Staging of primary liver cancer

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Once your doctor knows the type and stage of the cancer they can decide on the most appropriate treatment for you.

Generally, primary liver cancer is divided into four stages: small and localised (stage one); spread into surrounding structures (stages two or three); or spread into other parts of the body (stage four). If the cancer has spread to distant parts of the body this is known as secondary cancer (or metastatic cancer).

Stage 1 The cancer is no bigger than 2cm in size and hasn’t begun to spread to the blood vessels of the liver, nearby lymph nodes or other parts of the body.

Stage 2 The cancer hasn’t begun to spread to the lymph nodes or other parts of the body, but is bigger than 2cm in size, or the cancer is affecting the blood vessels in the liver, or there are multiple tumours in one of the lobes of the liver – each tumour is no bigger than 2cm in size.

Stage 3 This stage is divided in two:

• Stage 3A The cancer is affecting the blood vessels in the liver but hasn’t spread to lymph nodes or other parts of the body. Or the tumour is bigger than 2cm in size, or there are multiple tumours in one lobe of the liver.
• Stage 3B The tumour can be of any size and the blood vessels of the liver may or may not be affected, but the cancer has spread to nearby lymph nodes.

Stage 4 The cancer has spread to parts of the body further away from the liver, such as the lungs.

If the cancer comes back after initial treatment this is known as recurrent cancer.

TNM staging system

Another staging system known as the TNM system is also used. This can give more precise information about the extent of the cancer.

• T describes the size of the tumour.
• N describes whether the cancer has spread to the lymph nodes.
• M describes whether the cancer has spread to another part of the body (secondary or metastatic cancer).

Your specialist can tell you more about the TNM system. However, it is more common for doctors to talk about primary liver cancer in terms of stages 1 to 4.