Stages of Liver Cancer: What Do Stages 1 - 4 Mean?

When we learn that someone has liver cancer, the first thing we often ask is, “What stage?” This is because identifying the stage gives us an idea of how far cancer has spread and the possible treatment outcomes. Here’s what you need to know about the stages of liver cancer.

There are several ways to determine the stages of liver cancer

The first thing you need to know is that your doctor may use one of the several liver cancer staging methods. This article will cover two of those methods: the TNM staging (stages 1 – 4) and The Barcelona Clinic Liver Cancer (BCLC) system.

The TNM staging stands for tumor, nodes, and metastasis. Generally, this staging system aims to determine:

• Tumor: How many tumors are there? What about its size and location? Has it reached nearby structures?
• Nodes: Has cancer reached nearby lymph nodes or not?
• Metastasis: Has cancer reached distant lymph nodes? Has it affected other organs such as the bones?

On the other hand, the BCLC system categorizes liver cancer stages based on the symptoms present, characteristics of the tumor, liver function, and performance status.

Please note that, for the doctor to complete the staging process, you need to undergo several tests.

TNM Stages of liver cancer

Many of us are familiar with the TNM stages of cancer. We understand that the higher the stage is, the more the cancer has spread. But what exactly happens during each liver cancer stage?

Stage I

The first stage indicates that there is a small tumor confined in the liver and it hasn’t grown or spread into the blood vessels. It has not affected any lymph node or distant structures.

Stage II

Stage II liver cancer indicates that a small tumor has invaded the blood vessel. Likewise, the cancer is also at the 2^nd stage if there are multiple tumors, but they are no larger than 5 cm.

At this stage, too, the tumor has not affected nearby lymph nodes or distant organs.

Stage III

This liver cancer stage has three subgroups:

• In stage IIIA, the patient has multiple tumors, and at least one of them is larger than 5 cm.
• Whereas in stage IIIB, the patient has at least one tumor (regardless of size) that has invaded a major vein in the liver.
• Finally, in stage IIIC, the patient has a tumor that affected a nearby organ or reached outside the liver’s lining.

At stage III, please note that the tumor has not yet spread to the lymph nodes or distant structures.

Stage IV

This liver cancer stage has two subgroups:

• Stage IVA – There is at least one tumor (regardless of size) that has reached a nearby lymph node, but it has not spread to other organs.
• Stage IVB – There can be one or multiple tumors that might or might not have affected the lymph nodes but have already affected distant structures, like the lungs or bones.

BCLC Stages of liver cancer

The BCLC staging has four stages:

• Very early stage – At this stage, the tumor is smaller than 2 cm.  The patient has normal bilirubin levels. Note that high bilirubin levels usually mean that there’s something wrong with the liver.
• Early-stage – The tumor is less than 5 cm; there may or may not be increased bilirubin levels and liver vein pressure.
• Intermediate stage – The patient may have a large tumor or multiple tumors.
• Advanced stage – The tumor has spread to the liver vein, lymph node, or distant structures.

The importance of early detection

Early detection of liver cancer is usually tricky. According to doctors, early-stage liver cancer usually does not have signs and symptoms. Moreover, it’s difficult to see a small tumor because the ribcage covers a portion of the liver.

However, early detection is still crucial as it gives liver cancer patients more treatment options. For this reason, be in constant communication with your doctor, especially if you are at risk.

Risk factors usually include cirrhosis, hepatitis infection, and other liver diseases. So, if you are at risk, talk to your doctor about screening tests.

Learn more about Liver Cancer here.