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Staging is a process used by doctors to determine the extent of spread of a cancerous tumor. Staging plays an important role in determining the treatment options for many types of cancers, including liver cancer. For example, if the results of the staging tests indicate that you have early-stage liver cancer that is localized to a small area of the liver but the rest of the liver is not affected by the cancer, the doctor will most likely recommend surgical resection to remove the cancerous portion of the liver. If, on the other hand, the results of staging indicate that the cancer has spread throughout the liver or has metastasized (spread) to other organs in the body, this is considered to be an advanced-stage of liver cancer that cannot be removed by surgery (nonresectable liver cancer) and other treatment options will have to be considered.

Staging also provides useful information regarding the prognosis (chances of recovery) for the disease. In general, patients with early-stage, localized liver cancer where the tumor can be removed by surgery (resectable liver cancer) have a better prognosis than patients with advanced-stage liver cancer where the tumor has spread throughout the liver or has metastasized to other organs outside the liver.

Although well-defined and generally accepted staging systems exist for most types of cancers, unfortunately, this is not the case for hepatocellular carcinoma. Because of wide variations of the tumor characteristics and liver function among patients with liver cancer, currently there is no single staging system for liver cancer that is universally accepted and used by doctors around the world. Of the various staging systems that have been developed for hepatocellular carcinoma, the Child-Pugh Staging (CPS) system is, perhaps, the one that is used most frequently. The CPS system evaluates the extent of liver damage (residual liver function) in patients with cirrhosis of the liver by measuring five different factors:

• Serum bilirubin levels
• Serum albumin levels
• Prothrombin time - a test used to measure how long it takes for blood to clot.
• Presence of ascites - abnormal accumulation of fluid in the abdomen
• the presence of hepatic encephalopathy - This condition refers to damage to the central nervous system (brain and spinal cord) that occurs in some patients with liver failure. Symptoms include changes in consciousness which can range from mild (e.g., confusion) to severe (e.g., coma).

Based on the results of the CPS staging system scores, patients with liver cancer are grouped into one of the following risk categories:

• Class A - low risk group
• Class B - intermediate risk group
• Class C - high risk group

In general, the prognosis for patients in the CPS Class A group is better than for patients in either the CPS Class B or CPS Class C groups.