A cancer’s “stage” is a description of how much cancer is in the body. Fibrolamellar carcinoma is staged like other primary liver cancers, with cancer stages ranging from stage I through IV. In general, the lower the stage number, the less the cancer has grown or spread. Liver cancer staging is based on the results of physical exams, imaging tests and biopsies or the examination of tissue removed during surgery. There are several different staging systems used for liver cancers like FLC. In the United States, the staging system most often used is the TNM system, developed by the American Joint Committee on Cancer (AJCC).  This system is based on three primary factors: T (tumor) – a description of the number and size of the liver tumors N (node) - whether the cancer is present in a patient's nearby lymph nodes M (metastasis) – if the cancer has spread to distant parts of the patient's body. Using this system, the following stages are determined: Stage I - A single primary tumor of any size has been found. The tumor has not grown into any blood vessels. In addition, the cancer has not spread to nearby lymph nodes or metastasized to distant sites. Sometimes this stage is divided into two subcategories: In stage IA, the single tumor is smaller than 2 cm In stage IB, the single tumor is larger than 2cm. Stage II – Either a single primary tumor of any size exists and has grown into liver blood vessels, or several small tumors are present. If several tumors are present, all are less than five centimeters in diameter. In addition, the cancer has not spread to nearby lymph nodes or distant sites. Stage III – Several tumors have been found and the cancer has neither spread into nearby lymph nodes, nor metastasized to distant sites. This stage has two subcategories: In stage IIIA - at least one of the tumors is larger than five centimeters. In stage IIIB - at least one tumor has grown into a branch of the portal vein or the hepatic vein – the major veins in the liver. Stage IV - Stage IV liver cancer includes two subcategories: In stage IVA - a single tumor or multiple tumors of any size have spread to nearby lymph nodes, but have not metastasized to distant sites. In stage IVB – a single tumor or multiple tumors of any size may or may not have spread to nearby lymph nodes, but have spread to another part of the body. In addition to the TNM system, other liver cancer staging systems are also used, especially internationally. These other systems generally try to take into account the impact on the function of the liver as well.  These systems include: The Barcelona-Clinic Liver Cancer (BCLC) system The Cancer of the Liver Italian Program (CLIP) system The Okuda system.