stage IIIC (T4, N0, M0)
A tumor is growing into a nearby organ (other than the gallbladder), or a tumor has grown into the outer covering of the liver. The cancer has not spread to nearby lymph nodes or distant sites.
Stage IVA (Any T, N1, M0)
Tumors in the liver can be any size or number and they may have grown into blood vessels or nearby organs. The cancer has spread to nearby lymph nodes. The cancer has not spread to distant sites.
Stage IVB (Any T, Any N, M1)
In this stage, the cancer has metastasized or spread to distant sites or other parts of the body. The tumors can be of any size or number, and nearby lymph nodes may or may not be involved.
The treatment of liver cancer can be determined after ascertaining the stage of cancer. The prognosis is better when this condition is diagnosed in the early stages. The survival rate and life expectancy decrease in the advanced stages.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.