Staging
In order to properly describe the liver cancer, doctors use a staging system that takes into account the size and location of the tumor, the number of tumors, and whether or not the cancer has spread or metastasized to other areas of the body. Staging is critical in determining the treatment options available.
Staging of Hepatocellular Carcinoma (HCC)
Stage I
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Description
- Localized to the liver. There is only one tumor in the liver. The tumor has not spread to the blood vessels in the liver.
- Stage 1b Single tumor > 2 cm
Treatment
- The treatment of choice is usually a surgical resection (partial hepatectomy), that could be combined with systemic chemotherapy. Other treatments that may be considered include tumor ablation, liver transplantation, embolization, radiation therapy, and targeted therapy.
Stage II
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Description
Extension in the Liver
- There is only one tumor in the liver and the tumor has invaded blood vessels in the liver.
- OR
- There are multiple tumors in the liver, all of which are smaller than 5 cm.
Treatment
- The goal is usually a surgical resection (partial hepatectomy) that must be preceded by another treatment in order to decrease tumor burden and allow a safe resection. The preoperative treatment (neoadjuvant treatment) could be a local treatment or a systemic chemotherapy according to tumor origin. Other treatments that may be considered include tumor ablation, liver transplantation, embolization, radiation therapy, and targeted therapy.
Stage IIIa
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Description
- There are multiple tumors in the liver. At least one of these tumors is larger than 5 cm.
Treatment
- A surgical resection (partial hepatectomy) usually cannot be considered for large tumors or multiple tumors. Other treatment options that may be considered include embolization, ablation, systemic therapy, radiation therapy, and targeted therapy.
Stage IIIb
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Description
- There may be only one tumor or multiple tumors of any size in the liver. The cancer has spread to a major vein in the liver (portal vein or hepatic vein).
- The cancer has spread directly to nearby organs such as the stomach, but not to the gallbladder or lymph nodes.
- The cancer has passed through the outer lining of the liver.
Treatment
- A surgical resection (partial hepatectomy) usually cannot be considered for tumors that have spread to a major blood vessel in the liver. Other treatment options that may be considered include embolization, ablation, systemic therapy, radiation therapy, and targeted therapy.
Stage IVa
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Description
- The cancer has spread to the lymph nodes.
Treatment
- A surgical resection cannot be considered for advanced liver cancer that has spread to other organs or lymph nodes. Systemic chemotherapy is usually proposed. Other treatment options may include radiation therapy, targeted therapy, clinical trials, palliative treatments.
Stage IVb
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Description
- The cancer has spread to other parts of the body.
Treatment
- A surgical resection cannot be considered for advanced liver cancer that has spread to other organs or lymph nodes. Systemic chemotherapy is usually proposed. Other treatment options may include radiation therapy, targeted therapy, clinical trials, palliative treatments.
Staging of Cholangiosarcoma
Staging of Angiosarcoma/Hemangiosarcoma
Staging of Hepatoblastoma
- Please refer to "Understanding Hepatoblastoma - Staging" for more information.
