Liver and intrahepatic bile ducts - tumor
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TNM staging of hepatocellular carcinomas (AJCC 8th edition)

Author: Raul S. Gonzalez, M.D. (see Authors page)
Deputy Editor Review: Debra Zynger, M.D.

Revised: 16 July 2018, last major update July 2018

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: TNM staging[TIAB] hepatocellular carcinoma[TI] full text[sb]

Cite this page: Gonzalez, R.S. TNM staging of hepatocellular carcinomas (AJCC 8th edition). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/livertumorstaging.html. Accessed July 20th, 2018.

Pathologic TNM staging of hepatocellular carcinomas, AJCC 8th edition
Definition / general
  • Hepatocellular carcinomas (including fibrolamellar carcinoma) are covered by this staging system
  • Not covered by this staging system are intrahepatic cholangiocarcinomas or combined hepatocellular cholangiocarcinomas (use the intrahepatic bile duct tumors staging system instead)
  • Hepatoblastoma is not staged using AJCC criteria
Essential features
ICD-10 coding
  • C22.0: Liver cell carcinoma
Primary tumor (pT)
  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • T1: Solitary tumor ≤ 2 cm or > 2 cm without vascular invasion
    • T1a: Solitary tumor ≤ 2 cm (with or without vascular invasion​)
    • T1b: Solitary tumor > 2 cm without vascular invasion
  • T2: Solitary tumor > 2 cm with vascular invasion or multiple tumors, none > 5 cm
  • T3: Multiple tumors, at least one of which is > 5 cm
  • T4: Tumor involves a major branch of the portal vein or hepatic vein or tumor directly invades adjacent organs other than the gallbladder or tumor perforates the visceral peritoneum
Regional lymph nodes (pN)
  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Regional lymph node metastasis

  • Notes: Regional lymph nodes include hilar, hepatoduodenal ligament, inferior phrenic and caval lymph nodes
Distant metastasis (pM)
  • M0: No distant metastasis
  • M1: Distant metastasis
Prefixes
  • y: Preoperative radiotherapy or chemotherapy
  • r: Recurrent tumor stage
Stage grouping
Stage IA: T1a N0 M0
Stage IB: T1b N0 M0
Stage II: T2 N0 M0
Stage IIIA: T3 N0 M0
Stage IIIB: T4 N0 M0
Stage IVA: any T N1 M0
Stage IVB: any T any N M1
Registry data collection variables
  • Alpha fetoprotein (AFP)
  • Fibrosis score
  • Hepatitis serology
  • Creatinine (part of the Model for End Stage Liver Disease [MELD] score)
  • Bilirubin (part of the MELD score)
  • Prothrombin time (international normalized ratio [INR]; part of the MELD score)
Histopathologic type
  • Hepatocellular carcinoma
  • Fibrolamellar carcinoma
  • Scirrhous hepatocellular carcinoma
  • Sarcomatoid hepatocellular carcinoma
Board review question #1
Using AJCC 8th edition criteria, the presence of vascular invasion in a hepatocellular carcinoma > 2 cm upstages the tumor in what way?

  1. pT1a to pT1b
  2. pT1b to pT2
  3. pT2 to pT3
  4. pT3 to pT4
Board review answer #1
B. pT1b to pT2