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Staging of liver cancer

TNM Classification

The TNM system describes the extent of the disease at the time of diagnosis. "T" describes the extent of the local tumor. "N" expresses whether there are metastases to lymph nodes. "M" expresses metastasis.

The TNM classification differentiates between clinical classification (TNM) and the pathology classification (pTNM).

This classification is intended primarily for hepatocellular carcinoma (HCC). It can also be used for intrahepatic cholangiocarcinoma (IHCC).

Primary Tumor (T)

  • TX – primary tumor cannot be assessed
  • T0 – no evidence of primary tumor


  • T1 – solitary tumor without vascular invasion.
  • T2 – solitary tumor with vascular invasion; or multiple tumors none more than 5 cm in greatest dimension.


  • T3 – multiple tumors more than 5 cm or tumor involving a major branch of the portal or hepatic vein(s).
  • T4 – tumor(s) with direct invasion of other organs other than gallbladder or with perforation of visceral peritoneum. 

Regional lymph nodes (N)

  • NX – regional lymph nodes cannot be assessed
  • N0 – no regional lymph node metastasis
  • N1 – regional lymph node metastasis

Metastasis (M)

  • MX – metastasis cannot be assessed
  • M0 – no metastasis
  • M1 – metastasis


Stage Division

Stage I

Stage II 

Stage III

Stage IV

T1 N0 M0


     A   B  C

   T1–4 NX–1 M1


T2 N0 M0



T3 N0 M0



T4 N0 M0



T1–4 N1 M0



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