The U.S. National Cancer Institute does not currently endorse any foreign translations of PDQ® and no such endorsement should be inferred for the following translation.

Childhood Liver Cancer: Treatment

Last Modified : 2004-12-16


General Information About Childhood Liver Cancer

Childhood liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver.

The liver is one of the largest organs in the body, filling the upper right side of the abdomen, inside the rib cage. The liver has two parts, a right lobe and a smaller left lobe. The liver has many important functions, including:


There are two main types of childhood liver cancer:


This summary refers to the treatment of primary liver cancer (cancer that begins in the liver). Treatment of metastatic liver cancer, which is cancer that begins in other parts of the body and spreads to the liver, is not discussed in this summary. Primary liver cancer can occur in both adults and children. Treatment for children, however, is different than treatment for adults. (Refer to the PDQ summary on Adult Primary Liver Cancer Treatment for more information.)

Certain diseases and disorders can increase the risk of developing childhood liver cancer.

Risk factors for hepatoblastoma include the following:


Risk factors for hepatocellular carcinoma include the following:


Possible signs of childhood liver cancer include a lump or pain in the abdomen.

Symptoms are more common after the tumor becomes large. Other conditions can cause the same symptoms. A doctor should be consulted if any of the following problems occur:


Tests that examine the liver and the blood are used to detect (find) and diagnose childhood liver cancer.

The following tests and procedures may be used:


Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:


Prognosis may also depend on:


Childhood liver cancer may be cured if the tumor is small and can be completely removed by surgery. Complete removal is possible more often for hepatoblastoma than for hepatocellular carcinoma.


Stages of Childhood Liver Cancer

After childhood liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body.

The process used to find out if cancer has spread within the liver or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

There are 2 staging systems for childhood liver cancer:


The following tests and procedures may be used in the staging process:


The following stages are used after surgery:
Stage I

In stage I, all of the cancer was removed by surgery.

Stage II

In stage II, all of the cancer that can be seen without a microscope was removed by surgery. A small amount of cancer remains in the liver, but it can be seen only with a microscope or the tumor cells may have spilled into the abdomen during surgery.

Stage III

In stage III:


Stage IV

In stage IV, the cancer has spread to other parts of the body.

The following stages are used for childhood hepatoblastoma before surgery:
PRETEXT Stage 1

In stage 1, the cancer is found in one quadrant of the liver.

PRETEXT Stage 2

In stage 2, cancer is found in two quadrants of the liver that are next to each other.

PRETEXT Stage 3

In stage 3, cancer is found in three quadrants of the liver that are next to each other or two quadrants that are not next to each other.

PRETEXT Stage 4

In stage 4, cancer is found in all four quadrants.


Recurrent Childhood Liver Cancer

Recurrent childhood liver cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the liver or in other parts of the body.


Treatment Option Overview

There are different types of treatment for patients with childhood liver cancer.

Different types of treatments are available for children with liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, a clinical trial should be considered for all children who have liver cancer. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with liver cancer should have their treatment planned by a team of doctors with expertise in treating this rare childhood cancer.

Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who specialize in certain areas of medicine and who have experience and expertise in treating children who have liver cancer. It is especially important to have a pediatric surgeon with experience in liver surgery. Other specialists may include the following:


Three types of standard treatment are used:
Surgery

When possible, the cancer is removed by surgery.


Chemotherapy or radiation therapy is sometimes given before surgery, to shrink the tumor and make it easier to remove. This is called neoadjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Chemoembolization of the hepatic artery (the main artery that supplies blood to the liver) is a type of regional chemotherapy used to treat childhood liver cancer. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with a substance that blocks the artery, cutting off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. The tumor is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine.

Treatment using more than one anticancer drug is called combination chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Other types of treatment are being tested in clinical trials.

Information about ongoing clinical trials is available from the NCI Web site.


Treatment Options by Stage


Stage I and II Childhood Liver Cancer

Treatment for stages I and II and PRETEXT stages 1, 2, and 3 hepatoblastoma may include the following:


Treatment for stage I and II hepatocellular carcinoma is usually surgery to remove the tumor, followed by combination chemotherapy.


Stage III Childhood Liver Cancer

Treatment of stage III and PRETEXT stage 4 hepatoblastoma may include the following:


Treatment of stage III hepatocellular carcinoma is usually combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.


Stage IV Childhood Liver Cancer

Treatment of stage IV hepatoblastoma may include the following:


Treatment of stage IV hepatocellular carcinoma may be combination chemotherapy to reduce the size of the tumor, followed by surgery to remove as much of the tumor as possible.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.


Treatment Options for Recurrent Childhood Liver Cancer

Treatment of recurrent hepatoblastoma is usually surgery to remove isolated (single and separate) metastatic tumors.

Treatment in a clinical trial should be considered for recurrent hepatocellular carcinoma.

Information about ongoing clinical trials is available from the NCI Web site.