Stages of HCC

What staging is

Staging is a system doctors and researchers use to group cancers according to the size of the tumour and whether there is spread to lymph nodes or other body tissues. Through experience and research, doctors have found which treatments work best for each stage.

It’s important to know your cancer stage if you’re looking for information. The other pages in this section will tell you what the likely treatments are for each stage of HCC.

There are different staging systems used in cancer medicine. In HCC, doctors usually use the Barcelona Clinic Liver Cancer (BCLC) staging system.

People with cancer often talk about their cancer being stage 1 to stage 4. This number staging is widely used for other types of cancer but not so often for HCC.

Barcelona Clinic Liver Cancer (BCLC) staging

This is the most widely used system for staging HCC. Although it’s called the ‘Barcelona system’ it’s used all over the world. Doctors use it to:

• classify how far the cancer has grown and whether it has spread
• decide on treatment
• get an idea of the likely outcome of treatment  (the prognosis)

As well as including the number and size of tumours in your liver, BCLC stage takes into account your general health and how well your liver is working.

Your general health

Doctors use a standard measure of health called ‘performance status’ or PFS. This has 5 categories – 0-4:

• 0 means you are well – pretty much as normal
• 1 means you are well enough to do everything you normally do, except for heavy work
• 2 means you are up for most of the day, but not well enough to work
• 3 means you need to rest for more than half the day and need some help in looking after yourself
• 4 means you are in bed or chair all day and need a lot of help looking after yourself

It’s helpful to include performance status in HCC staging because it affects which treatments you can have. If you are very unwell, some of the treatments may be too much for you to cope with.

How well your liver works

There is another system for measuring how well your liver works. This is called the Child-Pugh (say: child pew) system. It includes:

• results of your liver blood tests (bilirubin, proteins and blood clotting)
• whether you have fluid in your tummy (abdomen) – called ascites 
• whether your liver condition is affecting your brain  (encephalopathy)

After taking these into account, your doctor will put you into one of three groups, A, B or C:

• A means your liver is working normally
• B means there is some liver damage
• C means there is a lot of liver damage

As well as the cancer, your Child-Pugh score will be affected by any other liver conditions you have, such as cirrhosis.

Barcelona staging groups

There are 5 groups in this system – 0, A, B, C and D

Barcelona stage 0
Stage 0 means you have very early stage HCC. You have a single liver tumour that measures less than 2cm across. You are well (performance status 0) and your liver is working normally (Child-Pugh A).

Barcelona stage A
Stage A means early stage HCC. You have either a single tumour (of any size) or up to 3 tumours that are all less than 3cm across. You are well (performance status 0). Your liver may be working normally or there may be some liver damage (Child-Pugh A or B).

Barcelona stage B
B means intermediate stage HCC. In stage B, you have multiple tumours in your liver, but you are well overall (performance status 0). Your liver is working normally or there is only moderate liver damage (Child-Pugh A or B).

Barcelona stage C
Stage C means advanced HCC. The liver tumours have grown into blood vessels, or have spread to lymph nodes or other body organs. You may not feel as well as normal and may be less active, but are still reasonably fit (performance status 1 or 2). In this stage, your liver is still working normally or there may be moderate liver damage (Child-Pugh A or B).

Barcelona stage D
Stage D means you are very unwell and need help looking after yourself (performance status 3 or 4). Or it may mean you have a lot of liver damage (Child-Pugh C). This may be from the cancer, or from other liver disease that you have.