Stages of liver cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome (your prognosis).

The most common staging system for liver cancer is the Barcelona Clinic Liver Cancer (BCLC) system. It only applies to hepatocellular carcinoma. There are 5 stages – stage 0 followed by stages A, B, C and D. Talk to your doctor if you have questions about staging.

The BCLC system considers the following factors:

your Child-Pugh classification score, which measures the amount of liver damage caused by scarring (cirrhosis)
tumour characteristics, including how many tumours are in the liver, the size of the tumours, if the tumours cause symptoms and where the cancer has spread
your performance status, which measures how well you are able to do daily activities and is based on the Eastern Cooperative Oncology Group (ECOG) score

Find out more about staging cancer.

Stage 0 (very early stage)

There is 1 tumour that is 2 cm or smaller. It isn’t causing any symptoms. The tumour has not grown into the large blood vessels in the liver.

The Child-Pugh classification is A. The ECOG score is 0.

Stage A (early stage)

There are up to 3 tumours. All of the tumours are smaller than 3 cm. They aren’t causing any symptoms. The tumours have not grown into the large blood vessels in the liver.

The Child-Pugh classification is A or B. The ECOG score is 0.

Stage B (intermediate stage)

There are more than 3 tumours in the liver or 1 to 3 tumours with at least 1 that is larger than 3 cm. They aren’t causing any symptoms. The tumours have not grown into the large blood vessels in the liver.

The Child-Pugh classification is A or B. The ECOG score is 0.

Stage C (advanced stage)

The cancer has grown into the large blood vessels in the liver or it has spread outside the liver to other parts of the body. It is causing symptoms.

The Child-Pugh classification is A or B. The ECOG score is 1 or 2.

Stage D (end stage)

The cancer may have grown into the large blood vessels or spread to other parts of the body. It is causing symptoms.

The Child-Pugh classification is C. The ECOG score is 3 or 4.

Recurrent liver cancer

Recurrent liver cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.

Kelly W Burak, MD, FRCPC, MSc(Epid)
Vincent Tam, BSc(Hon), MD, FRCPC

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