Staging should use validated staging protocols such as the Barcelona Clinic Liver Cancer guidelines. Note that staging of both the liver disease and the tumour are important and independent parameters necessary to inform treatment planning and should be clearly documented in the patient’s medical record. Tumour staging typically involves a chest CT and bone scan to exclude lung and bone metastases respectively, in addition to a multiphase CT or MRI of the liver and abdomen.

Staging parameters include radiological imaging (tumour size, number and location of lesions, metastases and vascular invasion), Eastern Cooperative Oncology Group (ECOG) status and a liver function assessment using the Child–Pugh score or a similar scoring system. A volumetric assessment of any residual liver may help in treatment planning, particularly for a liver resection.

Where appropriate, patients should be screened for metastatic disease before treatment begins.

Visit the Cancer Institute New South Wales website for information about understanding the stages of cancer.