Liver & intrahepatic bile ducts


Staging-hepatocellular carcinoma

Editor-in-Chief: Debra L. Zynger, M.D.
Raul S. Gonzalez, M.D.

Last author update: 10 December 2020
Last staff update: 7 May 2021

Copyright: 2002-2023,, Inc.

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

Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez R. Staging-hepatocellular carcinoma. website. 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
Essential features
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
Distant metastasis (pM)
  • M0: No distant metastasis
  • M1: Distant metastasis
  • 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?

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