Stage 4 liver cancer is when cancer spreads from your liver into lymph nodes or to distant organs and tissues. It can’t be cured, but treatments may help slow progression and manage symptoms.

Liver cancer is cancer that starts in your liver. The American Cancer Society estimates that 41,210 people in the United States will receive a diagnosis of liver cancer in 2023. Liver cancer rates have more than tripled since 1980.

Many liver cancers aren’t diagnosed until they’ve reached a later stage. Stage 4 is the most advanced stage of liver cancer. It happens when liver cancer has spread farther beyond your liver. Keep reading to learn more.

Generally speaking, stage 4 liver cancer is when liver cancer has spread farther from your liver. The Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute notes that 26% and 19% of liver cancers are diagnosed when they’ve already spread regionally and distantly, respectively.

The American Joint Committee on Cancer (AJCC) system is the staging system most commonly used for liver cancer in the United States. It stages liver cancer based on three factors:

  • Tumor (T): This is an assessment of how large the cancer is and if there are multiple tumors.
  • Lymph nodes (N): This notes whether or not the cancer has spread into your nearby lymph nodes.
  • Metastasis (M): This refers to whether or not the cancer has spread to your more distant lymph nodes or organs.

Within the AJCC system, stage 4 liver cancer is actually divided into two different categories:

Stage 4A liver cancer consists of:

  • a single tumor or multiple tumors of any size (any T)
  • cancer that has spread to your nearby lymph nodes (N1)
  • cancer that has not spread to your distant organs and tissues (M0)

Stage 4B liver cancer is classified as:

  • a single tumor or multiple tumors of any size (any T)
  • cancer that may or may not have spread to your nearby lymph nodes (any N)
  • cancer that has spread to your distant organs and tissues (M1)

When it has metastasized, liver cancer is more likely to spread to certain areas. These include your:

Is stage 4 liver cancer terminal?

Terminal cancer is cancer that can’t be treated into remission and leads to death. You may also see it referred to as end stage cancer.

While stage 4 liver cancer is often terminal, it can still be treated. Treatments for terminal liver cancer are aimed at prolonging your survival, managing your symptoms, and improving your quality of life.

The outlook for someone with stage 4 liver cancer is generally poor. The SEER database notes that the 5-year relative survival rates for liver cancer that has spread regionally or distantly are 14.3% and 3.5%, respectively.

Five-year survival rates are a measure of how many people with a certain type and stage of cancer are alive 5 years after they received the diagnosis. But while 5-year relative survival rates can be informative, they’re only statistics.

Survival rate statistics are based off of many people who have had a certain type and stage of cancer over many years. As such, they don’t take into account newer advances in treatment or individual factors like age and overall health.

The various factors that can play a role in the outlook for someone with stage 4 liver cancer are:

Stage 4 liver cancer can’t be cured. Instead, treatment aims to:

  • slow the cancer’s progression
  • prolong your survival
  • manage your symptoms
  • improve your quality of life

Because stage 4 liver can’t be removed using surgery, the treatments used are systemic. Systemic treatments are those that work throughout your body.

The systemic treatments that may be used for stage 4 liver cancer are targeted therapy and immunotherapy. Let’s explore these now.

Targeted therapy

Targeted therapy specifically targets markers on the liver cancer cells. Drugs that may be used at first include sorafenib (Nexavar) or lenvatinib (Lenvima). If these aren’t effective, other targeted therapy drugs that may be recommended are:

  • cabozantinib (Cabometyx)
  • regorafenib (Stivarga)
  • ramucirumab (Cyramza)

Immunotherapy

Immunotherapy, which helps your immune system to respond to your cancer, may also be an option. Examples of immunotherapy drugs or drug combinations that may be used are:

Clinical trials

It’s also possible that your care team may recommend that you participate in a clinical trial. Clinical trials test the safety and effectiveness of new treatments before they become more widely available.

Find more information on National Cancer Institute-supported clinical trials for liver cancer here.

Stage 4 liver cancer is the most advanced stage of liver cancer. It’s divided up into two different categories: stage 4A and 4B.

While stage 4 liver cancer can’t be cured, it can be treated. Treatment for stage 4 liver cancer typically involves the use of systemic treatments like targeted therapy and immunotherapy.

The outlook for someone with stage 4 liver cancer is generally poor, but each person with cancer is different. Your care team can give you a better idea of your outlook based on individual factors like your liver function, age, and overall health.