About stages of liver cancer

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

There are several systems used to stage liver cancer (HCC). Many doctors use combination staging systems based on:

  • the size of the tumour
  • the number of tumours in the liver
  • how well the liver works (measured by the Child-Pugh scale or CPS)
  • whether the cancer is affecting your activities (doctors call this performance status or PS). 

We understand that waiting to know the stage of your cancer can be a worrying time. We're here if you need someone to talk to. You can:

The TNM staging system

  • 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 (known as metastatic or secondary cancer).

This system gives detailed information about the tumour stage.

Performance status (PS)

Performance status (PS) is a scale to rate how well you are:

  • PS 0 – you are fully active and can do much as you did before your illness.
  • PS 1 – you cannot do heavy physical work, but can do everything else.
  • PS 2 – you are up and about for more than half the day. You can look after yourself but cannot work.
  • PS 3 – you have troublesome symptoms and are in bed or a chair for more than half the day. You need help to look after yourself.
  • PS 4 – you are in bed or a chair all the time and need complete care.

Barcelona Clinic Liver Cancer (BCLC) staging system

This system considers the extent of the cancer, how well your liver is working (CPC) and how well you are (PS).

It has five stages:

Stage 0 – There is one tumour in the liver that is smaller than 2cm across. Your liver is working normally, and you are very well.

Stage A – There is one tumour in the liver that is smaller than 5cm across. Or, there are up to three tumours that are smaller than 3cm across. Your liver is working normally, and you are very well.

Stage B – There are many tumours in the liver. You are well, and your liver is working normally.

Stage C – You are not as well. There is some damage to your liver, or the cancer has spread into main blood vessel of the liver. Or, the cancer has spread to nearby lymph nodes or other parts of your body.

Stage D – You are not well, and your liver is not working well. You may have symptoms caused by liver damage such as a build-up of fluid in the tummy area (abdomen).

Early, intermediate or advanced

For the stages of HCC, you may also hear the terms:

  • very early
  • early
  • intermediate
  • advanced.

These terms are less specific than those used in the scientific staging systems. But the stages of the BCLC system can help explain them:

  • stage 0 is very early
  • stage A is early
  • stage B is intermediate
  • stages C and D are advanced.

About our information

  • References

    Below is a sample of the sources used in our primary liver cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016; 40: 2425–2440. Available from: doi.org/10.1007/s00268-016-3700-1 [accessed Feb 2020] 

    NICE. Lenvatinib for untreated advanced hepatocellular carcinoma: Technology appraisal guidance (TA 551) [Internet]. 2018. Available from: www.nice.org.uk/guidance/TA551 [accessed Feb 2020] 

    NICE. Liver disease. Quality standard (QS 152) [Internet]. 2017. Available from: www.nice.org.uk/guidance/QS152 [accessed Feb 2020] 

    NICE. Liver cancers overview [Internet]. 2019. Available from: pathways.nice.org.uk/pathways/liver-cancers/liver-cancers-overview [accessed Feb 2020]

    NICE. Regorafenib for previously treated advanced hepatocellular carcinoma. Technology appraisal guidance (TA555) [Internet]. 2019. Available from: www.nice.org.uk/guidance/ta555 [accessed Feb 2020]

    Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2018; 29 (S4): iv238–iv255. Available from doi.org/10.1093/annonc/mdy510 [accessed Feb 2020]    


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.