Stage 4 liver cancer
The stage of 
liver cancer tells you how big it is and whether it has spread to other parts of the body. This helps your doctor recommend the best treatment for you.
Primary liver cancer is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases.
Staging systems
Doctors use different systems to stage liver cancer. This page is about stage 4 cancer, which is part of the number staging system. This system has 4 stages, stage 1 to stage 4.
This page also tells you what stage 4 means in the TNM system. This system describes:
- the size of the primary tumour (T)
- whether the cancer has spread to the
lymph nodes (N) - whether the cancer has spread to another part of the body (M)
What is stage 4 liver cancer?
Stage 4 liver cancer is divided into 2 further stages - stage 4A and 4B.
Stage 4A means the cancer is any size and there may be more than one tumour. It may have grown into blood vessels or the organs around the liver. It has spread to lymph nodes but not to distant parts of the body. In TNM staging, stage 4A is the same as Any T, N1, M0.
Stage 4B means the cancer is any size and there may be more than one tumour. It may have grown into blood vessels or the organs around the liver. It may or may not have spread into lymph nodes. It has spread to another part of the body such as the lungs or bones. In TNM staging this is the same as Any T, Any N, M1.
Other staging systems
The number and TNM staging systems describe the size and position of liver cancer. However, people with liver cancer often have scarring of the liver (cirrhosis). So doctors also need a system that describes how well your liver is working and your health (your performance status). Then they can decide what treatment would be best. For this, doctors use a system called the Barcelona Clinic Liver Cancer (BCLC) strategy.
Treatment for stage 4 liver cancer
Unfortunately when liver cancer is advanced, treatment won't be able to cure it. Treatment for stage 4 aims to control the cancer, relieve symptoms and give you a good quality of life.
Targeted and immunotherapy cancer drugs
Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. They are called immunotherapies.
You might have a combination of these drugs, or treatment with a single drug. Examples include:
- atezolizumab and bevacizumab
- lenvatinib
- sorafenib
Treating symptoms
You may also have other treatments to control specific symptoms such as sickness and pain.
Research and clinical trials
Researchers are always trying to improve the treatment and quality of life for people with liver cancer.
