Liver Cancer: Prognosis and Survival Rates

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Liver cancer is one of the deadliest cancers in the world: It’s estimated that more than 700,000 people die from the disease each year. In the United States alone, over 20,000 men and over 9,000 women will lose their lives to liver cancer in 2021. The incidence of liver cancer has also tripled in the past three decades, with the number of deaths from the disease doubling in that same time frame.

Although this may sound alarming to those who have been diagnosed with liver cancer, survival rates are an average and vary from person to person depending on a variety of factors. Receiving the right treatment could help a person with liver cancer live a long and full life.

Doctor using digital tablet to talk to senior man

Ariel Skelley / Getty Images

Staging

The stage of liver cancer depends on whether it has spread from its original location in the liver. Staging also depends on how much cancer is in the body. Determining what stage the cancer is at will help doctors decide the severity as well as treatment options. It also plays a role in calculating survival rates. Cancer affects people differently since each person is unique, but the stages can be used to determine survival rates because people with a specific stage of liver cancer tend to have similar outlooks and courses of treatment.

Liver cancer stages range from stage 1 through 4. The lower the number, the less the cancer has spread. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

The system most often used to determine stages in the United States is the American Joint Committee on Cancer (AJCC) TMN system. TNM stands for:

  • T: The extent and size of the tumor. Doctors will look at how large the cancer growth is, how many growths there are, and if it has reached the surrounding structures of the liver. 
  • N: How far it has spread to the nearby lymph nodes.
  • M: Whether the liver cancer is metastasizing, or spreading to sites outside of the liver, such as the bones or lungs.

The severity of the cancer is taken into account when using the TNM system, and each letter is typically followed by another letter or number that provides more details on the specific factors. A higher number means the cancer is more advanced. This then leads to a process known as stage grouping, where the letters and numbers are combined to determine a final stage.

Using this staging system, liver cancer can be categorized into seven stages.

Liver Cancer Stages
 AJCC Stage  Stage Grouping  Stage Description
IA  T1a
N0
M0
A single tumor that is 2 cm (4/5 inch) or smaller and hasn’t grown into blood vessels (T1a).
 
Since it has not spread to nearby lymph nodes or distant sites, both N and M are 0.
 IB T1b
N0
M0
Characterized as a single tumor that is larger than 2 cm or 4/5 inch and hasn’t grown into blood vessels (T1b).
 
This cancer has not yet spread to distant sites (M0) or nearby lymph nodes (N0). 
 II T2
N0
M0
Either a single tumor that is larger than 2 cm or 4/5 inches and has grown into surrounding blood vessels, or more than one tumor but none larger than 5 cm, or 2 inches, across (T2).
 
In this stage, the cancer has also not spread to the lymph nodes or distant sites (N0 and M0). 
 IIIA T3
N0
M0
More than one tumor, with one or more being larger than 5 cm across (T3).
 
In this stage, there is no spread to the lymph nodes or distant sites (N0 and M0). 
 IIIB T4
N0
M0
At least one tumor that has grown into a large vein of the liver, commonly the hepatic or portal vein (T4).
 
It has not yet spread to nearby lymph nodes (N0) or distant sites (M0). 
 IVA Any T
N1
M0
Either one or multiple tumors of any size (any T) that have spread to the nearby lymph nodes (N1) but not yet to distant sites (M0).
 IVB Any T
Any N
M1
A single or multiple tumors of any size (any T) that have spread to distant organs such as the lungs or bones (M1). It may or may not have spread to nearby lymph nodes during this stage (any N).

Stage 4 Liver Cancer

Stage 4 liver cancer may have a low survival rate, but new treatments continue to be developed and can help improve survival rates. Treatments such as immunotherapy and targeted drugs have advanced to the point where patients with previously inoperable liver cancer or those who didn’t qualify for liver transplantation may see a change in tide following one of the newer forms of treatment.

Prognosis

The SEER database is used to keep track of different survival rates, but their staging system is slightly different. SEER stages cancers by three different characteristics: localized, regional, and distant.

Stages IA, IB, II, and IIIA in the TNM system can be classified as localized since there has been no spread to the lymph nodes or other organs. Stages IIIB and IVA are categorized as regional because it has spread to structures outside of the liver such as veins but not to distant sites. Finally, stage IVB falls under the category of distant because the cancer has spread to other parts of the body.

The relative five-year survival rate for liver cancer is 19.6%, but that rate can differ by stage. When that is broken down into stages, the number can change drastically. This is because when liver cancer is caught early, the survival outlook is much higher than if it is caught in its latest stages. The survival rates for liver cancer by stage are as follows.

Liver Cancer Survival Rates
 SEER Stage  Five-Year Relative survival rate
 Localized   34%
 Regional   12%
 Distant   3%

Survival rates are based on historical data and may therefore not reflect the rates as they are today because they do not take into account the advancements in treatment options.

Liver Cancer Demographics

Prognosis will also depend on other factors such as sex, race, or geographical location. For example, men have a higher incidence and death rate when it comes to liver cancer compared with women. Those of Asian or Pacific Islander descent also have the highest incidence among all races, with those of European, Middle Eastern American, or North African American ethnicity seeing the lowest incidence.

When it comes to geographical location, liver cancer is much more common in Southeast Asia and sub-Saharan Africa compared with the United States. Age is also a factor when looking at liver cancer incidence. Men over the age of 65 and women over the age of 75 are at highest risk of liver cancer.

The statistics of the relative five-year survival rates for liver cancer do not include other types of cancer that may have metastasized to the liver.

Coping

When dealing with a liver cancer diagnosis, one important thing to take into consideration is the stage at which you are diagnosed. At the earliest stage of liver cancer, the prognosis is significantly better than that at any other stage. Other factors that should be taken into consideration is how healthy your liver is otherwise, how well you do with day-to-day activities, and how many tumors there are. Those with more than one tumor may have a less favorable prognosis than those with only one localized tumor.

For those dealing with late-stage liver cancer, prognosis and outlook may not be as positive as those with stage I or II liver cancer, but it is important to find support to help deal with treatment. Joining a support group may help you cope with the emotional turmoil that is inevitable when dealing with later-stage liver cancer. The American Cancer Society website has a directory of cancer support groups to help you find one in your local area.

Advanced-stage liver cancer is likely to be treated with immunotherapy, radiation therapy, or targeted therapy. There are also new therapies being developed that may help increase the efficacy of current treatments.

There are also ways to improve your quality of life so that you can feel better physically and mentally. Coping can be difficult at any stage, but there are a lot of options available to you so that no matter what your prognosis is, you can handle it accordingly.

A Word From Verywell

Being told that you have liver cancer can change your entire world. The initial shock will settle eventually, and when you begin looking at the big picture, dealing with the diagnosis will seem a lot easier. It’s important that you take things one day at a time and learn everything there is to know about your cancer, prognosis, and what you can do to feel good while going through treatment. Liver cancer is a difficult thing to deal with, but with the right treatment, support, and outlook, you can handle your diagnosis with ease.

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