Staging system: Barcelona Clinic Liver Cancer (BCLC)

Following is the Barcelona Clinic Liver Cancer (BCLC) staging system along with staging illustrations. Factors taken into consideration include the Eastern Cooperative Oncology Group (ECOG) Performance Status, which measures how the disease is affecting your ability to conduct daily activities, and the Child-Pugh scoring system, the most commonly used staging system for hepatocellular carcinoma, which is used to evaluate liver function.

Using BCLC, Stage 0 indicates the smallest amount of tumor cells present, and Stage D represents the largest amount. Once the stage is determined, it is subcategorized to signify the health of the liver: “A” indicates a well-functioning liver, “B” represents liver function that is significantly compromised, and “C” indicates severe liver damage.

BCLC - Illustrated Stages of Liver Cancer

Staging system: American Joint Committee on Cancer (AJCC)

The American Joint Committee on Cancer’s (AJCC) TNM staging system may be used to classify and stage liver cancer. Although cancers with similar stages tend to have a similar outlook and are often treated in much the same way, your doctor will also consider the results of your physical exam, biopsy and imaging tests.

The AJCC system classifies the cancer by tumor (T), node (N) and metastasis (M), as well as histologic grade. The T category describes the size and location of the primary tumor. The N category indicates whether the lymph nodes show evidence of cancer cells. The number and location of these lymph nodes are important because they show how far the disease has spread. The M category describes metastasis (spread of cancer to another part of the body), if any. The grade describes how abnormal the cancer cells and tissue look under a microscope and how likely they are to grow and spread. The results of the TNM analysis are then combined to determine the overall stage of the cancer for each individual.

In general, using the TNM system, liver cancer may be classified into one of these four stages:

Stage I: A tumor has formed but is confined to the liver and has not yet invaded any blood vessels, nearby lymph nodes or distant sites.

Stage II: There may be more than one tumor, and cancerous cells may have grown into nearby blood vessels.

Stage III: There is a large tumor or more than one tumor, but the cancer has not yet spread in lymphatic channels or bloodstream to regional lymph nodes or distant sites.

Stage IV: The tumor(s) may be any size and has spread to regional lymph nodes and/or distant parts of the body.

Despite treatment, it is possible or even likely for HCC to return. If that happens, your treatment team will use additional diagnostic tests, such as a biopsy or surgical procedure, to verify your cancer stage. Final staging may occur after treatment has begun. Once your stage is confirmed, your treatment team will be able to determine whether another form of treatment is necessary.

AJCC - Illustrated Stages of Liver Cancer