TNM staging for liver cancer
Staging looks at the size of the cancer (tumour) and whether it has spread anywhere else in the body. There are different staging systems that doctors can use for liver cancer. The TNM staging system is one of these.
TNM stands for Tumour, Node, Metastasis. It 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)
Your doctor gives each letter (T, N and M) a number, depending on how far the cancer has grown.
TNM staging is used for staging liver cancer. 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.
Tumour (T)
Tumour describes the size of the tumour (area of cancer). There are 4 stages of tumour size in liver cancer - T1 to T4.
The T stage depends on:
- the size of the tumour or tumours
- whether the cancer has grown into any blood vessels in the liver
If you have surgery to remove your cancer, a sample of liver tissue is then sent to the laboratory. A specialist will look at the cells under a microscope. This might show small (microscopic) growth of cancer cells into the vein or artery.
Scans might also show if your cancer is growing into the blood vessels.
T1 means the cancer hasn’t grown into the blood vessels of the liver. It is split into T1a and T1b:
- T1a means that there is a single tumour in the liver that is 2 cm or less
- T1b means that there is a single tumour that is more than 2cm
T2 means that either:
- there is a single tumour that is more than 2cm and it has grown into blood vessels OR
- there are 2 or more tumours in the liver, and they are all less than 5cm
T3 means there are 2 or more tumours in the liver. At least one of them is more than 5cm
T4 means that the cancer has grown:
- into a major branch of one of the main blood vessels (the portal or hepatic veins) OR
- into organs close to the liver (not including the gallbladder) OR
- through the lining that wraps around the internal organs of the abdomen (visceral peritoneum)
Nodes (N)
Nodes describes whether the cancer has spread to the lymph nodes. There are 2 N stages:
- N0 means that there are no cancer cells in nearby lymph nodes
- N1 means that there are cancer cells in lymph nodes near the liver
If there are cancer cells in the lymph nodes, the cancer is advanced.
Metastasis (M)
Metastasis describes whether the cancer has spread to a different part of the body. There are 2 M stages:
- M0 means there is no sign that the cancer has spread outside the liver
- M1 means there are cancer cells in other parts of the body such as the lungs or bones
How the TNM staging system is used
TNM staging helps your doctor describe very accurately and clearly what stage your cancer is. But they may also describe your cancer using other staging systems such as the:
- number staging system
- Barcelona clinic liver cancer (BCLC) strategy
Treatment
The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:
- where the cancer is in your liver
- how well your liver is working
- other health conditions
- your wishes
For cancer that is only in your liver, it might be possible to remove it with surgery. This might be surgery to remove part of your liver (liver resection) or a liver transplant.
You might have a local treatment into your liver if you can't have surgery. This could be:
- heat treatment to destroy the tumour (radiofrequency ablation or microwave ablation)
- chemoembolisation (TACE) or embolisation (TAE)
- selective internal radiotherapy (SIRT)
- stereotactic ablative radiotherapy (SABR)
For advanced liver cancer you might have targeted or immunotherapy cancer drugs. You may have other treatments, such as painkillers or anti sickness drugs, to help with symptoms.
