LIVER – HEPATOCELLULAR CARCINOMA (ICD‐O‐3 C22.0)

Rules for Classification

The classification applies only to hepatocellular carcinoma.

Cholangio‐ (intrahepatic bile duct) carcinoma of the liver has a separate classification (see Liver – Intrahepatic Bile Ducts). There should be histological confirmation of the disease.

Note

Although the presence of cirrhosis is an important prognostic factor, it does not affect the TNM classification, being an independent prognostic variable.

Regional Lymph Nodes (Fig. 199)

The regional lymph nodes are the hilar, hepatic (along the proper hepatic artery), periportal (along the portal vein), inferior phrenic and caval nodes.

Schematic illustration of Lymph nodes along the
abdominal vena cava
above the renal vein. — **Fig. 199**

TNM Clinical Classification

T – Primary Tumour

TX	Primary tumour cannot be assessed
T0	No evidence of primary tumour
T1a	Solitary tumour less than or equal to 2 cm in greatest dimension with or without vascular invasion (Fig. 200)
T1b	Solitary tumour more than 2 cm in greatest dimension without vascular invasion
T2	Solitary tumour with vascular invasion or multiple tumours, none more than 5 cm in greatest dimension (Figs. 201, 202)
T3	Multiple tumours any more than 5 cm in greatest dimension (Fig. 203)
T4	Tumour(s) involving a major branch of the portal or hepatic vein or with direct invasion of adjacent organs (including the diaphragm), other than the gallbladder, or with perforation of visceral peritoneum (Figs. 204, 205)

Schematic illustration of Solitary tumour less than or equal to 2 cm in greatest dimension with or without vascular invasion. — **Fig. 200**

Schematic illustration of Solitary tumour with vascular invasion or multiple tumours, none more than 5 cm in greatest dimension. — **Fig. 201**

N – Regional Lymph Nodes

NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis (Fig. 206)

Schematic illustration of Multiple tumours any more than 5 cm in greatest dimension. — **Fig. 203**

Schematic illustration of tumour(s) involving a major branch of the portal or hepatic vein or with direct invasion of adjacent organs, other than the gallbladder, or with perforation of visceral peritoneum. — **Fig. 204**

Schematic illustration of tumour(s) involving a major branch of the portal or hepatic vein or with direct invasion of adjacent organs (including the diaphragm), other than the gallbladder, or with perforation of visceral peritoneum. — **Fig. 205**

Schematic illustration of Regional lymph node metastasis. — **Fig. 206**

M – Distant Metastasis

M0	No distant metastasis
M1	Distant metastasis

TNM Pathological Classification

The pT and pN categories correspond to the T and N categories.

pM1	Distant metastasis microscopically confirmed

Note

pM0 and pMX are not valid categories.

pN0

Histological examination of a regional lymphadenectomy specimen will ordinarily include 3 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.