After being diagnosed with primary liver cancer, adult patients need to be tested to determine if the cancer has spread in the liver or if it has metastasized to other parts of the body.
The process of determining whether the cancer has spread in the liver or metastasized to other parts of the body is called “staging. Knowing the stage is important for your doctor to plan treatment.
Common tests for staging liver cancer
- CT scan (also called CAT scan): A test that shows a series of detailed images of the body’s internal organs or tissues (such as the chest, abdomen, and pelvis) from different angles. These images are generated by a computer connected to an X-ray instrument, and a contrast medium is given intravenously or swallowed to help show the organ or tissue more clearly. This test is also known as computed tomography, computed tomography, and computed axial tomography.
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MRI (magnetic resonance imaging): A test that uses magnetic fields, radio waves, and a computer to obtain a series of detailed images of the inside of the body, also known as nuclear magnetic resonance (NMRI).
- PET scan (positron emission tomography): A test that can detect malignant cells in the body. A small amount of radioactive glucose is injected intravenously, followed by a PET scanner that rotates and scans around the body to produce an image of the distribution of sugar in the body. Malignant tumor cells will appear brighter on the image because these cells are more active and have taken up more sugar than normal cells.
How does liver cancer spread?
Cancer spreads in the body in three ways: through organ tissues, the lymphatic system, and the blood.
- Organ tissues. Cancer spreads from the primary site by growing into the surrounding area.
- Lymphatic system. Cancer spreads from the primary site by entering the lymphatic system and migrating to other parts of the body via the lymphatic vessels.
- Blood. Cancer spreads from the primary site by entering the bloodstream and migrates to other parts of the body through blood vessels.
When cancer spreads from the primary site to other parts of the body, it is called “metastasis. Cancer cells can be shed from the primary site and migrate through the lymphatic system or bloodstream to form a new tumor in another part of the body (metastatic cancer).
- Lymphatic system. Cancer cells enter the lymphatic system and migrate through the lymphatic vessels to form a metastatic tumor in another part of the body.
- Blood. Cancer cells enter the bloodstream, migrate through blood vessels, and form metastases elsewhere in the body.
Metastatic cancer is the same type of cancer as the primary cancer. For example, if primary liver cancer metastasizes to the lungs, the cancer cells in the lungs are actually liver cancer cells. Then the disease is called “metastatic liver cancer” (or metastatic liver cancer to the lungs), not lung cancer.
The BCLC staging system for hepatocellular carcinoma
There are several staging systems for hepatocellular carcinoma. Of these, the Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely used. This system is used to predict a patient’s chances of recovery and to help develop a treatment plan. Adults with primary liver cancer can be staged using the BCLC.
The system stages liver cancer based on the following factors:
- Whether the cancer has spread in the liver or has metastasized to other parts of the body.
- Liver function.
- The patient’s general health status.
- Symptoms due to cancer.
BCLC staging includes stage 5:
- Stage 0: very early stage
- Stage A: early
- Stage B: intermediate
- Stage C: late stage
- Stage D: end-stage
When developing a treatment plan, refer to the following groupings:
- BCLC stages 0, A, and B: For patients with BCLC stages 0, A, and B, radical treatment is available.
- BCLC stages C and D: For patients with BCLC stages C and D, palliative treatment to relieve liver cancer symptoms and improve quality of life is available. Treatment at this time is unlikely to cure liver cancer.
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