Liver cancer

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Staging liver cancer

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. Extent includes the size of the tumour and where the cancer is in the body. Your healthcare team uses the stage to plan treatment and estimate your prognosis.

Barcelona Clinic Liver Cancer staging system

The Barcelona Clinic Liver Cancer (BCLC) system is the most widely accepted and used staging system for hepatocellular carcinoma. It considers the following:

  • the person’s Child-Pugh classification score, which measures the amount of liver damage caused by scarring (cirrhosis)
  • tumour characteristics, including how many tumours are in the liver, the size of the tumours, if the tumours cause symptoms and where the cancer has spread
  • performance status based on the Easter Cooperative Oncology Group (ECOG) score (the higher the number, the more problems the person has doing daily activities)

BCLC stages
BCLC stageChild-Pugh classification scoreTumour characteristicsECOG score


(very early)


There is 1 tumour. It is 2 cm or less in size. It isn’t causing any symptoms.

The tumour has not grown into the blood vessels.




A or B

There are up to 3 tumours. They are all smaller than 3 cm in size. They aren’t causing any symptoms.




A or B

There are tumours in several areas of the liver (called multifocal disease). They aren’t causing any symptoms.




A or B

The tumour or tumours have grown into blood vessels or the cancer has spread to other parts of the body. They are causing symptoms.

1 or 2




There is 1 or more tumours in the liver. They can be any size. They are causing symptoms.

The tumour may have grown into the blood vessels or the cancer has spread to other parts of the body.

3 or 4

Recurrent liver cancer

Recurrent liver cancer means that the cancer has come back after it has been treated. If it comes back in the same place where the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to the primary tumour, it’s called regional recurrence. It can also recur in another part of the body, which is called distant metastasis, or distant recurrence.

performance status

The measure of how well a person is able to perform ordinary tasks and carry out daily activities.

Examples of scales used to evaluate performance status include the Eastern Cooperative Oncology Group (ECOG), World Health Organization (WHO) and the Karnofsky performance status scale.


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Making progress in the cancer fight

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