Hepatocellular carcinoma is one of the common malignant tumors in China, with insidious onset, diverse clinical manifestations, and lack of specificity, which can easily lead to misdiagnosis.
Symptoms of liver cancer
The early symptoms of liver cancer are not obvious, even patients do not feel bad for a long time after the disease has developed, and only when the disease has reached a certain level will symptoms such as pain in the liver area, decreased appetite, fatigue and weakness, and weight loss gradually appear.
Because most liver cancer occurs on top of chronic hepatitis and cirrhosis, it is difficult to rely on these symptoms to diagnose liver cancer. Patients with advanced liver cancer can often feel a huge abdominal mass and will have abdominal pain, jaundice, ascites, vomiting blood and coma.
So, early-stage liver cancer is mostly asymptomatic, and when symptoms appear, it is mostly advanced liver cancer.
Staging of liver cancer
The purpose of tumor staging is to assess the progressive status of the tumor to guide the development of treatment plans and to predict the patient’s prognosis.
Key factors in tumor staging include tumor size, liver function status, patient strength score, and treatment outcome.
Currently, liver cancer relies on staging methods such as TNM, CLIP, CUPI, GRETCH, JIS, Okuda, and BCLC, with the most commonly used currently being the Barcelona staging (Barcelona clinic liver cancer, BCLC) proposed in 1999, as detailed in the table below.
This staging divides liver cancer into 4 stages:
- Stage A: suitable for radical treatment (surgical resection, liver transplantation, radiofrequency ablation);
- Stage B: Mostly interventional (transarterial chemoembolization);
- Stage C: Mostly interventional (transarterial chemoembolization);
- Stage C: most often treated with targeted drugs or enrolled in clinical trials;
- Stage D: most often treated with targeted drugs or enrolled in clinical trials;
- Stage D: The patient’s prognosis is extremely poor due to poor liver function and physical condition, which cannot tolerate various antitumor treatments, and is usually given palliative supportive symptomatic treatment to improve symptoms.
| BCLC Staging | ||
| Installation | Tumor characteristics | Related liver characteristics |
| A1 | Single tumor size less than 5cm | No portal hypertension, normal bilirubin |
| A2 | Single tumor less than 5cm in size | with portal hypertension and normal bilirubin |
| A3 | Single tumor less than 5 cm in size | with portal hypertension and abnormal bilirubin |
| A4 | 3 tumors less than 3cm in size | Child-Pugh A-B |
| Multiple tumors or giant masses | Child-Pugh A-B | |
| Vascular invasion or extrahepatic metastases | Child-Pugh A-B | |
| D (terminal) PST 3-4 | Either of these characteristics | Child-Pugh C |