Liver Cancer Staging

If liver cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is an attempt to find out whether the cancer has spread, and if so, to what parts of the body.

Stage I

There is one tumor and it has not spread to nearby blood vessels.

Stage II

During this stage either:

• One tumor that has spread to nearby blood vessels; or
• More than one tumor, none of which is larger than 5 centimeters.

Stage III

Divided into stages IIIA, IIIB, and IIIC:

• Stage IIIA – one of the following is found: more than one tumor larger than 5 centimeters; or one tumor that has spread to a major branch of blood vessels near the liver.
• Stage IIIB – there are one or more tumors of any size that have either: spread to nearby organs other than the gallbladder; or broken through the lining of the peritoneal cavity.
• Stage IIIC – the cancer has spread to nearby lymph nodes.

Stage IV

Cancer has spread beyond the liver to other places in the body, such as the bones or lungs. The tumors may be of any size and may also have spread to nearby blood vessels and/or lymph nodes.

When liver cancer spreads, the cancer cells may be found in the lungs. Cancer cells also may be found in the bones and in lymph nodes near the liver.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if liver cancer spreads to the bones, the cancer cells in the bones are actually liver cancer cells. The disease is metastatic liver cancer, not bone cancer. It’s treated as liver cancer, not bone cancer. Doctors sometimes call the new tumor “distant” or metastatic disease.

To learn whether the liver cancer has spread, your doctor may order one or more of the following tests:

• CT scan of the chest: A CT scan often can show whether liver cancer has spread to the lungs.
• Bone scan: The doctor injects a small amount of a radioactive substance into your blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.
• PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether liver cancer may have spread.