When it is clear from the liver biopsy that the diagnosis is liver cancer, then the question is how widespread the cancer is.
The physician cannot treat the patient until it is known, in which stage the cancer is, as each stage requires a different approach. This is why staging is so important and this might require yet some more testing using the tests already described. In particular it is important to know how big the original (primary) tumor is.
The physician needs to know whether it has spread within the liver, outside the liver into local lymph glands, further into lymph glands along the aorta or even further away with metastases in distant organs. Here is a brief summary how the staging is done (modified from Ref. 1, p.896) according to the TNM classification from the IUCC, which stands for International Union Against (contre= French for “against”) Cancer. TNM is explained by:T=tumor; N=lymph nodes; M=distant metastases).
Staging of liver cancer( TNM)
Stage:
I : tumor ‹ 2cm(=4/5″) in diameter, no lymph node metastases
II : like stage I, but vascular invasion; tumor › 2 cm(=4/5″) without vascular invasion; several smaller tumors ‹ 2 cm limited to one lobe without vascular invasion
III : like stage I or II, but with regional lymph node metastases; tumor › 2cm(=4/5″) with vascular invasion; several tumors limited to one lobe ‹ 2 cm(=4/5″) with vascular invasion; or several tumors limited to one lobe with or without vascular invasion
IVA : several tumors in more than one lobe; or tumors involve major branch of hepatic or portal veins
IVB : like stage IVA, but in addition distal metastases
As can be seen with stage I the tumor is very localized. This makes it ideal for surgical resection. Stage II is also localized, but only to one lobe or one of the 8 liver segments. This means that more invasive surgery should remove all of these tumors, provided the staging is correct and there is no hidden lymph node that would make it a stageIII and no hidden distant micrometastases that would make it stage IV.
Some of stage III and IVA classified patients may benefit from a liver transplant, but stage IVB patients have an extremely poor outlook. Any patient with liver cancer belongs into a larger center where the whole array of treatment options can be offered, the special tests for staging can be made and the patient can be fully informed about treatment options. Not everyone, even if offered a liver transplant, can undergo this huge procedure. But the patient needs to know what the alternatives are and how this affects the liver cancer survival rate.
References:
1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on Hepatobiliary Neoplasms.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on Hepatobiliary Neoplasms.
3. SA Hussain et al. Ann Oncol 2001 Feb;12(2):161-172.
4. M Nakamura et al. J Cell Physiol 2001 Jun;187(3):392-401.
5. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc
