Stage Information for Adult Primary Liver Cancer
For purposes of treatment, patients with liver cancer are grouped into 1 of 3 groups: localized resectable, localized unresectable, or advanced disease. These groups are described with the following AJCC stage groupings:
Localized Resectable Adult Primary Liver Cancer
(Selected T1 and T2; N0; M0)
Localized resectable liver cancer is confined to a solitary mass in a portion of the liver, or a limited number of tumors confined to one lobe, that allows the possibility of complete surgical removal of the tumor with a margin of normal liver. Liver function tests are usually normal or minimally abnormal, and there should be no evidence of cirrhosis beyond Child class A or chronic hepatitis. Only a small percentage of liver cancer patients will prove to have such localized resectable disease. Preoperative assessment that includes 3-phase helical computed tomography and/or magnetic resonance scanning should be directed toward determining the presence of extension of tumor across interlobar planes, involvement of the hepatic hilus, or encroachment on the vena cava. A resected specimen should ideally contain a 1 cm margin of normal liver. Patients with cirrhosis and resectable tumors are also eligible for liver transplantation; if eligible, sometimes other measures are instituted until liver transplantation becomes available.
Localized and Locally Advanced Unresectable Adult Primary Liver Cancer
(Selected T1, T2, T3, and T4; N0; M0)
Localized and locally advanced unresectable liver cancer appears to be confined to the liver, but surgical resection of the entire tumor is not appropriate because of location within the liver or concomitant medical conditions (such as cirrhosis). These patients may be considered for liver transplantation.[2,3,4] For other patients, percutaneous or intraoperative radiofrequency ablation (RFA) or other forms of ablation of small (<3 cm) appropriately located tumors, or transarterial chemoembolization (TACE) may be options.
Advanced Adult Primary Liver Cancer
(Any T, N1 or M1)
Advanced liver cancer is present in both lobes of the liver or has metastasized to distant sites. Median survival is usually 2 to 4 months. The most common metastatic sites of hepatocellular cancer are the lungs and bone. Multifocal disease in the liver is common, particularly when cirrhosis or chronic hepatitis is present. Chemoembolization has been beneficial in selected patients who have no extrahepatic metastases.
- Mazzaferro V, Regalia E, Doci R, et al.: Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334 (11): 693-9, 1996.
- Llovet JM, Burroughs A, Bruix J: Hepatocellular carcinoma. Lancet 362 (9399): 1907-17, 2003.
- Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases.: Management of hepatocellular carcinoma. Hepatology 42 (5): 1208-36, 2005.
- Bruix J, Sherman M, Llovet JM, et al.: Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35 (3): 421-30, 2001.
- Pawlik TM, Reyes DK, Cosgrove D, et al.: Phase II trial of sorafenib combined with concurrent transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma. J Clin Oncol 29 (30): 3960-7, 2011.
- Tanaka K, Nakamura S, Numata K, et al.: The long term efficacy of combined transcatheter arterial embolization and percutaneous ethanol injection in the treatment of patients with large hepatocellular carcinoma and cirrhosis. Cancer 82 (1): 78-85, 1998.