Liver cancer (BCLC staging)

Changed by Bruno Di Muzio, 20 Feb 2018

Updates to Article Attributes

Body was changed:

Barcelona clinic liver cancer (BCLC) staging uses a set of criteria to guide management of patients with hepatocellular carcinoma (HCC).

The classification takes the following variables into account 1,2:

The classification system sorts patients into one of four categories:

  • stage 0 (very early stage)
    • asymptomatic early tumours
      • PS 0
      • Child-Pugh A
      • solitary lesion measuring less than 2 cm in diameter
    • management
      • resection
      • if portal hypertension/hyperbilirubinaemia, transplant is then recommended  
  • stage A (early stage)
    • asymptomatic early tumours
      • PS 0-2
      • resectionChild-Pugh A to C
      • solitary lesion > 2 cm or early multifocal disease characterised by up to 3 lesions measuring less than 3 cm
    • management
      • usually, percutaneousresection is viable for single lesions  
      • if multiple lesions, transplant is then recommended  
      • if other clinical comorbidities are present, radiofrequency ablation, transplantation is then recommended   
  • stage B (intermediate stage)
    • asymptomatic multinodular tumoursmultifocal disease 
      • PS 0
      • intra-arterial therapies (chemoembolisation and radioembolisationChild-Pugh A to C
      • multifocal disease: more than one lesion with at least one over 3 cm, or more than 3 lesions regardless their size
    • management is usually recommended with transcatheter arterial chemoembolisation (TACE)
  • stage C (advanced stage)
    • symptomatic tumours and/or invasive tumoursand/or metastatic disease
      • PS 1-2
      • Child-Pugh A to C
      • vascular invasion and/or nodal disease and/or metastatic disease
    • management is usually palliative: sorafenib, phase II trial agents, or other palliative treatments
  • stage D (end-stage disease)
    • terminal stage
      • PS > 2
      • Child-Pugh C
      • it is not a radiological stage, only clinical
    • symptomatic treatment only
    • equivalent to Okuda stage III
  • -<li><a href="/articles/ecog-performance-status">performance status</a></li>
  • +<li>
  • +<a href="/articles/ecog-performance-status">performance status (PS)</a> </li>
  • +<li>radiologic tumour extent<ul>
  • +</ul>
  • +</li>
  • -<li>asymptomatic early tumours</li>
  • +<li>asymptomatic early tumours<ul>
  • +<li>PS 0</li>
  • +<li>Child-Pugh A</li>
  • +<li>solitary lesion measuring less than 2 cm in diameter</li>
  • +</ul>
  • +</li>
  • +<li>management<ul>
  • +<li>if portal hypertension/hyperbilirubinaemia, transplant is then recommended  <ul><li>if other clinical comorbidities, <a href="/articles/radiofrequency-ablation">radiofrequency ablation</a> is then recommended  </li></ul>
  • +</li>
  • +</ul>
  • +</li>
  • -<li>asymptomatic early tumours</li>
  • -<li>resection, percutaneous ablation, transplantation</li>
  • +<li>asymptomatic early tumours<ul>
  • +<li>PS 0-2</li>
  • +<li>Child-Pugh A to C</li>
  • +<li>solitary lesion &gt; 2 cm or early multifocal disease characterised by up to 3 lesions measuring less than 3 cm</li>
  • +</ul>
  • +</li>
  • +<li>management<ul>
  • +<li>usually, resection is viable for single lesions  </li>
  • +<li>if multiple lesions, transplant is then recommended  </li>
  • +<li>if other clinical comorbidities are present, <a href="/articles/radiofrequency-ablation">radiofrequency ablation</a> is then recommended   </li>
  • +</ul>
  • +</li>
  • -<li>asymptomatic multinodular tumours</li>
  • -<li>intra-arterial therapies (chemoembolisation and radioembolisation)</li>
  • +<li>asymptomatic multifocal disease <ul>
  • +<li>PS 0</li>
  • +<li>Child-Pugh A to C</li>
  • +<li>multifocal disease: more than one lesion with at least one over 3 cm, or more than 3 lesions regardless their size</li>
  • +</ul>
  • +</li>
  • +<li>management is usually recommended with <a href="/articles/transcatheter-arterial-chemoembolisation">transcatheter arterial chemoembolisation (TACE)</a>
  • +</li>
  • -<li>symptomatic tumours and/or invasive tumours</li>
  • -<li>sorafenib, phase II trial agents, or palliative treatments</li>
  • +<li>symptomatic tumours and invasive and/or metastatic disease<ul>
  • +<li>PS 1-2</li>
  • +<li>Child-Pugh A to C</li>
  • +<li>vascular invasion and/or nodal disease and/or metastatic disease</li>
  • +</ul>
  • +</li>
  • +<li>management is usually palliative: sorafenib, phase II trial agents, or other palliative treatments</li>
  • -<li>symptomatic treatment</li>
  • +<li>terminal stage<ul>
  • +<li>PS &gt; 2</li>
  • +<li>Child-Pugh C</li>
  • +<li>it is not a radiological stage, only clinical</li>
  • +</ul>
  • +</li>
  • +<li>symptomatic treatment only</li>

ADVERTISEMENT: Supporters see fewer/no ads

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.