In the ward, patients or family members of liver cancer patients often ask, “Doctor, what is the extent of my disease? Is there any hope?
To answer this question, the key is to clarify the stage of liver cancer.
Like other diseases, liver cancer also has a process of development from nothing to something, from small to large. Which stage the disease is in plays a very important role in formulating the corresponding treatment plan and judging the patient’s prognosis.
The staging system of hepatocellular carcinoma has undergone many changes. Primary liver cancer (hepatocellular carcinoma) mostly occurs on the background of hepatitis and cirrhosis, so in fact patients with liver cancer are actually suffering from two diseases (tumor and liver disease), and the function of the liver has a considerable impact on the prognosis of the disease. Many previous staging systems (represented by the TNM staging of the International Union Against Cancer) only considered the tumor itself and ignored the impact of liver disease, thus not reflecting the disease stage well. Many subsequent staging systems include liver function assessment as one of the staging indicators, which can more comprehensively reflect the disease condition and guide treatment and prognosis. The most representative one is the Barcelona Clinic Liver Cancer (BCLC), which is the most commonly used staging system in clinical practice today.
BCLC staging includes four main categories of prognostic factors (1) the general status of the patient (2) the status of the tumor (3) the status of liver function. The following table shows the four stages of patients into ABCD
BCLC Staging
Behavioral status ECOG score
Tumor status
Liver function status
0 (earliest stage)
0
Single ≤2cm
normal bilirubin,no portal hypertension
A(early stage)
A1
0
Single ≤5cm
Normal bilirubin, no portal hypertension
A2
0
Single ≤5cm
Normal bilirubin, portal hypertension
A3
0
Single ≤5cm
abnormal bilirubin,portal hypertension
A4
0
All three tumors ≤3cm
Child-Pugh A-B
B (mid-stage)
0
Multiple or single >5cm
Child-Pugh A-B
C (late stage)
1-2
Vascular invasion or metastasis
Child-Pugh A-B
D (end-stage)
3-4
Any tumor
Child-Pugh C
The BCLC staging system is considered to be the best staging system and has been proven in numerous clinical studies to have strong classification and prognostic capabilities, allowing for the identification and treatment of early stage liver cancer patients through surveillance of high-risk groups.
The BCLC staging system also suggests different treatments for different patients according to different stages, and the indications for surgery in BCLC clinical staging system have been recognized in some countries.