After adult primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body.

The process used to find out if cancer has spread within the liver or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
• Doppler ultrasound: A type of ultrasound that uses differences in the ultrasound echoes to measure the speed and direction of blood flow.

The following stages are used for adult primary liver cancer:

Stage I

In stage I, there is one tumor and it has not spread to nearby blood vessels.

Pea, peanut, walnut, and lime show tumor sizes.

Stage II

In stage II, one of the following is found:

• one tumor that has spread to nearby blood vessels; or
• more than one tumor, none of which is larger than 5 centimeters.

Stage III

Stage III is divided into Stage IIIA, IIIB, and IIIC.

• In stage IIIA, one of the following is found:
  • more than one tumor larger than 5 centimeters; or
  • one tumor that has spread to a major branch of blood vessels near the liver.
• In stage IIIB, there are one or more tumors of any size that have either:
  • spread to nearby organs other than the gallbladder; or
  • broken through the lining of the peritoneal cavity.
• In stage IIIC, the cancer has spread to nearby lymph nodes.