Staging and Child-Pugh classification

The stage of a cancer describes its size and whether it has spread from where it first started. Knowing the stage is important because it helps you and your doctors to decide on the best treatment for you.

Doctors may use a number system to find out the stage of HCC:

Stage 1 There is one tumour in the liver and the cancer hasn’t spread into any blood vessels in the liver.

Stage 2 There is one tumour that has spread into a blood vessel, or several tumours that are all no bigger than 5cm.

Stage 3 is divided into:

  • 3A There is more than one tumour and at least one is bigger than 5cm.
  • 3B The cancer has grown into a major blood vessel in the liver.
  • 3C The cancer has spread outside the liver into organs nearby (except the gall bladder).

Stage 4 is divided into:

  • 4A The cancer has spread outside the liver into lymph nodes in that area. Lymph nodes are sometimes called glands, and help fight infection.
  • 4B The cancer has spread to another part of the body, such as the lungs or bones (sometimes called secondary or metastatic liver cancer).

Child-Pugh classification

Doctors will also assess how well your liver is working using the Child-Pugh classification system. It gives a score from A to C, depending on how well the liver is working.

A means the liver is working well, while C means it’s very damaged and as a result isn’t working well. The results help doctors decide on the treatments that are best for your situation. Having certain treatments will depend on how well the liver is able to cope.

Child-Pugh looks at:

  • the level of bilirubin (a waste product of old red blood cells) in the blood
  • the level of albumin (blood protein) in the blood
  • how quickly your blood clots (prothrombin time) whether there’s any fluid build-up in the abdomen (ascites)
  • whether liver damage is affecting how the brain is working (encephalopathy).

Back to Understanding your diagnosis

My Cancer Treatment

Macmillan is supporting a new online tool to help you make decisions about your treatment and care. The tool currently only covers England.

Treatment overview

There are various treatments for HCC. The treatment you have will depend on different factors, including the stage of the cancer.