Stage 3 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.
Primary liver cancer is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases.
Staging systems
Doctors use different systems to stage liver cancer. This page is about stage 3 cancer, which is part of the number staging system. This system has 4 stages, stage 1 to stage 4.
This page also tells you what stage 3 means in the TNM system. This system describes:
- the size of the primary tumour (T)
- whether the cancer has spread to the
lymph nodes (N) - whether the cancer has spread to another part of the body (M)
What is stage 3 liver cancer?
Stage 3 liver cancer hasn’t spread to the lymph nodes or any distant body parts. It is divided into stage 3A and stage 3B.
Stage 3A means there are two or more tumours. At least one of them is larger than 5cm. In TNM staging this is the same as T3, N0, M0.
Stage 3B means the cancer has grown into one of the main blood vessels of the liver (the portal vein or hepatic vein).
Or it has spread into organs close to the liver (not including the gallbladder), or through the lining that wraps around the internal organs of the abdomen (the visceral peritoneum).
Stage 3B liver cancer is the same as T4, N0, M0 in the TNM staging system.
Other staging systems
The number and TNM staging systems describe the size and position of liver cancer. However, people with liver cancer often have scarring of the liver (cirrhosis). So doctors also need a system that describes how well your liver is working and your health (your performance status). Then they can decide what treatment would be best. For this, doctors use a system called the Barcelona Clinic Liver Cancer (BCLC) strategy.
Treatment for stage 3 liver cancer
The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:
- where the cancer is
- how well your liver is working
- your general health, level of fitness and cancer related symptoms
The treatments for stage 3 include:
Embolisation treatment
Embolisation is a treatment that blocks or reduces the blood supply to the cancer.
You might have trans arterial embolisation (TAE) to cut off the blood supply to the cancer. Your doctor does this by injecting a substance such as a gel or tiny beads to block the liver's blood supply.
Some people have chemotherapy directly to the area of your liver that contains the cancer before the blood supply is blocked. This is called chemoembolisation or trans arterial chemoembolisation (TACE).
You usually have this treatment if you can't have surgery, or to help control the cancer while you are waiting for a liver transplant. Or you may have this treatment to shrink a tumour so that it then becomes small enough to remove with surgery.
Targeted and immunotherapy cancer drugs
Targeted drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. They are called immunotherapies.
You might have a combination of these drugs, or treatment with a single drug. Examples include:
- atezolizumab and bevacizumab
- sorafenib
- lenvatinib
Surgery to remove part of your liver
Depending on the size of the cancer and where it is in your liver, you might be able to have surgery to remove part of your liver (liver resection). The rest of your liver must be working well.
Selective internal radiotherapy (SIRT)
SIRT is a type of internal radiotherapy that uses radioactive beads. The beads get stuck in the small blood vessels in and around the cancer. Then the radiation destroys the cancer cells.
Stereotactic ablative radiotherapy (SABR)
SABR is also called stereotactic body radiotherapy (SBRT) or stereotactic radiotherapy. It is a type of external targeted radiotherapy. The tumour gets a high dose of radiation to kill cancer cells. But the tissues near the tumour only get a low dose of radiation which lowers the risk of side effects.
Treating symptoms
You can also have other treatments to control specific symptoms such as sickness and pain.
Research and clinical trials
Researchers are always trying to improve the treatment and quality of life for people with liver cancer.
