Page views in 2022: 2,948
Page views in 2023 to date: 1,416
Cite this page: Gonzalez R. Staging-hepatocellular carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/livertumorstaging.html. Accessed June 6th, 2023.
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
ICD 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
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 style question #1
Using AJCC 8th edition criteria, the presence of vascular invasion in a hepatocellular carcinoma > 2 cm upstages the tumor in what way?
- pT1a to pT1b
- pT1b to pT2
- pT2 to pT3
- pT3 to pT4
Board review style answer #1
Back to top
