What are the new diagnosis and staging criteria for primary liver cancer?

In order to better help doctors detect the disease early, the Chinese Anti-Cancer Association Liver Cancer Professional Committee revised the "Clinical Diagnosis and Staging Standards for Primary Liver Cancer" in 2001. The original diagnostic standards for liver cancer have many shortcomings in clinical practice, and there have been many controversies about the discovery of patients' tumors. Japan, Europe and the United States also have their own liver cancer staging standards. The Chinese Anti-Cancer Association Liver Cancer Professional Committee took into account that the UICC standard can only be judged after obtaining a pathological examination, and there are not many liver cancer cases in my country that can be surgically removed or pathologically examined. Referring to the clinical staging schemes of various countries in the world combined with liver function conditions and considered, it formulated clinical diagnosis and staging standards suitable for my country's national conditions.

Staging Standards:

Liver function is Child A: the maximum diameter of a single tumor is ≤3cm, without cancer thrombus, abdominal lymph nodes and distant metastasis, or the sum of the maximum diameters of a single (or two) tumors is ≤5cm, in half the liver, without cancer thrombus, abdominal lymph nodes and distant metastasis.

Liver function is Child A or B: the sum of the largest diameters of a single or two tumors is greater than 10 cm in half the liver, or the sum of the largest diameters of two tumors is greater than 5 cm in the left and right hemilivers, or multiple tumors without cancer thrombus, abdominal lymph node liver function and distant metastasis are Child A; if there is portal vein branch, hepatic vein or bile duct cancer thrombus, it is Child B. Another situation is that regardless of the tumor condition, there is portal vein trunk or inferior vena cava cancer thrombus, abdominal lymph node or distant metastasis, which is Child A or B.

Liver function is Child C: regardless of the tumor condition, cancer thrombus, or metastasis.

Diagnostic criteria:

1. AFP ≥ 400 μg/L may also be caused by pregnancy or embryonic tumors of the reproductive system, active liver disease and metastatic liver cancer. In liver cancer testing, patients should be tested for enlarged, hard and nodular liver masses or for those with space-occupying lesions that are characteristic of liver cancer in imaging examinations.

2. Patients with AFP < 400 μg/L and two imaging examinations showing space-occupying lesions with characteristics of liver cancer, or patients with two positive liver cancer markers (DCP, GGTⅡ, AFU and CA19-9, etc.) and one imaging examination showing space-occupying lesions with characteristics of liver cancer, of course, must exclude pregnancy, germinal tumors of the reproductive system, active liver disease and metastatic liver cancer.

3. Patients with clinical manifestations of liver cancer and definite extrahepatic metastatic lesions (including bloody ascites visible to the naked eye or cancer cells found therein) and who can rule out metastatic liver cancer.

These new liver cancer staging and clinical diagnostic criteria are expected to effectively help timely diagnosis, allowing patients to receive early treatment so that they can be cured of liver cancer and live a healthy life.

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