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    Adult Primary Liver Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Adult Primary Liver Cancer

    Prognostic modeling in hepatocellular carcinoma (HCC) is complex because variables of two diseases--cirrhosis and cancer--are involved in as many as 80% of the cases. Tumor features and the factors related to functional hepatic reserve must be taken into account. The key prognostic factors are only partially known and vary at different stages of the disease. More than ten classifications are used throughout the world, but no system is accepted worldwide.

    American Joint Committee on Cancer (AJCC) Staging System

    Definitions of TNM

    The TNM classification for staging, proposed by the AJCC, is not widely utilized. Clinical use of TNM staging is limited because liver function is not considered. It is also difficult to use this system to select treatment options because TNM staging relies on detailed histopathological examination available only after excision. TNM may be useful in prognostic prediction after liver resection.

    The AJCC has designated staging by TNM to define liver cancer.[1]

    Table 1. Primary Tumor (T)a

    a Reprinted with permission from AJCC: Liver. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual, 7th ed. New York, NY: Springer, 2010, pp 191-9.
    TX Primary tumor cannot be assessed.
    T0 No evidence of primary tumor.
    T1 Solitary tumor without vascular invasion.
    T2 Solitary tumor with vascular invasion or multiple tumors none >5 cm.
    T3a Multiple tumors >5 cm.
    T3b Single tumor or multiple tumors of any size involving a major branch of the portal vein or hepatic vein.
    T4 Tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum.

    Table 2. Regional Lymph Nodes (N)a

    a Reprinted with permission from AJCC: Liver. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual, 7th ed. New York, NY: Springer, 2010, pp 191-9.
    NX Regional lymph nodes cannot be assessed.
    N0 No regional lymph node metastasis.
    N1 Regional lymph node metastasis.

    Table 3. Distant Metastasis (M)a

    a Reprinted with permission from AJCC: Liver. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual, 7th ed. New York, NY: Springer, 2010, pp 191-9.
    M0 No distant metastasis.
    M1 Distant metastasis.
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