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Liver Cancer

Childhood cancer of the liver is a rare disease in which malignant cells are found in the liver. The liver is one of the largest organs in the body, filling the upper right side of the abdomen and protected by the rib cage. The liver has many functions.

Primary liver cancer is different from cancer that has spread from another place in the body to the liver (liver metastases).

There are two types of primary liver cancer (hepatoblastoma and hepatocellular cancer), based on how the cancer cells look under a microscope. Hepatoblastoma is more common in young children before age 3 and may be caused by an abnormal gene. Children whose family members carry a gene related to a certain kind of colon cancer may be more likely to develop hepatoblastoma. Children infected with hepatitis B or C (viral infections of the liver) are more likely than other children to get hepatocellular liver cancer. Pediatric hepatocellular cancer is found in children from birth to age 19 years.

If your child has cancer symptoms, your child's doctor may order special x-rays, such as a CT scan or a liver scan. If a lump is seen on an x-ray, your child's doctor may refer you to a Cleveland Clinic childhood cancer specialist. The oncologist will then refer you to an oncologic surgeon who will remove a small amount of tissue from the liver. This is called a biopsy. The tissue will be looked at under the microscope to see if there are any liver cancer cells.

Your child's chance of recovery (prognosis) and choice of treatment for liver cancer will depend on the stage of your child's cancer (whether it is just in the liver or has spread to other places). It will also depend on how the cancer cells look under a microscope (the histology), and your child's general state of health. The overall survival rate for children with hepatoblastoma is 70%, but only 25% for hepatocellular carcinoma.

Once liver cancer is diagnosed, more tests will be done to find out if the cancer cells have spread to other parts of the body. This is called staging. Your child's doctor needs to know the stage of disease in order to plan most appropriate cancer treatment. The following stages are used for childhood cancer of the liver:

Stage I

Stage I pediatric liver cancer means the cancer can be completely removed with surgery.

Stage II

Stage II pediatric liver cancer means that most of the cancer can be removed in an operation but very small (microscopic) amounts of cancer are left in the liver following surgery.

Stage III

Stage III pediatric liver cancer means that some of the cancer may be removed in an operation, but part of the tumor cannot be removed and remains either in the abdomen or in the lymph nodes.

Stage IV

Stage IV pediatric liver cancer means the cancer has spread to other parts of the body, regardless of the extent of liver involvement.

Recurrent disease means that the cancer has come back (recurred) after it has been treated. The cancer may come back in the liver or in another part of the body.

There are treatments for all children with liver cancer. Four kinds of pediatric treatment are used:

  • surgery (taking out the cancer in an operation)
  • chemotherapy (using drugs to kill cancer cells).
  • radiation therapy (using high-dose x-rays to kill cancer cells)
  • pediatric liver transplantation (replacing the liver with a donated liver)

Surgery may be used to take out the cancer and part of the liver where the cancer is found. Surgery may also be used to remove cancer that has spread to other parts of the body, such as the lung. If surgery to remove the tumor is not possible, pediatric liver transplantation may be performed after complete removal of the diseased liver.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be given to your child before surgery to help reduce the size of the liver cancer. Your child may be given chemotherapy after surgery to kill any remaining cells. Chemotherapy given after surgery is called adjuvant chemotherapy. Chemotherapy for childhood liver cancer is usually put into the body through a needle in a vein or artery. This type of chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the liver. In another type of chemotherapy, called direct infusion chemotherapy, drugs are injected directly into the blood vessels that go into the liver.

Sometimes a special treatment called chemo-embolization is used to treat childhood liver cancer. Chemotherapy drugs are injected into the main artery of the liver with substances that block or slow the flow of blood into the cancer. This lengthens the time the drugs have to kill the cancer cells. It also prevents the cancer cells from getting oxygen or other materials that they need to grow.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Treatments for childhood liver cancer depend on the type (hepatoblastoma or hepatocellular carcinoma cancer) and stage of your child's disease, your child's age and general health.

Your child may receive liver treatment that is considered standard based on its effectiveness in patients in past clinical studies, or you may choose to have your child take part in a clinical trial. Clinical trials are designed to compare potentially better therapy with therapy currently accepted as standard of care to hopefully find better ways to treat cancer patients. Clinical trials are going on in many parts of the country for most stages of childhood liver cancer. The good news is that Children's Oncology Group clinical trials are closely overseen by a data monitoring committee, so that in real time, if one treatment is found to be better than another, the treating physicians are notified immediately, and your child's treatment will be changed right away if necessary.

Stage I Hepatoblastoma or Hepatocellular Carcinoma

Your child's treatment will probably be complete removal of the liver cancer by surgery followed by adjuvant chemotherapy.

Stage II Hepatoblastoma or Hepatocellular Carcinoma

Your child's treatment will probably be removal of the liver cancer by surgery followed by chemotherapy.

Stage III Hepatoblastoma

Your child's cancer treatment may be one or more of the following:

  1. Chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible. 
  2. Chemotherapy
  3. Radiation therapy.
  4. Direct infusion of drugs into blood vessels going into the liver.
  5. Liver transplant: Surgical removal of the liver followed by replacement with a donor's liver.
Stage III Hepatocellular Carcinoma

Your child's treatment will probably be chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible.

Stage IV Hepatoblastoma

Your child's treatment may be one or more of the following:

  1. Chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible followed by chemotherapy.
  2. Surgical removal of cancer that has spread to the lungs.
  3. Chemotherapy.
  4. Radiation therapy followed by additional surgery.
  5. Direct infusion of chemotherapy drugs into blood vessels going into the liver.
  6. Chemotherapy drugs injected into the main liver artery with substances that block or slow the flow of blood (chemo-embolization chemotherapy).
  7. Liver transplant: Surgical removal of the liver followed by replacement with a donor's liver.
  8. Clinical trials are testing new therapies and should be considered for your child.
Stage IV Hepatocellular Carcinoma

Your child's treatment will probably be chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible.

Recurrent Childhood Liver Cancer

Recurrent Hepatoblastoma

Treatment depends on where the cancer recurred and how the cancer was treated before. Treatment may include additional surgery. Clinical trials are testing new therapies and should be considered for your child.

Recurrent Hepatocellular Carcinoma

Clinical trials are testing new cancer therapies and should be considered for your child.

Cleveland Clinic Children's

Here at Cleveland Clinic Children's, we specialize in the care of children and young adults with cancer. We use a team approach that cares for all members of the family, recognizing that this is a very difficult time for all of them. Our goal is to have our patients get through therapy with as normal a life as possible, and to emerge from therapy knowledgeable about how to maintain their health.

Should you have more questions about the child or young adult in your life with cancer, please contact Cleveland Clinic Cancer Answer line at 216.444.3024 or 800.223.2273, extension 4-3024. Your question will be forwarded to the Chair of the Pediatric Oncology Department.

We wish you and your child well.

For other websites regarding childhood cancer:

Source: National Institutes of Health, National Cancer Institute, Children's Oncology Group

© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved.

This information is provided by the Cleveland Clinic Health System and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Rev. 1/03


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