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Liver Cancer - Stages and Types of Liver Cancer

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What Is Liver Cancer?

The liver is the largest internal organ and has several essential functions, including metabolism, detoxification, and the storage of various nutrients. Different types of cells in the liver perform these functions. These cells have predetermined division patterns based on the information present in the genes. At times, these cells may forego their designated functions and start dividing abnormally due to mutations, leading to the formation of a cancerous mass or tumor.

It is important not to ignore any symptoms that could possibly indicate liver carcinoma, as this condition needs prompt medical attention for effective management.

How common is Liver Cancer?

Liver cancer is one of the primary causes of cancer deaths globally. There has been a steady increase in the number of people diagnosed with and dying from this condition. Studies have suggested that various lifestyle factors contribute to this rise in the incidence rate.

Reports suggest that liver carcinoma is one of the most common cancer types, with the male-female ratio for hepatocellular carcinoma standing at 4:1 and the age of presentation spanning from 40 to 70.

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What are the Different Types of Liver Cancer?

There are various types of liver cancer, depending on the type of cell from which it arises. Of all the types of liver cancer, hepatocellular carcinoma is the most common.


Primary Liver Cancers

Hepatocellular Carcinoma (HCC)

HCC occurs in the cells of the liver (hepatocytes). The condition is also called hematoma and is the most common type of liver cancer. It accounts for almost 75% of all liver cancers and about 85 to 90% of all primary liver cancers. Patients with cirrhosis and chronic hepatitis have an increased risk for HCC.

Cholangiocarcinoma (Bile Duct Cancer)

This is an aggressive form of liver carcinoma that develops in the bile ducts of the liver. Cholangiocarcinoma may be intrahepatic or extrahepatic.



Other types of Liver Cancer

Hepatoblastoma

It is a rare tumor that occurs in the liver cells. It most commonly occurs in early childhood. Hepatoblastoma generally starts in the right lobe of the liver.

Fibrolamellar Carcinoma

It is a rare form of liver carcinoma that generally develops in teenagers and adults below the age of 40. The clinical findings and behavior of fibrolamellar carcinoma are significantly different from those of HCC.

Metastatic Liver Cancer

Metastatic liver cancer begins in the liver and spreads to other organs, such as the lungs. It is also referred to as advanced-stage liver carcinoma, which will often require a multimodal treatment approach. In these cases, the treatment goal is to prolong survival and improve the quality of life.

Angiosarcoma

Hepatic angiosarcoma is an aggressive liver carcinoma that develops in the lymphatic or blood vessels. Patients with angiosarcoma experience jaundice, abdominal pain, and fatigue.



What are the Liver Cancer Stages?

TNM Staging System


The TNM staging system assists oncologists in staging different cancers based on various criteria. It includes the extent of tumor (T), lymph node spread (N), and cancer metastasis (M).

The information obtained during TNM staging is used to assign a specific stage to each patient’s liver cancer case, where the stages 0, 1, 2, 3, and 4 (0, I, II, III, and IV) are used to indicate different stages of the disease. Stage 0 is often used to indicate precancerous lesions.


Stage 1

Stage 1 liver cancer is subdivided into Stage 1A and Stage 1B. In Stage 1A liver cancer, the liver tumor is ≤2 cm, has not grown into the blood vessels and has not spread to the lymph nodes. In Stage 1A liver cancer, the liver tumor is >2 cm, has not grown into the blood vessels, and has not spread to the lymph nodes.

Stage 2

Stage 2 liver cancer involves either a single liver tumor >2 cm in size that has grown into blood vessels OR two tumors, none larger than 5 cm. In both cases, the liver tumor does not spread to lymph nodes.

Stage 3

The patients with Stage 3A liver cancer have multiple tumors, of which one is ≥5 cm. The tumor does not spread to lymph nodes or distant sites. In stage 3B liver cancer, a tumor of any size grows into the major branch of the large liver vein. The cancer does not spread to lymph nodes or distant sites.

Stage 4

Patients with Stage 4A liver cancer have a tumor that would have spread to the nearby lymph nodes and not to distant sites. Patients with Stage 4B liver cancer have a tumor that has spread to distant sites, such as the lungs or bones. It may be referred to as end-stage liver cancer with a low survival rate.

Conclusion


Liver carcinoma develops in the liver. Primary liver cancer initiates in the liver, while secondary liver cancer (liver metastases) spreads to the liver from other organs. There are several types of liver cancer, such as hepatocellular carcinoma, cholangiocarcinoma, angiocarcinoma, and hepatoblastoma. The liver cancer stages are defined based on the TNM staging system.

Frequently Asked Questions

What is the most common type of liver cancer?

Hepatocellular carcinoma is the most common type of liver carcinoma and accounts for almost three-fourths of all liver cancers.

Any person can be affected by liver carcinoma. However, certain factors enhance the risk of liver carcinoma. These factors include chronic hepatitis, cirrhosis, non-alcoholic fatty liver disease, diabetes, excessive alcohol consumption, and inherited liver disease.

The survival rate of hepatocellular carcinoma depends on several factors, including the stage of diagnosis, patient age, response to treatment, underlying medical condition, and overall health. It has been estimated that patients with early-stage HCC had >70% survival at five years and <20% at five years in patients with advanced-stage HCC.

Patients with bile duct cancer do not experience pain during the early stages of the disease. However, as the disease progresses and the tumor becomes larger, they may experience pain. The intensity of bile duct cancer pain depends upon the characteristic of tumor growth, i.e., whether it grows into the nerves, surrounding organs, or blocks the bile duct.

Cholangiocarcinoma is the most aggressive liver cancer and is usually diagnosed in the advanced stage.

Yes, liver cancer is treatable. We have multiple advanced treatment approaches available today. Early-stage liver cancer has relatively better clinical outcomes than advanced-stage liver cancer.

Patients with fatty liver disease have a higher risk of liver carcinoma The risk further increases when fatty liver disease progresses to non-alcoholic steatohepatitis and liver cirrhosis. The accumulation of fat in the liver enhances the risk of liver cancer.

For patients in the final stages of liver cancer, doctors often recommend treatment to delay the disease progression or control cancer growth, provide relief from pain and other cancer-related discomfort, and help patients have a better quality of life. The treatment plan may mostly involve systemic therapies like immunotherapy, targeted therapy, or pain-relieving medications.