Liver cancer (BCLC staging)
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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:
- performance status (PS)
- Child-Pugh score
-
radiologic tumour extent
- tumour size
- multiple tumours
- vascular invasion
- nodal spread and extrahepatic metastases
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
- if other clinical comorbidities, radiofrequency ablation is then recommended
- asymptomatic early tumours
- 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
, transplantationis then recommended
-
usually,
- asymptomatic early tumours
- 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)
- asymptomatic
- stage C (advanced stage)
- symptomatic tumours and
/orinvasivetumoursand/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
- symptomatic tumours and
- 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
-
terminal stage
-<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 > 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 > 2</li>
- +<li>Child-Pugh C</li>
- +<li>it is not a radiological stage, only clinical</li>
- +</ul>
- +</li>
- +<li>symptomatic treatment only</li>