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National Cancer Institute

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Childhood liver cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is childhood liver cancer?
STAGE EXPLANATION
Stages of childhood liver cancer
Stage I
Stage II
Stage III
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How childhood liver cancer is treated
Treatment by stage
STAGE I CHILDHOOD LIVER CANCER
Stage I Hepatoblastoma
Stage I Hepatocellular Carcinoma
STAGE II CHILDHOOD LIVER CANCER
Stage II Hepatoblastoma
Stage II Hepatocellular Carcinoma
STAGE III CHILDHOOD LIVER CANCER
Stage III Hepatoblastoma
Stage III Hepatocellular Carcinoma
STAGE IV CHILDHOOD LIVER CANCER
Stage IV Hepatoblastoma
Stage IV Hepatocellular Carcinoma
RECURRENT CHILDHOOD LIVER CANCER
Recurrent Hepatoblastoma
Recurrent Hepatocellular Carcinoma
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that provides up-to-date information on cancer and its prevention, detection, treatment, and supportive care. PDQ is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

Cancer in children and adolescents is rare. The majority of children with cancer are treated at cancer centers with special facilities to treat childhood cancers. There are organized groups of doctors and other health care professionals who work together by doing clinical trials to improve treatments for children with cancer.

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your child's doctor, who knows your child and has the facts about your child's disease. PDQ can also provide the names of additional health care professionals and hospitals that specialize in treating children who have cancer.

Before your child begins treatment, you may want to consider entering your child in a clinical trial. PDQ can be used to learn more about the trials. A clinical trial is a research study that attempts to improve current treatments or find new treatments for people with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers specific scientific questions in order to find new and better ways to help people with cancer. During clinical trials, information is collected about new treatments, their risks, and how well they do or do not work. When a clinical trial shows that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the "standard" treatment. Children who are treated in clinical trials have the advantage of getting the best available therapy. In the United States, about two thirds of children with cancer are treated in a clinical trial at some point in their illness.

Listings of current clinical trials are available on PDQ. In the United States, there are two major groups (called cooperative groups) that organize clinical trials for childhood cancers: the Childrens Cancer Group (CCG) and the Pediatric Oncology Group (POG). Doctors who belong to these groups or who take part in other clinical trials are listed in PDQ.

To learn more about cancer and how it is treated or to learn more about clinical trials for your child's kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer your cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is childhood liver cancer?

Childhood liver cancer, also called hepatoma, is a rare disease in which cancer (malignant) cells are found in the tissues of your child's 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. It plays an important role in making your food into energy and also filters and stores blood.

Primary liver cancer is different from cancer that has spread from another place in the body to the liver (liver metastases). For information on the treatment of adult liver cancer, see the PDQ patient information summary on adult primary liver cancer.

There are two types of cancer that start in the liver (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 of families whose members carry a gene related to a certain kind of colon cancer may be more likely to develop hepatoblastoma (genes carry the hereditary information that you get from your parents). Children infected with hepatitis B or C (viral infections of the liver) are more likely than other children to get hepatocellular cancer. Hepatocellular cancer is found in children from birth to age 4 or in children ages 12 to 15.

If your child has 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 remove a small amount of tissue from the liver using a needle inserted into the abdomen. This is called a needle biopsy and is usually done using an x-ray to guide the doctor. Your child's doctor will have the tissue looked at under the microscope to see if there are any cancer cells.

Your child's chance of recovery (prognosis) and choice of treatment depend on the stage of your child's cancer (whether it is just in the liver or has spread to other places), how the cancer cells look under a microscope (the histology), and your child's general state of health.


STAGE EXPLANATION


Stages of childhood liver cancer

Once liver cancer is found, 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 treatment. The following stages are used for childhood liver cancer:


Stage I

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


Stage II

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


Stage III

Stage III childhood liver cancer means that 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.


Stage IV

Stage IV childhood liver cancer means the cancer has spread to other parts of the body.


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.


TREATMENT OPTION OVERVIEW


How childhood liver cancer is treated

There are treatments for all children with liver cancer. Three kinds of 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)

Surgery may be used to take out the cancer and part of the liver where the cancer is found. Sometimes the entire liver may be surgically removed and replaced by a liver transplant from a donor.

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 when the doctor has removed the cancer 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 and 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).


Treatment by stage

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

Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child take part in a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients. Clinical trials are ongoing in many parts of the country for most stages of childhood liver cancer. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE I CHILDHOOD LIVER CANCER


Stage I Hepatoblastoma

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


Stage I Hepatocellular Carcinoma

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


STAGE II CHILDHOOD LIVER CANCER


Stage II Hepatoblastoma

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


Stage II Hepatocellular Carcinoma

Your child's treatment will probably be removal of the liver cancer by surgery followed by chemotherapy. For more information, please see the PDQ patient information summary on adult primary liver cancer.


STAGE III CHILDHOOD LIVER CANCER


Stage III 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.

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. For more information, please see the PDQ patient information summary on adult primary liver cancer.


STAGE IV CHILDHOOD LIVER CANCER


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 may 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. For more information, please see the PDQ patient information summary on adult primary liver cancer.


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 may be considered for your child.


Recurrent Hepatocellular Carcinoma

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


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about childhood liver cancer, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is toll-free and a trained information specialist can answer your questions.

The Cancer Information Service can also send you booklets. The following booklet about liver cancer may be helpful to you:

In Answer to Your Questions About Liver Cancer

The following booklet on childhood cancer may be helpful to you:

Young People with Cancer: A Handbook for Parents
Talking with Your Child About Cancer
Managing Your Child's Eating Problems During Cancer Treatment
When Someone in Your Family Has Cancer

The following general booklets on questions related to cancer may also be helpful:

Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
What You Need To Know About Cancer

There are many other places where material about cancer treatment and information about services are available. Check the hospital social service office for local and national agencies that help with finances, getting to and from treatment, care at home, and dealing with other problems.

Write to the National Cancer Institute at this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 09/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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