The BCLC staging system
The BCLC staging system looks at the number and size of tumours in the liver and at how well you are overall (your performance status - PS), as well as your liver function. To assess this, doctors usually use the Child-Pugh score (see below).
There are 5 stages to the BCLC staging system.
Stage 0 (Very early stage)
This means the tumour is less than 2cm, you feel well (PS 0) and your liver is working normally (Child-Pugh A).
Stage A (Early stage)
This means there is a single tumour of any size, or up to 3 tumours all less than 3 cm. You feel well and are active (PS 0), and your liver is working well (Child-Pugh A or B).
Stage B (Intermediate Stage)
This means there are many tumours in the liver, but you feel well (PS 0) and your liver is working well (Child-Pugh A or B).
Stage C (Advanced stage)
This means the cancer has spread into the blood vessels, lymph nodes or other body organs. Or you do not feel well and are less active (PS 1 or 2). Your liver is still working well. (Child-Pugh A or B).
Stage D
This means you have severe liver damage (Child-Pugh C), or you are not well and need help in being looked after (PS 3 or 4).
The Child-Pugh system
The Child-Pugh system 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
Performance status (PS)
Performance status (PS) is a scale to grade how well you are. The BCLC staging system 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
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