Stages of liver cancer

BCLC strategy and the Child-Pugh score for liver cancer

The stage of liver cancer tells you how big it is and whether it has spread to other parts of the body. This helps your doctor recommend the best treatment for you.

There are different staging systems that doctors can use for liver cancer. One of these is the Barcelona Clinic Liver Cancer (BCLC) strategy. The BCLC looks at:

the number and size of tumours in your liver
your general health and fitness - this is called your performance status or PS
your levels of a tumour marker called alpha fetoprotein (AFP)
how well your liver is working (liver function) including a system called the Child-Pugh score

The BCLC strategy is for staging . HCC is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases.

Find out about secondary liver cancer

Performance status (PS)

Performance status (PS) is a scale to grade how well you are, your cancer related symptoms, and what activities you are able to do. The BCLC strategy uses the Eastern Cooperative Oncology Group (ECOG) scale:

PS 0 – you are fully active, more or less as you were before your illness
PS 1 – you can’t carry out heavy physical work, but can do anything else
PS 2 – you are up and about more than half the day. You can look after yourself but can’t work
PS 3 – you are in bed or a chair for more than half the day. You need help to look after yourself
PS 4 – you are in bed or a chair all the time and need complete care

How well your liver is working

When deciding on treatment your doctor has to think about how well your liver is working. This is especially the case if you have liver damage (cirrhosis). Unfortunately, people with severe liver damage may be too unwell to have treatment for their cancer.

Your doctor can use different tests to find out how well your liver is working. These include:

testing the amount of albumin and bilirubin in your blood (ALBI score)
tests of how well you kidneys and liver are working together (MELD score)
looking at liver tests and symptoms together (Child-Pugh score)

The Child-Pugh score

The Child-Pugh score looks at the following 5 things that tell how well the liver is working:

bilirubin levels in the blood
albumin levels in the blood (albumin is a protein made by the liver)
how quickly the blood clots (prothrombin time)
if there is fluid in the abdomen (ascites)
if the liver disease is affecting brain function (encephalopathy)

Each one is given a number score, and based on that score, people fall into 1 of 3 classes:

class A means the liver is working normally
class B means mild to moderate damage
class C means there is severe liver damage - unfortunately you may be too sick to have treatment for the cancer

The BCLC strategy

There are 5 stages to the BCLC strategy:

Stage 0

This means there is 1 tumour which is is less than 2cm. You feel well (PS 0) and your liver is working normally.

Stage A

This means there are up to 3 tumours all less than 3 cm. You feel well (PS 0), and your liver is working well.

Stage B

This means there are many tumours in the liver, but you feel well (PS 0) and your liver is working well.

Stage C

This means the cancer has spread into the blood vessels, or other body organs. You do not feel well and are less active (PS 1 or 2) but your liver is still working well.

Stage D

The tumour can be any size. You have severe liver damage, or you are not well and need help to look after yourself (PS 3 or 4).

Treatment options

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

where the cancer is in your liver
other health conditions
your wishes

For cancer that is only in the liver, it might be possible to remove it with surgery. This might be surgery to remove part of your liver (liver resection) or a liver transplant.

You might have a local treatment into your liver if you can't have surgery. This could be:

radiofrequency ablation (RFA) or microwave ablation (MWA)
chemoembolisation (TACE) or embolisation (TAE)
selective internal radiotherapy (SIRT)
stereotactic ablative radiotherapy (SABR)

For liver cancer that has spread you might have targeted or immunotherapy drugs.

If you have severe liver damage, you are usually too unwell to have treatment for your cancer. But your doctor will give you different treatments to help control your symptoms.

Other stages

Last reviewed: 25 Mar 2025

Next review due: 24 Mar 2028

Stages of liver cancer

The stage of a cancer tells you how big it is and how far it’s spread. It helps your doctor decide which treatment you need.

Types of liver cancer

There are different types of cancer that start in the liver. The most common type is hepatocellular carcinoma (HCC).

Treatment for liver cancer

Your treatment for liver cancer depends on the stage of your cancer and how well your liver is working. The most common treatments are surgery, heat treatment, drug treatments and radiotherapy.

Living with liver cancer

There is support available to help you cope with a diagnosis of liver cancer, life during treatment and life after cancer.

Liver cancer main page

Primary liver cancer is cancer that started in the liver. This section is mainly about the most common type of liver cancer, hepatocellular carcinoma (HCC).