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Vp1 to Vp4: how portal vein involvement is graded | CION Cancer Clinics
Vp1 to Vp4 shows how far a liver cancer has grown into the portal vein, from small outer branches at Vp1 to the main trunk at Vp4. The higher the grade, the fewer local treatments remain open. This page explains each grade in plain words, how a radiologist decides it, and what it does and does not change about the plan. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What do Vp1, Vp2, Vp3 and Vp4 mean on a liver scan report?
- What does each Vp grade describe?
- How does the Vp grade change what treatment is possible?
- How do doctors decide which Vp grade you have?
- What do people often misread about the Vp grade?
- What this page cannot tell you
- Common questions about Vp grading
The short answer
What do Vp1, Vp2, Vp3 and Vp4 mean on a liver scan report?
Vp1 to Vp4 is a scale that shows how far a liver cancer has grown into the portal vein. Vp1 means only small, outer branches are involved. Vp4 means the tumour has reached the main trunk of the vein, or the branch on the other side of the liver.
The portal vein is the large vein that carries blood from the gut into the liver. Inside the liver it divides like a tree: one trunk, then a right and a left branch, then smaller and smaller branches. When hepatocellular carcinoma (HCC), the commonest primary liver cancer, grows into this tree, the plug of cancer is called a portal vein tumour thrombus. The Vp grade tells the team which part of the tree it has reached.
Where the scale comes from
The Vp system was set out by Japanese liver cancer specialists and is now used widely across Asia, including in India. Some Chinese centres use a similar four-type scale with different labels. Both ask the same question: how close is the tumour to the trunk?
The grade describes the vein, not the whole cancer. It is read alongside the tumour size, number and your liver function.On your report
What does each Vp grade describe?
- Vp0
- No tumour seen in the portal vein. This is what most people with early liver cancer have.
- Vp1
- Tumour in the small outer branches only, beyond the second division of the vein. Often seen only on a detailed scan or under the microscope.
- Vp2
- Tumour in a second-order branch, the branch that feeds one section of one side of the liver.
- Vp3
- Tumour in a first-order branch, meaning the main right or main left portal vein.
- Vp4
- Tumour in the main trunk of the portal vein, or in the branch on the opposite side from the tumour, or in both branches.
- Tumour thrombus
- Living cancer growing inside a vein. It is different from a bland clot, which is clotted blood with no cancer in it.
Not sure whether this applies to you?
Ask an oncologistWhy the grade matters
How does the Vp grade change what treatment is possible?
Any tumour in the portal vein moves liver cancer to an advanced stage. The grade then decides how much room is left for local treatment.
Vp1 and Vp2
The thrombus is in branches on the same side as the tumour. Some surgical teams will still consider removing that part of the liver if the liver is healthy. Careful TACE may also be possible, alongside or before systemic treatment.
Vp3
A main branch is blocked, so half the liver has lost much of its portal blood flow. Surgery is rarely offered. Systemic treatment usually leads, and Y-90 or radiation aimed at the thrombus may be added.
Vp4
The trunk or both sides are involved. The healthy liver now relies on its artery, so TACE is usually unsafe. Systemic treatment is the main option, with radiation in selected people.
What the grade does not change
- Transplant is ruled out at every grade
- Liver function still sets the limits
- The grade alone never predicts one person's outlook
From scan to grade
How do doctors decide which Vp grade you have?
A contrast scan in phases
A triple-phase CT or a liver MRI takes pictures as dye passes through the arteries and then the veins. CION arranges these scans through accredited diagnostic partners.
Tumour or plain clot
The radiologist checks whether the material in the vein lights up with the artery dye, widens the vein and touches the tumour. Those signs point to tumour. A plain clot does not light up. How the two are told apart.
Tracing the branch
The radiologist follows the vein from the trunk outwards and notes the furthest point reached. That gives the grade.
The tumour board review
The grade is discussed together with the tumour, the blood tests and your fitness. The board may ask for an MRI if the CT is unclear.
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Commonly believed
What do people often misread about the Vp grade?
"Vp1 is minor, so it barely matters."
Even the lowest grade means the cancer has entered the blood vessels. It still changes the stage and rules out transplant. What it keeps open is the chance of local treatment in carefully chosen cases.
"Vp4 means there is nothing left to try."
Systemic treatment, including immunotherapy combinations and targeted tablets, is designed for exactly this situation. Radiation can also be aimed at the thrombus. The grade narrows the options. It does not remove them.
"The grade on the report is final."
Grading depends on scan quality and on who reads it. A second reading of the same images, or an MRI, sometimes changes the grade, or shows the material is a plain clot after all.
Being straight with you
What this page cannot tell you
It cannot grade your scan. Only a radiologist looking at all the phases of the images can do that, and borderline cases are often debated at the tumour board. It also cannot tell you which treatment you will be offered, because the grade is one input among several. For why any portal vein involvement shifts the plan, read why portal vein involvement changes the treatment plan.
Who this does not apply to
The Vp scale is used for HCC. It does not apply to a plain clot in the portal vein of someone with cirrhosis and no cancer, and it is not the main tool for bile duct cancer or for cancer that has spread to the liver from another organ. Tumour in the hepatic veins, which drain blood out of the liver, has its own grading and is covered on hepatic vein and vena cava involvement.
If your report mentions a thrombus but gives no grade, ask the radiologist or your oncologist which branch is involved.Questions we are asked
Common questions about Vp grading
My report says Vp3. What does that mean in plain words?
It means the tumour has grown into the main right or left branch of the portal vein. That side of the liver has lost much of its portal blood flow. Surgery is rarely offered, and the team will usually build the plan around systemic treatment, sometimes with radiation or Y-90 added.
Is Vp the same as the BCLC stage?
No. BCLC is the overall staging system for liver cancer and looks at the tumour, the liver function and your fitness. Any portal vein tumour, whatever its Vp grade, usually places the cancer in BCLC stage C. The Vp grade adds detail inside that stage.
Why does my report not mention a Vp grade?
Many radiologists describe the branch in words, such as right portal vein or main portal vein, instead of using the Vp label. The meaning is the same. If the report only says thrombus, ask which branch is involved and whether it looks like tumour or plain clot.
Can the grade go down with treatment?
Yes, sometimes. Systemic treatment, radiation or Y-90 can shrink a tumour thrombus, and a later scan may show the vein partly open again. In a few people this reopens the question of local treatment. Your team will compare scans over time to judge this.
Is TACE possible with Vp1 or Vp2?
It may be, if the liver function is good and the main trunk is open. The interventional radiologist and oncologist decide together, and CION coordinates TACE through accredited partner hospitals. At Vp4, TACE is usually avoided because it can starve the liver of blood. See when TACE is not safe.
Does a higher grade mean less time?
Higher grades are linked with more advanced disease in large groups of patients, but the grade cannot predict what will happen to one person. Liver function, fitness and how the cancer responds to treatment matter just as much. Ask your oncologist to explain what the grade means for your plan, not for a number.
Do I need an MRI as well as a CT?
Not always. A good triple-phase CT often shows the portal vein clearly. An MRI is added when it is unclear whether the material is tumour or clot, or how far it reaches. Your team will tell you if it would change the decision.
Can CION review a report from another hospital?
Yes. Bring the scan images on a disc or a link, not only the printed report, along with recent blood tests. The tumour board can look at the portal vein again and explain the grade and the options. Call the CION helpline to arrange it.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- EASL — EASL Clinical Practice Guidelines: management of hepatocellular carcinoma
- American Cancer Society — Liver Cancer Stages
- Merck Manual Consumer Version — Portal Vein Thrombosis
- RadiologyInfo.org (RSNA/ACR) — Abdominal and Pelvic CT
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Why portal vein involvement changes the planWhat any grade means for surgery, transplant and TACETumour thrombus or blood clotCheck the material in the vein is tumour at allTreatment options with portal vein involvementThe choices at each gradePortal vein tumour thrombosis explainedThe basics, if this is new to you
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Not sure what the Vp grade on your report means?
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