Mariah
Osteosarcoma Survivor
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Josh
Brain Tumor Survivor
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Sydney
Leukemia Survivor
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Alijah
Leukemia Survivor
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Rosie
Wilms Tumor Survivor
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Ryan
Leukemia Survivor
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Sydney
Retinoblastoma Survivor
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Liver Cancer/Hepatoblastoma

Research brings hope to children with a rare cancer

Childhood liver cancer is a disease in which cancerous cells form in the tissue of the liver. Liver cancer is rare in children and teenagers. There are two main types of childhood liver cancer:

  • Hepatoblastoma: A type of liver cancer that usually does not spread outside the liver. This type usually affects children younger than 3 years old.
  • Hepatocellular carcinoma: A type of liver cancer that often spreads to other places in the body. This type usually affects children older than 14 years old.

Two less common types of childhood liver cancer are:

  • Undifferentiated embryonal sarcoma of the liver (UESL): The third most common liver cancer in children and adolescents. It usually occurs in children between the ages of 5 and 10 years.
  • Infantile choriocarcinoma of the liver: A very rare tumor that appears to start in the placenta and spreads to the fetus. The tumor is usually found during the first few months of life.

Symptoms

Symptoms are more common after the tumor becomes large. Symptoms may include:

  • A painless lump in the abdomen.
  • Swelling or pain in the abdomen.
  • Weight loss for no known reason.
  • Loss of appetite.
  • Early puberty in boys.
  • Nausea and vomiting.

Diagnosis

If the doctor suspects liver cancer is causing the child’s symptoms, the following tests and procedures may be used to learn more:

  • Blood tests: A blood sample taken from the child will allow doctors to run tests on the blood, including a serum tumor marker test, a complete blood count (CBC), and liver function tests.
  • Abdominal x-ray: An x-ray of the organs in the abdomen. An x-ray is a type of energy beam that can go through the body onto film, making a picture of areas inside the body.
  • Ultrasound exam: High-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes in this procedure. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
  • CT scan (computerized tomography): In this procedure, detailed pictures of the chest and abdomen are taken from different angles by a computer linked to an x-ray machine. Dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly in the image.
  • MRI (magnetic resonance imaging): For this imaging procedure, magnet, radio waves, and a computer make a series of detailed pictures of areas inside the body.
  • Biopsy: A sample of the patient’s tissue is removed and checked for signs of cancer under a microscope. The sample may be taken during surgery to remove or view the tumor.

Staging

After liver cancer is diagnosed, the doctors will “stage” the disease. “Staging” is a process of testing and analysis to determine how far the cancer has spread. Once doctors know the stage of the disease, they can choose the most effective way to treat it.  Additional tests such as a CT scan, an MRI, an ultrasound, or even surgery may be required.


There are two staging systems for childhood liver cancer, presurgical and postsurgical.

Presurgical (before surgery) staging: The stage is based on where the tumor has spread within the four parts (sections) of the liver, as shown by imaging procedures such as MRI or CT. This staging system is called PRETEXT.

  • Stage I: Cancer is found in one section of the liver. Three sections of the liver that are next to each other do not have cancer in them.
  • Stage II: Cancer is found in one or two sections of the liver. Two sections of the liver that are next to each other do not have cancer in them.
  • Stage III: One of the following is true:
    • Cancer is found in three sections of the liver and one section does not have cancer.
    • Cancer is found in two sections of the liver and two sections that are not next to each other do not have cancer in them.
  • Stage IV: Cancer is found in all four sections of the liver.

Postsurgical (after surgery) staging: The stage is based on the amount of tumor that remains after the patient has had surgery.

  • Stage I: The tumor was in the liver only and all of the cancer was removed by surgery.
  • Stage II The tumor was in the liver only and 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 before surgery or during surgery.
  • Stage III: One of the following is true:
    • The tumor cannot be removed by surgery.
    • Cancer that can be seen without a microscope remains after surgery.
    • The cancer has spread to nearby lymph nodes.
  • Stage IV: The cancer has spread to other parts of the body.

Recurrent childhood liver cancer is cancer that was once treated but has now come back, either in the liver or in other parts of the body.

Treatment

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. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.


Five types of standard treatment are used:

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.


Chemotherapy

Strong anti-cancer drugs are given orally or through an injection during chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated. For childhood liver cancer, one type of regional chemo used is called chemoembolization of the hepatic artery.

  • 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.

Surgery

Doctors will operate to remove the cancer whenever possible. Chemotherapy may be given before surgery to shrink the tumor, or after surgery to destroy any remaining cancer cells. The different types of surgery performed are:

  • Cryosurgery: Also known as cryotherapy, this treatment uses an instrument, possibly guided by ultrasound, to freeze and destroy abnormal tissue, such as carcinoma in situ.
  • Partial hepatectomy: The cancerous part of the liver is removed in this surgery. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with a small amount of normal tissue around it.
  • Total hepatectomy and liver transplant: The entire liver is removed and replaced with a healthy liver from a donor in this surgery. A liver transplant may be possible when cancer has not spread beyond the liver and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed.
  • Resection of metastases: This is surgery to remove cancer that has spread outside of the liver, such as to nearby tissues, the lungs, or the brain.

Radiation therapy

This treatment uses high-energy x-rays or other types of radiation to kill or stop cancer. The radiation may come from a machine, or it may come from a substance sealed in needles, seeds, wires, or catheters placed directly into the cancer.


Percutaneous ethanol injection

A small needle is used to inject ethanol (alcohol) directly into a tumor to kill cancer cells for this treatment.

Treatment by stage for hepatoblastoma

Stages I and II
Treatment may include:

  • Surgery to remove the tumor, followed by chemotherapy with one or more drugs, or watchful waiting.
  • Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible.
  • A clinical trial of a new combination of surgery or biopsy, watchful waiting, and chemotherapy.

Stage III
Treatment may include the following:

  • Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible.
  • Combination chemotherapy followed by liver transplant, if surgery to remove the tumor is not possible.
  • Chemoembolization of the hepatic artery, which may be followed by surgery to remove as much of the tumor as possible.
  • A clinical trial of a new combination of surgery or biopsy, chemotherapy, and liver transplant.

Stage IV
Treatment may include the following:

  • Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the cancer as possible, including cancer that has spread to other parts of the body such, as the lungs. If the cancer is completely removed, additional chemotherapy is given to kill any remaining cancer cells.
  • Chemotherapy followed by liver transplant, if surgery to remove the tumor is not possible.
  • If the tumor that has spread to other parts of the body cannot be completely removed by surgery after chemotherapy, further treatment may include the following:
    • High-dose chemotherapy, with or without stem cell transplant, or surgery to remove as much of the tumor as possible.
    • Chemoembolization of the hepatic artery to shrink the tumor, followed by surgery to remove as much of the tumor as possible.
    • Radiation therapy alone, or before, or after surgery to remove as much of the tumor as possible.
  • A clinical trial of new combinations of chemotherapy, surgery to remove the tumor, and liver transplant.

Treatment by stage of hepatocellular carcinoma

Stages I and II
Treatment may include the following:

  • Surgery to remove the tumor, followed by combination chemotherapy.
  • Combination chemotherapy followed by surgery to remove as much of the tumor as possible.
  • Chemoembolization of the hepatic artery to shrink the tumor, followed by surgery to remove as much of the tumor as possible.

Stage III and PRETEXT stage IV
Treatment may include the following:

  • Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible.
  • Combination chemotherapy followed by liver transplant if surgery to remove the tumor is not possible.
  • If the tumor cannot be completely removed by surgery after chemotherapy, further treatment may include the following:
    • Cryosurgery.
    • Percutaneous ethanol injection.
    • Chemoembolization of the hepatic artery to shrink the tumor, followed by surgery to remove as much of the tumor as possible.
    • Radiation therapy.

Postsurgically-staged stage IV
Treatment of hepatocellular carcinoma may be combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible.

Treatment by stage of undifferentiated embryonal sarcoma of the liver

Treatment may include the following:

  • Combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible and then more chemotherapy.
  • Surgery to remove the tumor followed by chemotherapy. A second surgery may be done to remove tumor that remains, followed by more chemotherapy.
  • Liver transplant if surgery to remove the tumor is not possible.
  • A clinical trial of chemotherapy before or after surgery, and radiation therapy may also be given.

Treatment of infantile choriocarcinoma of the liver

Treatment of infantile choriocarcinoma may be combination chemotherapy to shrink the tumor, followed by surgery to remove as much of the tumor as possible.

Treatment for recurrent childhood liver cancer

Treatment of recurrent hepatoblastoma may include the following:

  • Surgery to remove isolated (single and separate) metastatic tumors.
  • Liver transplant.
  • A clinical trial of a new treatment.

Treatment of recurrent hepatocellular carcinoma may include the following:

  • Chemoembolization of the hepatic artery to shrink the tumor, followed by surgery to remove the tumor.
  • Liver transplant.
  • A clinical trial of a new treatment.

Leading the way to a cure

The Masonic Cancer Center at the University of Minnesota has a strong national reputation for its members’ research on the causes and prevention of cancer. In the Center’s Prevention and Etiology Research Program, scientists work collaboratively to identify risk factors, evaluate strategies for early detection, develop and test approaches for prevention, and improve life for survivors.

Children’s Cancer Research Fund’s relationship with the University of Minnesota supports this work, providing crucial resources for pilot studies and clinical trials.
The HOPE (Hepatoblastoma Origins and Pediatric Epidemiology) Study seeks to learn more about the causes of hepatoblastoma, the growth of immature liver cells, in infants and children. Conducted by Dr. Logan G. Spector, the HOPE study gathers information from mothers whose children have hepatoblastoma and mothers whose children do not in order to discover environmental and genetic risk factors for the disease. For more information, see Our Research.

This information is displayed with permission of the University of Minnesota Cancer Center. For more information about this disease or to review active clinical trials, please visit the website of the Cancer Center.

Back to Types of Childhood Cancer