Liver cancer stages play a significant role in the diagnosis and treatment of the disease. The sooner you know which stage your liver cancer is in, the better. Early detection increases your treatment options. At Servicios Quirurgicos del Caribe in Mayaguez, PR, we can assist you in the liver cancer staging process.
About the Liver
The liver is a two-lobed organ found inside the ribcage and under the right lung. This organ has a larger right lobe and a smaller left lobe. It’s the largest internal organ, and it’s responsible for carrying out a variety of essential tasks.
Everything in the body is connected, and the liver is no different. Among other things, the liver connects with bile ducts that carry bile from the liver to the gallbladder and onward to the intestines to aid in the process of digestion, absorption, and detoxification.
Everything that enters the body through the mouth, lungs, or skin must first go through liver processing. Food, alcohol, drugs, and environmental toxins are all broken down by the liver for elimination through the stool or urine.
The liver is a vital organ, meaning a healthy liver keeps the body functioning correctly. Some of the many functions it performs every day include:
- Nutrient absorption and metabolizing
- Processing and repair of body tissue
- Energy creation
- Creation of blood clotting factors to regulate bleeding
- Processing toxic substances for elimination
What Is Liver Cancer?
Cancer occurs when cells grow quickly and abnormally without leaving the body. These extra cells may build up and cause a mass or tumor to form. Hepatocytes are the primary cells found on the liver. The liver also features cells like those lining the bile ducts and blood vessels. Liver cancer means the cells of the liver are growing out of control in an unhealthy way.
Types of Liver Cancer
Liver cancer can take many forms and affect different cells. Liver cancer may originate in the liver (primary) or move from somewhere else in the body into the liver (secondary or metastatic). There are several types of liver cancer. Affected cells, the location of those cells, and where the abnormal growth started determines the type of liver cancer present in the body.
Primary Liver Cancer
Primary liver cancer includes all cancers that begin in the liver and not somewhere else in the body.
Hepatocellular Carcinoma (HCC)
HCC is the most common type of liver cancer for adults and is categorized by different patterns of abnormal cell growth in the hepatocytes. It may appear as one tumor that continues to grow or as a series of cancerous nodules throughout the liver. A single tumor is often contained in one location until the late stages, when it may spread to other parts of the liver. Individuals with chronic liver damage (cirrhosis) more frequently experience a growth pattern of several cancerous nodules.
Intrahepatic Cholangiocarcinoma (Bile Duct Cancer)
Bile duct cancer occurs when the cells of the bile duct grow abnormally and at an uncontrolled rate. This type of cancer may begin in the liver but usually forms outside of the liver in the bile ducts.
Angiosarcoma and Hemangiosarcoma
These cancers originating in the liver’s blood vessel cells are rare. Some individuals have a higher risk of these types of liver cancers, including those who have been exposed to arsenic, radium, thorium dioxide, or vinyl chloride. Having hereditary hemochromatosis is another risk factor.
Hepatoblastoma is a type of very rare liver cancer affecting infants and children, usually by the age of four. This type produces cancerous growth on hepatoblastoma cells, which are tissues that closely resemble fetal liver cells.
Secondary Liver Cancer (Metastatic Liver Cancer)
Secondary or metastatic liver cancer occurs when cancer begins in another region of the body, such as the breast, colon, lung, or pancreas, but later spreads to the liver. The location where cancer begins is always the primary location. In Western countries, metastatic liver cancer is more prevalent than primary liver cancer.
What Are the Symptoms of Liver Cancer?
Liver cancer shares symptoms of many other conditions. Often signs of liver cancer are not noticeable until the disease is in the late stages, which makes treatment more difficult. If you experience any of the following symptoms, please schedule an appointment with us. Signs and symptoms of liver cancer may include:
- Abdominal pain
- Abnormal bleeding or bruising
- Appetite loss
- Enlarged liver
- Feeling of fullness
- Right shoulder blade pain
- Weight loss (unintended)
- Yellowing of the skin or eyes (jaundice)
What Is Liver Cancer Staging?
Liver cancer staging is the process of determining where it started, if it has spread, and if it is impacting other regions of the body. Staging begins after an individual has received a liver cancer diagnosis. This process is useful for discovering the amount of cancer in the body, tumor severity, and prognosis.
This process may include a physical exam, imagining tests (CT, MRI, ultrasound), and biopsies. Surgery may also be necessary to examine the tissue.
What System Defines the Liver Cancer Stages?
There isn’t one standardized staging system used among doctors worldwide to assess liver cancer. Doctors may use some staging systems in parallel to learn more about the cancer and the overall functioning of the liver. Some of the most common liver cancer staging systems include:
- AJCC (American Joint Committee on Cancer) TNM
- The Barcelona Clinic Liver Cancer (BCLC) system
- The Cancer of the Liver Italian Program (CLIP) system
- The Okuda system
Many doctors use the AJCC (American Joint Committee on Cancer) TNM system. In the TNM system, there are three predominating factors physicians look for: tumor attributes, node activity, and metastasis (spreading).
Collecting information about a tumor or tumors is the first thing doctors investigate during the TNM staging process. They assess the size of the tumor and its growth pattern. Doctors also look for more than one tumor and interaction with other parts of the liver, like the veins.
Doctors next assess if cancer has spread to the lymph nodes. Cancer cells spread through the lymph nodes, so this is an essential step in preventing spreading, identifying liver cancer stage, and treatment options.
The TNM system also looks for liver cancer spreading to distant lymph nodes and other organs of the body. Liver cancer most commonly spreads to the bones or lungs, which is where doctors will look for spreading first.
Child-Pugh is a cirrhosis staging system to assess how the liver is working. Many people who have liver cancer also have cirrhosis, and this can influence treatment opportunities.
Many doctors also use the Child-Pugh score to assess liver functioning after a liver cancer diagnosis. It is contained within the BCLC and CLIP staging systems and used alongside the TNM system.
Three of the five factors the Child-Pugh score takes into account are achieved through blood testing:
- Albumin (a substantial liver protein)
- Bilirubin (the substance responsible for jaundice)
- Prothrombin time (how well the liver makes clotting factors)
Doctors use other clinical measures to record the score for the final two factors in the Child-Pugh score:
- Presence of ascites (abdominal fluid buildup)
- Altered brain functioning
After they complete the tests, doctors compile the Child-Pugh score into classes A, B, and C. Class A shows normal liver functioning. Slight abnormalities in the liver are represented by class B. Severely impaired liver functioning is assigned to class C. Patients with class C are often ineligible for surgery or other major treatments.
What Are the Different Liver Cancer Stages?
Liver cancer stages range from stage I through stage IV. Stage I liver cancer is the lowest and means cancer has not spread to other parts of the body; stage IV indicates the most spreading.
Each staging system uses a different method for sub-categorizing liver cancer stages. Staging is a complex, profoundly personalized process. Every patient is different and has individual treatment needs, and staging is best understood through a dialogue with your doctor.
Below we highlight the simplified liver cancer stages using the TNM system.
Stage I (One) Liver Cancer
Stage IA liver cancer means there is one tumor smaller than 4/5 inches that is not interacting with blood vessels on the liver. There is no lymph node activity or spreading.
Stage IB liver cancer is diagnosed when a single tumor is larger than 4/5 inches. However, it isn’t growing into blood vessels, impacting lymph nodes, or spreading to distant sites.
Stage II (Two) Liver Cancer
Stage II liver cancer is when a patient has one tumor bigger than 4/5 inches that has grown into liver blood vessels. It may also be when there is more than one tumor that is less than two inches wide. Stage II tumors have not spread to lymph nodes or other regions of the body.
Stage III (Three) Liver Cancer
Stage IIIA liver cancer is more than one tumor, including at least one that is larger than two inches in diameter. The cancer is not interacting with lymph nodes or distant sites.
Stage IIIB liver cancer is any size or number of tumors that’s grown into a significant liver vein, like the hepatic vein or portal vein. This cancer has not spread to lymph nodes or elsewhere.
Stage IIIC liver cancer occurs when a tumor has grown into another organ or the outside of the liver. It has not spread to the lymph system or the rest of the body.
Stage IV (Four) Liver Cancer
Stage IVA liver cancer is the presence of one or more tumors of any size with cancerous spreading to the lymph nodes. Spreading has not impacted any distant sites.
Stage IVB includes tumors of any size that may or may not have spread to the lymph nodes but has spread to other organs like the bones or lungs.
What Are Liver Cancer Treatment Classifications?
After staging, doctors use a streamlined liver cancer classification system to design the best treatment plan. Treatment classification assesses tumor attributes, liver function, and the patient’s general health to determine if a tumor can be safely removed through surgical means.
Resection or Transplantation
Surgery or a liver transplant is often an option for patients with stage I or stage II liver cancer if they don’t have cirrhosis or other major medical issues. Few patients with liver cancer are eligible for this treatment plan.
Unresectable tumors are those that cannot be removed through surgery because of size, location, number, or interaction with other structures of the liver. Unresectable cancer has not spread to the lymphatic system nor other regions of the body; however, surgery is deemed unsafe.
Doctors classify inoperable tumors based on the overall health of the patient. It means a tumor is removable by surgery, but the surgery poses too many risks to the patient. Patients with cirrhosis may not have enough healthy liver tissue for the liver to function after a tumor is removed. Patients with other major medical problems also may not be candidates for operations.
Stage IV cancers in the TNM system are often not treatable through surgery because cancer has spread to lymph nodes or other organs.
Schedule an Appointment
Early detection of liver cancer is one of the best ways to maximize treatment options. We specialize in detecting liver cancer stages and can help you. Contact us today at Servicios Quirurgicos del Caribe in Mayaguez, PR, to schedule an appointment.