Types & Stages

Liver Tumors: Types & Stages

There are two types of primary liver tumors or cancers. The first and more common of the two is hepatocellular carcinoma (HCC). HCC is most commonly caused by cirrhosis of the liver. Alcoholism and hepatitis C are the two most common causes of cirrhosis in the U.S. Obesity, anabolic steroid abuse, exposure to certain chemicals, and Hepatitis B have also been linked to hepatocellular carcinoma.

Because it often doesn’t cause symptoms in its early stages hepatocellular carcinoma often goes undetected until in its advanced stages. When HCC symptoms are present, they include weight loss, nausea, pain on the upper right side of the abdomen, a feeling of fullness after eating a small amount, and jaundice (yellowing of the eyes and skin). HCC treatment options depend on the stage of the liver cancer and may include: liver resection, in which the tumor is surgically removed; radiofrequency ablation, in which microwaves are used to kill the tumor; radiation; and chemotherapy. A team of physicians works with our patients to decide which HCC treatment option will be best for him or her.

Cholangiocarcinoma, or bile duct cancer, is a fast­moving and often lethal form of cancer. It is a relatively rare, but aggressive tumor that grows from the bile ducts of the liver. There are only approximately 5,000 new cases of cholangiocarcinoma each a year and it is a difficult cancer to cure. The preferred cholangiocarcinoma treatment is surgical resection of the liver or liver transplantation. Cholangiocarcinoma treatment options are determined based on how advanced the cancer is. For bile duct cancer patients that are not surgical candidates, cholangiocarcinoma can be managed, though not cured, with adjuvant therapies like chemotherapy and radiation.

A staging system is a standard way for the cancer care team to sum up information about how far a cancer has spread. Doctors use staging systems to get an idea about a patient’s prognosis (outlook) and to help determine the most appropriate treatment.

The TNM system for staging contains 3 key pieces of information:

  • T describes the number and size of the primary tumor(s), measured in centimeters (cm), and whether the cancer has grown into nearby blood vessels or organs.
  • describes the extent of spread to nearby (regional) lymph nodes,which are bean­sized collections of immune system cells to which cancers often spread first.
  • M indicates whether the cancer has metastasized(spread) to distant parts of the body

Numbers or letters that appear after T, N, and M provide more details about each of these factors:

  • The numbers 0 through 4 indicate increasing severity.
  • The letter X means “cannot be assessed” because the information is not available.

T groups

  • TX:Primary tumor cannot be assessed
  • T0:No evidence of primary tumor
  • T1:A single tumor (any size) that hasn’t grown into blood vessels
  • T2:Either a single tumor (any size) that has grown into blood vessels, OR more than one tumor but no tumor is larger than 5 cm (about 2 inches) across
  • T3a:More than one tumor, with at least one tumor larger than 5 cm across T
  • 3b:At least one tumor (any size) that has grown into a major branch of a large vein of the liver (the portal or hepatic vein)
  • T4:The tumor (any size) has grown into a nearby organ (other than the gallbladder), OR the tumor is growing into the thin layer of tissue covering the liver (called the visceral peritoneum)

N groups

  • NX:Regional (nearby) lymph nodes cannot be assessed.
  • N0:The cancer has not spread to the regional lymph nodes.
  • N1:The cancer has spread to the regional lymph nodes.

M groups

  • M0:The cancer has not spread to distant lymph nodes or other organs.
  • M1:The cancer has spread to distant lymph nodes or other organs. Liver cancer most often spreads to the lining of the belly (peritoneum), the lungs, and to bones.

Stages of liver cancer

Once the T, N, and M groups have been determined, they are then combined to give an overall stage, using Roman numerals I to IV (1 to 4).

 Stage Stage grouping Stage description
I T1, N0, M0 There is a single tumor (any size) that has not grown into any blood vessels. The cancer has not spread to nearby lymph nodes or distant sites.
II T2, N0, M0 Either there is a single tumor (any size) that has grown into blood vessels, OR there are several tumors, and all are 5 cm (2 inches) or less across. The cancer has not spread to nearby lymph nodes or distant sites.
IIIA T3a, N0, M0 There is more than one tumor, and at least one is larger than 5 cm (2 inches) across. The cancer has not spread to nearby lymph nodes or distant sites.
IIIB T3b, N0, M0 At least one tumor is growing into a branch of a major vein of the liver (portal vein or hepatic vein). The cancer has not spread to nearby lymph nodes or distant sites
IIIC T4, N0, M0 A tumor is growing into a nearby organ (other than the gallbladder), OR a tumor has grown into the outer covering of the liver. The cancer has not spread to nearby lymph nodes or distant sites.
IVA Any T, N1, M0 Tumors in the liver can be any size or number and they may have grown into blood vessels or nearby organs. The cancer has spread to nearby lymph nodes. The cancer has not spread to distant sites
IVB Any T, Any N, M1 The cancer has spread to other parts of the body. (Tumors can be any size or number, and nearby lymph nodes may or may not be involved.)