Liver Cancer Stages

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Staging means finding out how far liver cancer has spread in your body. There are several systems used to stage liver cancer. Fred Hutch Cancer Center uses the Barcelona Clinic Liver Cancer (BCLC) staging system.

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BCLC Staging

The BCLC system groups liver cancer into five stages:

  • Stage 0
  • Stage A
  • Stage B
  • Stage C
  • Stage D

Stage 0 is the least advanced, and stage D is the most advanced. When your Fred Hutch team designs your treatment plan, they will consider the stage of your cancer along with many other factors. The stage is an important part of choosing which treatments are right for you.

The stage depends on:

  • How many tumors are in your liver and how big they are.
  • How well your liver is working.
  • Your overall health and activity level (called performance status).

Here’s what each stage means in more detail:

Stage 0 (very early-stage liver cancer)

There is only one tumor in your liver. It is less than 2 centimeters (cm) across. Your performance status is 0. Your liver is working well.

Stage A (early-stage liver cancer)

There are one to three tumors in your liver. All are less than 3 cm across. Your performance status is 0. Your liver is working well.

Stage B (intermediate-stage liver cancer)

There are many tumors in your liver. Your performance status is 0. Your liver is working well.

Stage C (advanced-stage liver cancer)

Cancer has spread to your blood vessels, lymph nodes or other parts of your body. Your liver is working well, but your performance status is 1 or 2, meaning you don’t feel as well and aren’t as active.

Stage D (end-stage liver cancer)

Your liver is severely damaged. Your performance status is 3 or 4, meaning you do not feel well, and you need help to take care of yourself.

How to Know Your Liver Cancer Stage

After you are diagnosed with liver cancer, you will have imaging scans and other tests, like blood tests to check your liver function. You may have biopsies to tell if the cancer has spread. In a biopsy, a pathologist checks samples of tissue under a microscope to see if they contain cancer cells.

Liver Cancer Survival Rates

In cancer care, “survival rate” usually means the percentage of people expected to survive their cancer for at least five years from the time it was diagnosed. Data experts estimate this rate based on information about large groups of people with the same type of cancer. The rate doesn’t include the risk of dying during those five years for some other reason.

The chance of surviving cancer for five years or more can be quite different from person to person. One important reason is the stage of the disease at the time of diagnosis. Even within a subset of people, like those with localized disease, there will be differences. Patients may have different treatments and respond to treatments in different ways.

This means it’s impossible to predict the lifespan of any one person based on survival rates. Your Fred Hutch care team can tell you more based on your unique situation.

Liver Cancer Stages FAQ

The TNM staging system is another way to describe how far liver cancer has spread. It is typically used for intrahepatic cholangiocarcinoma, a rare cancer that develops in the bile ducts within the liver. (This system is used for many other types of cancer too.) The letters stand for:

  • Tumor (T): The size of the main tumor and any spread of cancer into nearby tissue
  • Nodes (N): The number of nearby lymph nodes where cancer has spread
  • Metastasis (M): If cancer has spread (metastasized) to other parts of the body

If you would like to know the stage of your cancer in the TNM system, ask your Fred Hutch care team.

In general, people who have the same stage of cancer often have the same or similar treatments. Typically, the stage depends on how far the cancer has spread from where it started. For liver cancer, your care team will consider the extent and location of the cancer along with other factors, like how well your liver is working, how healthy you are overall, if they might be able to remove all the cancer with surgery and if you might be able to have a liver transplant.

Here’s one way physicians typically think about treatment options:

  • Localized liver cancer (only in the liver): Common treatments include surgery (partial hepatectomy or liver transplant), minimally invasive ablation (such as microwave or radiofrequency ablation) and radiation therapy. 
  • Locally advanced (has spread to nearby tissues) or metastatic (has spread farther in the body) liver cancer: Common treatments include minimally invasive procedures (such as chemoembolization), targeted therapy, immunotherapy and radiation therapy. 

Learn more about liver cancer treatment.

Researchers at Fred Hutch and beyond are always looking for better ways to treat advanced or metastatic liver cancer. Clinical trials are going on to test new drugs or new combinations of drugs. One important area of research is T-cell therapy, a type of immunotherapy. Immunotherapies use the power of your immune system to fight cancer. T cells are a type of white blood cell that help boost your body’s natural immune response to infections and tumors.

Learn more about liver cancer treatment.