This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on July 20, 2022.
Making an educated treatment decision begins with determining the stage, or progression, of the disease. The stage of liver cancer is one of the most important factors in evaluating treatment options.
This article will cover:
Staging helps:
Your care team speak the same language: The stage is a quick way for your care team to communicate how advanced the cancer is—where it’s spread, how large it is, and how much it’s affecting the body.
Inform treatment: Most importantly, your stage informs a treatment plan—more advanced cases may need a different approach than smaller tumors caught early on. Liver cancers in the same stage are typically treated in similar ways.
Determine clinical trial eligibility: Clinical trials are programs researching new drugs or treatments intended to improve a person’s chances of survival. You and your care team may work together to decide on a treatment plan that best manages a particular cancer and its symptoms and provides the best quality of life.
The TNM system is used to describe many cancers, and it’s the most common system used to stage liver cancer in the United States. However, TNM—created by the American Joint Committee on Cancer—doesn’t look at liver function. This is why other staging systems, such as the Barcelona Clinic Liver Cancer system, are sometimes used for primary liver cancer.
The TNM system bases the staging criteria on the evaluation of three primary factors:
T (tumor) describes the size of the original tumor.
N (node) indicates whether the cancer is present in the regional (nearby) lymph nodes.
M (metastasis) refers to whether cancer has spread to distant parts of the body. (The most common sites of liver cancer spread are the lungs and bones.)
A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. For example, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information couldn’t be assessed. Once the T, N and M scores have been assigned, an overall liver cancer stage is assigned.
The single primary tumor (any size) hasn’t grown into any blood vessels. The cancer hasn’t spread to nearby lymph nodes nor distant sites. This stage has two subcategories.
A single primary tumor (any size) has grown into blood vessels, or several tumors are present (all smaller than 5 cm). The cancer hasn’t spread to nearby lymph nodes nor distant sites.
This stage has two subcategories.
In stage 4 liver cancer the cancer may have spread to nearby lymph nodes and/or to distant sites within the body. Advanced liver cancer doesn’t often metastasize, but when it does, it’s most likely to spread to the lungs and bones. This stage has two subcategories:
Several liver cancer staging systems have been developed that take into account how the function of the liver may affect the prognosis:
Though the TNM system is the most common, there’s no single staging system consistently used by the medical community, so if you have questions about your liver cancer stage, make sure to discuss them with your oncology team.
The Child-Pugh score is part of the BCLC staging system and describes liver function using blood tests and imaging. Liver cancer patients often have cirrhosis as well, which is scarring of liver tissue due to disease or toxins. Cirrhosis may be described with this scale.
Child-Pugh measures liver function by looking at five factors:
The Child-Pugh score is used to determine the class of liver function:
In cancer care, doctors typically refer to five-year relative survival rates when discussing outcomes with their patients. These rates approximate the probability that someone with a certain type of cancer will live five years or longer after they are diagnosed, compared with people without that cancer. Survival rates can provide context, but they are rough measurements, and they don’t account for all of the individual factors that may influence patient outcomes. The calculations are also somewhat dated because they rely on patient data from five or more years ago. Due to recent treatment advances and other factors, current patients may have better outcomes than the rates suggest.
According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, the overall five-year relative survival rate for liver cancer is 20.3 percent, based on data from patients diagnosed between 2011 and 2017. The rate suggests that people with any stage of liver cancer are, on average, about 20.3 percent as likely as people without liver cancer to survive five years or longer after their diagnosis.
SEER also collects survival rates according to the cancer’s stage, but it uses three general stages for all cancer types, instead of grouping them according to the staging system of a particular cancer. The SEER stages are:
The five-year relative survival rates for liver cancer according to SEER stages are:
Some of the factors that play a role in determining a patient’s chance of recovery include the cancer’s stage, the extent of liver function and the patient’s overall health.
Early-stage liver cancer tumors in patients with otherwise healthy livers can sometimes be treated with surgery. However, it’s difficult to detect liver tumors early, and most patients already have cirrhosis or are not healthy enough to undergo surgery by the time they’re diagnosed.
Liver cancer tumors that cannot be completely removed by surgery often have low survival rates, but the length of time a patient may live with the cancer can vary.
While stage 4 liver cancer has low survival rates, some patients may live for years after their diagnosis. There are treatments available to help boost quality of life and prolong survival. New therapies are always being developed. Some of these newer treatments, such as virus therapy, have shown promise for patients with advanced liver cancer, leading to hope that outcomes may improve for stage 4 patients in the future.