Gastrointestinal (GI) Oncology

Patient and Family Education

Childhood Liver Cancer

What Is Childhood Liver Cancer? | Diagnosis | Stages and Treatments | About Cinical Trials | Greenebaum Cancer Center

Stages and Treatments

Once childhood primary liver cancer is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This process is called staging. A doctor needs to know the stage of the disease in order to plan treatment.

The following stages (and treatments) are used for childhood primary liver cancer:

Stage I: The cancer can be removed by surgery. For both hepatoblastoma and hepatocellular carcinoma, the child's treatment will probably be complete removal of the liver cancer followed by adjuvant chemotherapy.

Stage II: Most of the cancer may be removed in an operation, but very small (microscopic) amounts of cancer are left in the liver following surgery. This is very rare.

Stage III: Some of the cancer may be removed in an operation, but some of the tumor cannot be removed and remains either in the abdomen or in the lymph nodes. For stage III hepatoblastoma, the child's treatment may be one or more of the following:

Chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible
Chemotherapy
Radiation therapy
Direct infusion of drugs into blood vessels going into the liver
Liver transplant involving surgical removal of the liver followed by replacement with a donor's liver

For stage III hepatocellular carcinoma, the 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: The cancer has spread to other parts of the body. A child with stage IV hepatoblastoma may be treated with one or more of the following:

Chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible, followed by chemotherapy
Surgical removal of cancer that has spread to the lungs
Chemotherapy
Radiation therapy followed by additional surgery
Direct infusion of chemotherapy drugs into blood vessels going into the liver
Chemotherapy drugs injected into the main liver artery with substances that block or slow the flow of blood (chemo-embolization chemotherapy)
Liver transplant involving surgical removal of the liver followed by replacement with a donor's liver
Clinical trials testing new therapies

A child with stage IV hepatocellular carcinoma will probably be treated with chemotherapy to reduce the size of the tumor followed by surgery to remove as much of the cancer as possible.

Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the liver or in another part of the body. Your child's treatment will depend on the type of cancer (hepatoblastoma or hepatocellular carcinoma), where the cancer recurred, and how the cancer was treated before. Parents may want to consider enrolling their child in clinical trials that are testing new therapies.

About the Treatments and Side Effects

There are four primary treatment options for children with primary liver cancer:

surgery
chemotherapy
radiation therapy
liver transplantation

Surgery

Surgery may be used to take out the cancer and the part of the liver where cancer is found. Sometimes the entire liver may be surgically removed and replaced by a liver transplanted from a donor. Surgery may also be used to remove cancer that may have spread to other parts of the body, such as the tissues surrounding the liver, the lungs, or the brain.

Side effects of surgery: The side effects of surgery depend on the location of the tumor and the type of operation, among other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can usually be controlled with medicine. The recovery period after an operation varies from patient to patient.

(top)

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: A treatment period is followed by a recovery period, then another treatment period, and so on.

If a doctor removes all the cancer that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any remaining cells. Chemotherapy that is given after surgery to remove the cancer is called adjuvant chemotherapy.

Sometimes a special treatment called chemo-embolization is used to treat childhood primary 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 and it also prevents the cancer cells from getting oxygen or other materials that they need to grow. In another type of chemotherapy, called direct infusion chemotherapy, drugs are injected directly into the blood vessels that go into the liver.

Side effects of chemotherapy: Chemotherapy drugs generally fight rapidly dividing cells in the body. Cells that divide rapidly include both the targeted cancer cells and healthy cells in the blood, digestive tract, and hair follicles. Depending on which anticancer drugs a patient receives, he or she may experience symptoms when healthy cells are damaged along with the cancer cells. If healthy blood cells are destroyed by chemotherapy, the patient may be more susceptible to infections, bruising or bleeding, and fatigue. When cells in the hair roots or digestive tract are affected by anticancer drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not all chemotherapy patients develop all of these side effects, and the symptoms usually go away during the recovery period or after the treatments are done. Doctors can prescribe medicines and other treatments to control most of the symptoms.

(top)

Radiation Therapy

Radiation therapy is the use of high-energy x-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 into the area where the cancer cells are found (internal radiation therapy).

Side effects of radiation: The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

(top)

Liver Transplantation

If surgery to remove the tumor is not possible, a child may undergo liver transplantation to remove the diseased liver and replace it with a healthy one from a donor.

(top)

This page was last updated on: September 23, 2009.

For More Information

Make an Appointment