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Liver Cancer Stages

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Liver cancer stages can help the doctor decide the path of the treatment of the liver cancer patient. Liver cancer grows slowly from a small tumor to large tumor and thereafter it starts spreading to the nearby organs. Initially, liver cancer affects the liver from inside or outside or ducts connecting the liver and is called as primary liver cancer. This starts growing as cancer cells divide rapidly and invade the other parts of the liver. At this stage, the liver cancer is said to malignant. As the liver cancer spreads from liver to other organs, it is said to be metastasized.

Liver cancer stages provide a system of classifying cancer tumors. Liver cancer staging system provides details about the following aspects of liver cancer:

  • What is the size and number of the liver cancer tumors
  • What is the type of the liver cancer
  • What is the probability of it spreading to other organs and affecting the lymph nodes
  • For liver cancer in particular level of cirrhosis is predicted
  • Amount of bilirubin and albumin indicate severity of loss to liver function
  • Damage to other body functionality and its effects on normal physical activity

Worldwide live cancer is staged in various ways. The common staging systems that describe liver cancer stages are,

  • TNM System
  • Okuda System
  • Barcelona Clinic Liver Cancer Staging (BCLC)
  • Cancer of the Liver Italian Program staging system(CLIP)

All of these systems consider factors such as extent and size of tumor, its ability to metastasize, its growth rate and impact on liver function. For all systems, diagnostics tests are carried out first which include blood tests, x-ray tests, Urine tests, MRI (Magnetic Resonance Imaging) and CT scans

TNM system: TNM system is attributed to the American Joint Committee on Cancer (AJCC).It can be described as:

  • T stands for tumor size in centimeters and number of tumors. It describes the presence of primary tumors Number between 1-4 are used to describe sizes of the tumor for example T3 shows a tumor size higher than 5 cm. T3b describes a tumor affecting the veins around the liver such as portal and hepatic T4 describes a tumor invading the visceral peritoneum or thin tissue layers of the liver as well as spreading to nearby organ
  • N stands for liver lymph nodes N0 shows little or no existence of tumor that affects the lymph nodes. N1 means that the tumor has spread to the nodes
  • M describes metastasis of the tumor. For example M0 shows tumor is not spreading to other lymph nodes at a distance from liver or other organs. M1 means that the tumors are spreading from the liver to other organs

Barcelona Clinic Liver Cancer Staging, Okuda System and Cancer of the Liver Italian Program staging system (CLIP) are similar to one another and are widely followed in different countries. They too use a system similar to TNM system of staging of liver cancer. Besides the TNM ratings they also rely on factors such as cirrhosis of liver and patient degree of physical activity

Cirrhosis in liver cancer: Cirrhosis in liver cancer is a useful measure to predict the liver cancer stages. Cirrhosis can be pointed by Child-Pugh Score. It considers the following factors:

  • Bilirubin: High levels of bilirubin in urine, blood and stool tests indicate severe damage to liver function along with diseases like jaundice and liver cancer
  • Albumin: Albumin is useful to carry out the process of osmosis in the body
  • Ascites: Indicate fluid in the liver and hence liver damage
  • Hepatic encephalopathy: It indicates impact of liver damage on functioning of brain and cognitive abilities

A point system is used to predict the staging of cirrhosis, for example, 5-6 points indicate 85% survival chances after 2 years whereas 10-15 points indicate low survival chances after 2 years (as low as 35%)

Note on BCLC: BCLC is used commonly to stage hepatocellular carcinoma (HCC). It uses combination of Child-Pugh system, performance status ranking, tumor size and liver function observations to stage the liver cancer.

Child-Pugh system indicates cirrhosis. A (5-6 points), B (7-9 points), C (10-15 points), D (>15) status is used to mark the cirrhosis of liver. For example, A indicates lower cirrhosis and the start phase of HCC and D indicates extremely high cirrhosis and the end stage of HCC

Performance status tests indicate ability of the patient to perform normal activities. For example, 0 is used to indicate no impact on day to day activities but a 4 rating indicates high disability or confinement to bed.

Remarks are also added in the BCLC system, which point to presence of bilirubin, essential proteins and hypertension.

  • Stage A by BCLC usually indicates simple or single tumors with sizes less than 3 centimeters
  • Stage B by BCLC indicates large or multi nodular tumors
  • Stage C by BCLC indicates spreading from liver such as vascular invasion
  • Stage D by BCLC indicates a end stage

Liver cancer stages thus outline the nature of the tumor and its impact on the patient. Stages of liver cancer are crucial in determining the course of treatment for the patient.

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